Papillary mesothelioma of the peritoneum in the absence of asbestos exposure

Our plain-English summary of Papillary mesothelioma of the peritoneum in the absence of asbestos exposure, by T. Meister, T. Birkfellner, C. Poremba, et al (Zeitschrift Für Gastroenterologie, 2003).

The study

• Authors: T. Meister, T. Birkfellner, C. Poremba, J.C. Becker, J. Menzel, W. Domschke, M.M. Lerch
• Journal: Zeitschrift Für Gastroenterologie
• Published: 2003;41(4):329-32
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant mesothelioma of the peritoneum is a very rare neoplasm, commonly associated with asbestos exposure and often rapidly fatal. Well Differentiated Papillary Mesothelioma of the Peritoneum (WDPMP) is regarded as a less aggressive variety of the tumor. Progressive ascites is often the only clinical manifestation of the disease and differentiation of WDPMP from benign mesothelial hyperplasia or adenocarcinoma is difficult.

Patients And Methods: Here we report the case of a 45-year-old patient who presented with ascites but without evidence of portal hypertension, liver disease or abdominal malignancy. On diagnostic laparoscopy small tumor nodules were found to cover the parietal peritoneum and the greater omentum and histopathologically corresponded to papillary mesothelial hyperplasia with minimal nuclear atypia. Histochemically biopsies were positive for Calretinin, Cytokeratins and Epithelial Membrane Antigen (EMA). Based on these findings the diagnosis of WDPMP was made and the patient was closely followed without primary cytostatic therapy.

Conclusions: Progressive ascites was the only clinical symptom in this patient, while liver disease, portal hypertension and gastrointestinal malignancies were ruled out by clinical, laboratory and imaging techniques. Laparoscopic biopsy revealed WDPMP to be the underlying disease. Immunocytochemistry is required to establish the diagnosis of this rare malignant disorder which is even more uncommon in the absence of a history of asbestos exposure. Due to the indolent course of WDPMP therapy should only be initiated when signs of rapid tumor progression become apparent.

In plain English

This was a case report of one patient, a 45-year-old Caucasian man seen in Münster, Germany. The authors stated that he had not been exposed to asbestos. The German-language summary says this was based on his history; the article does not say how exposure was assessed. He arrived with a swelling abdomen, fluid in the abdomen (ascites), tiredness, slight breathlessness and night sweats. Routine blood tests were normal, but two tumour markers, CYFRA 21-1 and NSE, were above their reference ranges in blood. Endoscopy and a PET scan found no primary tumour. Keyhole surgery (laparoscopy) showed tiny nodules up to 4 mm across on the abdominal lining and omentum. Biopsies examined with special stains led to a diagnosis of well differentiated papillary mesothelioma of the peritoneum (WDPMP), a form the authors describe as less aggressive. The tumour's cell-growth index was 2%. He was followed without initial chemotherapy, and the article reports no later outcome. The authors concluded that special staining is needed for diagnosis and that treatment should start only if the tumour progresses rapidly or shows a high rate of cell growth.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 45-year-old Caucasian man, reported by the Department of Medicine B, University of Münster, Germany; dates of care not given
• Exposure: No asbestos exposure, according to the patient's history (the article does not describe how this was assessed or report any fiber analysis)
• Main results:
  • The patient presented with an expanding abdomen, ascites, fatigue and slight dyspnea, and reported intermittent night sweats
  • In the patient's blood, CYFRA 21-1 was 5.2 ng/ml (reference 0 to 3.3) and NSE was 13.5 ng/ml (reference 0 to 12.5). Other tumour markers, including CEA, were normal
  • The ascitic fluid was an exudate (total protein 4.6 g/dl, LDH 240 U/l), with CYFRA 21-1 of 121.9 ng/ml and NSE of 16.6 ng/ml. No reference ranges were given for the fluid. Tuberculosis was excluded
  • Upper and lower endoscopy were normal, and FDG-PET showed no definitive primary tumour site
  • Laparoscopy found small tumour nodules up to 4 mm in diameter on the parietal peritoneum and greater omentum
  • Biopsies showed papillary mesothelial proliferation with minimal nuclear atypia. Stains were positive for calretinin, cytokeratins and EMA, and the MIB-1 proliferation index was estimated at 2%. The diagnosis was WDPMP
  • The patient was closely followed without primary cytostatic (chemotherapy) treatment
• The authors' conclusion: The authors concluded that immunocytochemistry is required to diagnose this rare malignant disorder, which they described as even more uncommon without a history of asbestos exposure. Citing the present consensus, they wrote that treatments should be applied only when tumour progression is rapid or a high rate of tumour cell proliferation is evident

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Well-Differentiated Papillary Mesothelioma, Peritoneum, Asbestos Exposure, Mesothelioma, Neoplasm, Ascites, Reactive Mesothelial Hyperplasia, Adenocarcinoma.

Related studies

• Well-differentiated papillary mesothelioma of the peritoneum: a diagnostic dilemma on fine-needle aspiration cytology — J.G. Nasit, G. Dhruva (2014)
• Collagenous Spherulosis in Well-Differentiated Papillary Mesothelioma in a Female With Multilocular Peritoneal Inclusion Cysts — B. AbdullGaffar, L.G. Raman (2019)
• Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum — R.L. Attanoos, R. Webb, et al. (2002)
• Case report: Papillary mesothelioma of the peritoneum with foamy cell lining — S. Stolnicu, E. Quiñonez, et al. (2013)
• Mesothelioma of the pelvic peritoneum resembling papillary cystadenocarcinoma of the ovary; case report — M. Swerdlow (1959)
• Clinicopathological Characteristics of Well-differentiated Papillary Mesothelioma of The Peritoneum: A Single-institutional Experience of 12 Cases — M. Kim, H.S. Kim (2019)

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