Peritoneal mesothelioma without ascites formation

Our plain-English summary of Peritoneal mesothelioma without ascites formation, by E. van der Harst, E.H. van Dongen, P.P. Viergever, et al (Scandinavian Journal of Gastroenterology, 1993).

The study

• Authors: E. van der Harst, E.H. van Dongen, P.P. Viergever, W.W. Meijer
• Journal: Scandinavian Journal of Gastroenterology
• Published: 1993;28(2):190-2
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A case of malignant peritoneal mesothelioma without development of ascites is described. The patient had a 1-year history of non-specific symptoms preceding this diagnosis. The insidious onset of clinical signs, the diagnostic procedures, and the pathologic findings are discussed.

In plain English

This article was a case report from a hospital in Den Helder, the Netherlands. It described one patient with malignant peritoneal mesothelioma (a cancer of the abdominal lining) in whom no ascites (fluid build-up in the abdomen) developed. The patient, a 59-year-old male carpenter, came to doctors in January 1990 with six months of increasing abdominal discomfort. Extensive blood, stool, imaging and endoscopic tests were normal. Over the following months the patient developed weight loss, wasting, cramping, chronic diarrhoea and signs of malabsorption. In July 1990 a 30 cm mass could be felt in the lower abdomen. Only after detailed questioning did a 15-year history of occupational asbestos exposure emerge. The fiber type was not reported. Scans showed thickening of the bowel walls, mesentery and peritoneum, without ascites. A needle sample gave the diagnosis, and the patient died three weeks later of intestinal obstruction. Autopsy confirmed there was no ascites and no pleural involvement. The authors concluded that diagnosis remains extremely difficult, especially without ascites.

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 59-year-old male carpenter who presented in January 1990 with a 6-month history of increasing abdominal discomfort; authors based at Gemini Hospital, Den Helder, the Netherlands
• Exposure: A 15-year history of occupational asbestos exposure, identified only after more detailed history-taking; fiber type and products not reported
• Main results:
  • During months of investigations that found nothing abnormal, the patient developed weight loss, progressive cachexia, increasing abdominal cramping and chronic diarrhoea, followed by steatorrhoea, low albumin and iron-deficiency anaemia
  • In July 1990 a slightly tender nodular mass, 30 cm in diameter, was felt in the lower half of the abdomen
  • The asbestos exposure came to the authors' knowledge only at a later stage, after specific questioning
  • Ultrasound and CT scanning at that stage showed diffuse thickening of the bowel walls, mesentery and peritoneum, with no ascites
  • After the diagnosis of malignant mesothelioma by ultrasound-guided cytologic puncture, the patient died 3 weeks later from progressive intestinal obstruction
  • Autopsy showed tumour occupying the entire abdominal cavity, with bowel constriction and invasion of liver and spleen. Absence of ascites was confirmed and there was no pleural involvement
  • The authors' Medline search (1980-90) found no previous reports of malabsorption in peritoneal mesothelioma
• The authors' conclusion: The authors concluded that diagnosing peritoneal mesothelioma remains extremely difficult despite improved imaging, especially in rare cases without ascites. They added that a high index of clinical suspicion is necessary and that the clinical picture may include malabsorption diarrhoea.
• Limitations the authors state:
  • The diagnosis was made by cytology. The patient's worsening condition prevented obtaining tissue by laparotomy or laparoscopy, which the authors note has been advocated as giving the best diagnosis. They also note that definite cytologic diagnosis of mesothelioma is often difficult.

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, Ascites.

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