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, 2012).

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: 2012;94(3):e111-2
• Type of article: Case report
• Cited by: 1 article, 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 was a case report about one patient treated in the Department of General Surgery at the Royal Gwent Hospital in Newport, UK. An 80-year-old retired steel worker came to hospital with what looked like a trapped (incarcerated) right inguinal hernia. The groin lump had been present for three weeks, and he had had right lower abdominal pain for six months. When surgeons explored the groin, they found a sausage-shaped mass inside the hernia sac. They removed the right testis and cut the mass away at the deep end of the groin canal, reducing the bulk of the tumour. Laboratory examination showed a well differentiated tubulopapillary-type malignant mesothelioma. Based on earlier CT scans, the authors considered the peritoneum (the abdominal lining) the more likely origin, though the tumour may have come from the tunica vaginalis around the testis. The patient recovered without complications, was offered palliative chemotherapy, and was reported essentially symptom free eight months later. The article does not say whether this patient had been exposed to asbestos. 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 (single patient)
• Who was studied: One 80-year-old man, a retired steel worker, with an apparently incarcerated right inguinal hernia, treated at the Royal Gwent Hospital, Newport, UK
• Exposure: The article gives the patient's occupation as retired steel worker but reports no asbestos exposure history for him. Asbestos is mentioned only as general background in the discussion.
• Main results:
  • At groin exploration, a sausage-shaped mass was found coming down the inguinal canal inside a hernia sac
  • A right orchidectomy (removal of the right testis) was performed and the mass was excised at the level of the deep ring, debulking the tumour
  • Histology showed a well differentiated tubulopapillary-type malignant mesothelioma, 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, but the testis and the rest of the cord were not involved
  • The peritoneum was considered a more likely source than the tunica vaginalis, based on the CT findings
  • The patient recovered uneventfully, 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 state that the exact site where the mesothelioma arose was difficult to pinpoint in this case

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. (2011)
• 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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