Pitfalls in diagnosis of early stage malignant peritoneal mesothelioma: a case report

Our plain-English summary of Pitfalls in diagnosis of early stage malignant peritoneal mesothelioma: a case report, by P.S. Lee, K.M. Auyeung, D.A. King (Clinical Imaging, 2002).

The study

• Authors: P.S. Lee, K.M. Auyeung, D.A. King
• Journal: Clinical Imaging
• Published: 2002;26(4):263-6
• Type of article: Case report, Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare condition with an overall incidence of one to two cases per million [Arch. Surg. 123 (1988) 765.]. It is a tumour that arises from the mesothelium of a serosal cavity. While simultaneous peritoneal and pleural involvement is found in 30-45% of cases of mesothelioma, solitary peritoneal involvement is found only in 10-20%. The disease usually presents late. As a result, most reported cases in the radiological literature describe features of the advanced disease only. We report the radiological findings in early stage of MPM in a patient who was successfully treated by surgery. The diagnostic pitfalls in early stage disease are discussed and the radiological literature of MPM is reviewed.

In plain English

This case report, by radiologists at two Hong Kong hospitals, described one patient: a 60-year-old Chinese woman with vague left loin pain and low-grade fever who was found to have what the authors called early stage malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. The report does not describe any asbestos exposure for her. An ultrasound showed a 10-cm cystic lesion in the left flank, diagnosed as an abscess. A needle aspiration obtained only a trace of tissue, which showed inflammation and no evidence of cancer. A CT scan then showed a single mass along the abdominal lining, read as a suspected haematoma (a collection of blood). Six months later the mass had grown. A tru-cut needle biopsy strongly suggested a tumour probably of mesothelial origin. Surgery removed the tumour and part of the spleen, and malignant peritoneal mesothelioma with invasion of the spleen was diagnosed. A follow-up CT scan at 18 months showed no sign of recurrence. The authors concluded that early disease may appear only as peritoneal thickening, that needle biopsy may be inadequate, and that laparoscopy is now preferred.

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 of a single patient, with a brief discussion of the radiological literature
• Who was studied: One 60-year-old Chinese woman, reported from hospitals in Hong Kong (Prince of Wales Hospital and Queen Mary Hospital), who presented with vague left loin pain and low-grade fever
• Exposure: The report does not describe any asbestos exposure for this patient; asbestos is mentioned only in the general discussion of the disease
• Main results:
  • Initial ultrasound showed a 10-cm cystic lesion in the left flank, diagnosed as an abscess
  • The first ultrasound-guided aspiration showed inflammation with no evidence of malignancy
  • The first CT scan showed a single mass along the peritoneum and was read as a suspected haematoma
  • At 6-month follow-up the mass had grown, and a tru-cut biopsy strongly suggested a tumour probably of mesothelial origin
  • At surgery the tumour was removed en bloc with part of the spleen, and malignant peritoneal mesothelioma with invasion of the spleen was diagnosed
  • The patient remained disease free on a follow-up CT scan at 18 months
  • Features of advanced disease (ascites, involvement of the omentum or mesentery, retroperitoneal lymphadenopathy) were not seen in this patient
• The authors' conclusion: The authors concluded that early stage malignant peritoneal mesothelioma may show only peritoneal thickening without gastrointestinal symptoms, ascites or omental nodules. They concluded that it should be high on the list of possible diagnoses for a focal peritoneal-based mass when there is no primary tumour elsewhere and no history of trauma, that image-guided needle biopsy may be inadequate, and that laparoscopy is now the preferred investigation.

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, Mesothelium, Mesothelioma.

Related studies

• Computer-assisted diagnosis for early stage pleural mesothelioma: towards automated detection and quantitative assessment of pleural thickening from thoracic CT images — K. Chaisaowong, T. Aach, et al. (2007)
• An unusual case of ascites: pitfalls in diagnosis of malignant peritoneal mesothelioma — J.R. Clark, W.B. Ross (2000)
• Peritoneal mesothelioma: the role of computed tomography in diagnosis and follow up — P.J. Guest, R.H. Reznek, et al. (1992)
• Pleural irregularities and mediastinal pleural involvement in early stages of malignant pleural mesothelioma and benign asbestos pleural effusion — K. Kato, K. Gemba, et al. (2016)
• Pleural metastasis of malignant thymoma. A pitfall in the CT-diagnosis of pleural mesothelioma — J. Görich, S.A. Beyer-Enke, et al. (1989)
• ALK positive malignant peritoneal mesothelioma mimicking inflammatory myofibroblastic tumour: a diagnostic pitfall — A. Louw, C. Wallace, et al. (2020)

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