Peritoneal Malignant Mesothelioma Metastasizing to Lymph Node in Young Male-a Case Report

Our plain-English summary of Peritoneal Malignant Mesothelioma Metastasizing to Lymph Node in Young Male-a Case Report, by A. Singh, C. Bansal, D. Singla, et al (Indian Journal of Surgical Oncology, 2024).

The study

• Authors: A. Singh, C. Bansal, D. Singla, S. More, S. Chabhra, S. Bashir
• Journal: Indian Journal of Surgical Oncology
• Published: 2024;15(1):145-148
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Peritoneal malignant mesothelioma is an uncommon neoplasm with a poor prognosis. We hereby report a case of a 20-year-old male, first diagnosed on biopsy with axillary lymph node metastasis. He presented with abdominal pain and axillary lymphadenopathy, with no history of asbestos exposure. CECT showed peritoneal thickening and ascites. Ascitic fluid cytology showed reactive morphology. The diagnosis of metastatic deposits of malignant mesothelioma was made on histopathology and confirmed by immunohistochemistry. Tumor cells were immune-reactive for CK 5/6, calretinin, D2-40, and WT1 and negative for TTF1, CK 20, and CD 3. This case report has two important highlights-(i) unusual presentation with axillary lymph node metastasis leading to diagnostic dilemma in a young male with no asbestos exposure history and (ii) confirmatory diagnostic role of IHC in Peritoneal malignant mesothelioma.

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In plain English

This was a case report about one patient, a 20-year-old male student who had abdominal pain and an enlarged lymph node in the right armpit. The report states he had no history of asbestos exposure. The node measured 4 by 1.8 cm. A CT scan (CECT) showed thickening of the abdominal lining (peritoneum) and fluid in the abdomen (ascites). Cells in that fluid looked reactive. The removed lymph node contained sheets of abnormal cells, with increased cell division and areas of necrosis (dead tissue). Staining tests for cell markers (immunohistochemistry) were positive for CK 5/6, calretinin, D2-40 and WT1 and negative for TTF1, CK 20 and CD 3. Spread from the lung, thyroid, digestive tract and lymphoma was ruled out, and peritoneal malignant mesothelioma that had spread to the lymph node was diagnosed. The patient was referred to a tertiary oncology center but was reluctant to pursue treatment because of financial constraints. The authors concluded this was a very unusual presentation and that immunohistochemistry played the final confirmatory role in diagnosis.

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 (a single patient)
• Who was studied: One 20-year-old male student with abdominal pain and an enlarged right axillary (armpit) lymph node. The article does not state where or when the patient was seen.
• Exposure: No asbestos exposure: the patient had no history of asbestos exposure or of any previous chronic disease.
• Main results:
  • On examination the patient had a single, hard, mobile right axillary lymph node measuring 4 by 1.8 cm.
  • The CECT scan showed peritoneal thickening and ascites.
  • Cytology of the ascitic fluid showed reactive morphology.
  • The excised lymph node showed sheets of round cells, increased mitotic activity and areas of necrosis.
  • On immunohistochemistry the tumor cells were positive for CK 5/6, calretinin, D2-40 and WT1, and negative for TTF1, CK 20 and CD 3.
  • Metastasis from the lung, thyroid, gastrointestinal tract (GIT) and lymphoma was ruled out, and a confirmatory diagnosis of peritoneal malignant mesothelioma (PMM) was reported.
  • The patient was referred to a tertiary oncology center but was reluctant to pursue treatment because of financial constraints.
• The authors' conclusion: The authors concluded that the case was a very unusual presentation of peritoneal malignant mesothelioma, presenting with axillary lymph node metastasis in a young male with no asbestos exposure history and creating a diagnostic dilemma. They also concluded that immunohistochemistry plays the final confirmatory role in diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Neoplasm, Prognosis, Biopsy, Metastasis, Lymphadenopathy, Asbestos Exposure, Ascites.

Related studies

• Lymph node metastases in diffuse malignant peritoneal mesothelioma — D. Baratti, S. Kusamura, et al. (2010)
• Peritoneal malignant mesothelioma metastatic to supraclavicular lymph nodes — S. Zannella, M.A. Testi, et al. (2014)
• Asbestos content of lung tissue, lymph nodes, and pleural plaques from former shipyard workers — R.F. Dodson, M.G. Williams, et al. (1990)
• Intrapulmonary lymph nodes. Clinical, radiologic, and pathologic features — R.L. Kradin, P.W. Spirn, et al. (1985)
• Hyperplastic mesothelial cells in lymph nodes: report of six cases of a benign process that can stimulate metastatic involvement by mesothelioma or carcinoma — P. Argani, J. Rosai (1998)
• A comparison of asbestos burden in lung parenchyma, lymph nodes, and plaques — R.F. Dodson, M.G. Williams, et al. (1991)

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