Peritoneal mesothelioma masquerading as an inguinal hernia

Our plain-English summary of Peritoneal mesothelioma masquerading as an inguinal hernia, by S. Chakravartty, J.C. Singh, H. Jayamanne, et al (Annals of the Royal College of Surgeons of England, 2011).

The study

• Authors: S. Chakravartty, J.C. Singh, H. Jayamanne, V. Shah, G.L. Williams, B.M. Stephenson
• Journal: Annals of the Royal College of Surgeons of England
• Published: 2011;93(6):e107-8
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We report a case of an 80-year-old man who presented with a right inguinal hernia that appeared incarcerated. On exploration a sausage shaped mass was found in the sac, which was debulked and histologically shown to be a well differentiated malignant peritoneal mesothelioma. Rare tumours may present as inguinal hernias and palliative debulking may be effective when they present in inguinal hernia sacs.

In plain English

This case report from a hospital in Newport, UK, described one patient: an 80-year-old retired steel worker with what looked like a trapped (incarcerated) right inguinal hernia, present for three weeks, after six months of right lower abdominal pain. He was anaemic, and an earlier CT scan had suggested a possible inflammatory mass. At surgery, the surgeons found a sausage-shaped mass in the hernia sac. Because the tissues were badly swollen, they removed the right testis, then cut the mass out, reducing the tumour's bulk. Laboratory examination showed a well differentiated tubulopapillary-type malignant mesothelioma. The authors thought it more likely arose from the peritoneum (the abdominal lining) than from the lining around the testis, but said the origin was hard to pinpoint. The article did not report whether this patient had been exposed to asbestos. He recovered without problems, was offered palliative chemotherapy, and was essentially symptom free eight months later. The authors concluded that palliative debulking may be quite effective and preferred to aspiration cytology.

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 (one patient)
• Who was studied: One 80-year-old man, a retired steel worker, treated at the Department of General Surgery, Royal Gwent Hospital, Newport, UK
• Exposure: Not reported for this patient. The article gives his occupation as retired steel worker but does not describe any asbestos exposure. Statements about asbestos in the discussion refer to other published cases, not this patient.
• Main results:
  • The patient had an irreducible, painless lump in the right groin, present for three weeks, after six months of right lower abdominal pain. He was anaemic (Hb 8.6g/dl).
  • Earlier CT suggested a possible inflammatory mass, with the omentum extending towards the right inguinal region.
  • At surgery, a sausage-shaped mass was found coming down the inguinal canal in a sac. The cord structures could not be identified, so a right orchidectomy (removal of the testis) was carried out, and the mass was excised, debulking the tumour.
  • Histology showed a well differentiated tubulopapillary-type malignant mesothelioma, strongly positive for calretinin and cytokeratin and negative for Ber-EP4, which confirmed the diagnosis.
  • The proximal cut margin of the spermatic cord was infiltrated by tumour; the testis and the rest of the cord were not involved.
  • The tumour may have arisen from the tunica vaginalis, but the peritoneum was considered the more likely source because of the CT appearances.
  • Recovery was uneventful. The patient was offered palliative chemotherapy and was essentially symptom free eight months later.
• The authors' conclusion: The authors concluded that surgeons should be aware that incarcerated inguinal hernias in elderly patients with a history of chronic inflammation may harbour an unusual tumour, and that palliative debulking may be quite effective and preferred to aspiration cytology.
• Limitations the authors state:
  • The authors noted that it may be very difficult to pinpoint where the mesothelioma arose, as this case showed.

Topics

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

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Inguinal Hernia, Palliative Care.

Related studies

• Peritoneal mesothelioma masquerading as an inguinal hernia — S. Chakravartty, J.C. Singh, et al. (2012)
• Fine-needle aspiration of a well-differentiated papillary mesothelioma in the inguinal hernia sac: A case report and review of literature — Y.Y. Wheeler, F. Burroughs, et al. (2009)
• Incarcerated inguinal hernia from metastatic pleural mesothelioma: PET/CT imaging — V.X. Nguyen, B.D. Nguyen, et al. (2012)
• An unusual presentation of malignant mesothelioma: the incidental finding of tumor in the hernia sac during herniorrhaphy — J. Brenner, P.P. Sordillo, et al. (1981)
• Diffuse malignant mesothelioma arising in a paracolostomy hernial sac — P.B. Bethwaite, R. Evans, et al. (1996)
• A case of peritoneal mesothelioma masquerading as a urachal mass — K. Huynh, J. Krantz, et al. (2014)

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