Primary Peritoneal Mesothelioma: Diagnostic Challenges of This Lethal Imposter

Our plain-English summary of Primary Peritoneal Mesothelioma: Diagnostic Challenges of This Lethal Imposter, by S.K. Dusseault, O.E. Okobi, N. Thakral, et al (Case Reports in Gastroenterology, 2022).

The study

• Authors: S.K. Dusseault, O.E. Okobi, N. Thakral, V. Sankar, I. Gunawardene, B. Dawkins, Y. Abu, B. Davis
• Journal: Case Reports in Gastroenterology
• Published: 2022;16(3):588-594
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary Peritoneal Mesothelioma is a rapidly aggressive and rare neoplasm that arises from the lining of mesothelial cells of the peritoneum and spreads extensively within the confines of the abdominal cavity. The pathogenesis of all forms of mesothelioma is strongly associated with industrial pollutants, of which asbestos is the principal carcinogen. Characteristically, asbestos exposure has a strong relationship with mesothelioma of the pleura, but the peritoneal cavity is the second most commonly affected site. Additionally, in contrast to pleural mesothelioma, which has a male predominance (male-female ratio of between four and five to one), women comprise approximately one-half of all cases of malignant peritoneal mesothelioma. A thorough history of occupational/paraoccupational exposure along with histopathology is the key to timely diagnosis and treatment.

Copyright © 2022 by The Author(s). Published by S. Karger AG, Basel.

In plain English

This was a case report of one patient with primary malignant peritoneal mesothelioma, treated at Lakeside Medical Center in Belle Glade, Florida. A 67-year-old man, a retired office manager and former smoker originally from Cuba, came to the emergency room with four weeks of worsening abdominal pain. Scans found a blood clot in the lung and fluid in the abdomen. Fluid drained from the abdomen contained cells that raised suspicion of mesothelioma. He and his family reported no work in shipyards, construction, mining or mechanical work and no significant asbestos exposure. He had, however, worked in an administrative role at a rum factory in Cuba over 20 years earlier. The authors suggested he may have had only paraoccupational exposure. Surgery found widespread disease, and he died on day 15. Final pathology showed malignant epithelioid mesothelioma with rhabdoid features, which the discussion classified as the biphasic subtype. The authors concluded that doctors should suspect abdominal cancer in new-onset ascites with a prior unprovoked venous thromboembolism.

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 case)
• Who was studied: one 67-year-old man, a retired office manager and former smoker who had migrated from Cuba and lived in the USA for about 20 years, treated at Lakeside Medical Center, Belle Glade, Florida
• Exposure: No history of work in shipyards, construction, mining or mechanical work, and no significant asbestos exposure reported. He had worked in an administrative capacity at a rum factory in Cuba over 20 years earlier. The authors described his exposure as possibly only paraoccupational. No fiber type was identified.
• Main results:
  • The patient presented with a 4-week history of progressively worsening, generalized abdominal pain.
  • CT angiography on admission showed a right lower lobe pulmonary embolism and mild abdominal ascites.
  • The first paracentesis drained 4250 cc of dark straw-colored fluid. The serum ascites albumin gradient was 0.8.
  • The preliminary pathology report on the ascitic fluid raised high suspicion for malignant mesothelioma.
  • By day 7, repeat CT showed high-grade small bowel obstruction. Exploratory laparotomy revealed extensive spread of disease.
  • The patient died on day 15, before the final pathology report returned.
  • Peritoneal excision showed malignant epithelioid mesothelioma with rhabdoid features. In the discussion, the authors classified the tumor as the biphasic subtype.
• The authors' conclusion: The authors concluded that physicians should maintain a high index of suspicion for abdominal malignancy in new-onset ascites with a prior unprovoked venous thromboembolism. They also concluded that diagnostic delay should be avoided through rapid diagnostic paracentesis and calculation of the serum ascites albumin gradient.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Neoplasm, Mesothelial Cells, Peritoneum, Mesothelioma, Asbestos Exposure, Pleura, Peritoneal Cavity.

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