Secondary malignant peritoneal mesothelioma of the greater omentum after therapy for primary pleural mesothelioma

Our plain-English summary of Secondary malignant peritoneal mesothelioma of the greater omentum after therapy for primary pleural mesothelioma, by A. Gutzeit, C. Reischauer, K. Hergan, et al (Case Reports in Oncology, 2013).

The study

• Authors: A. Gutzeit, C. Reischauer, K. Hergan, S. Kos, J.E. Roos
• Journal: Case Reports in Oncology
• Published: 2013;6(1):236-41
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesothelioma is the most common malignant primary tumor of the pleura and usually associated with inhalation of asbestos fibers. In contrast, peritoneal mesothelioma is a rare entity whose pathomechanism is not yet fully understood. The coexistence of pleural mesothelioma with secondary involvement of the abdominal cavity has not been addressed in the literature. In this case report, we describe secondary malignant mesothelioma of the greater omentum. A 69-year-old man with histologically proven pleural mesothelioma on the right side and no past medical history of asbestos exposure received palliative treatment consisting of a talc pleurodesis. After a 6-month interval of stable disease, a local progressive tumor of the right pleura was seen on a CT scan. Eleven months later, during follow-up, the patient presented at our emergency department with a sudden onset of diffuse abdominal pain. Abdominal ultrasound revealed a mass within the greater omentum and the coexistence of free fluid. Subsequent abdominal CT scans demonstrated tumor infiltration from the right pleura by a transdiaphragmatic route into the abdomen, where diffuse infiltration of the greater omentum was observed. Aspiration of the ascites and the biopsy of the greater omentum confirmed the diagnosis of secondary malignant mesothelioma of the peritoneum. In conclusion, we present the extremely rare diagnosis of secondary malignant mesothelioma of the abdomen, which arose as a result of local progression from the right pleura into the abdomen.

In plain English

This article was a case report about a single patient. A 69-year-old man had a tissue-confirmed, epithelioid-type malignant pleural mesothelioma of the right chest. The authors reported that he had no known previous asbestos exposure. At first diagnosis, CT showed a localized tumor of the right pleura, with no enlarged lymph nodes in the middle of the chest (mediastinal lymphadenopathy), no spread to the lungs and no abdominal involvement. His large fluid collection was treated palliatively with right-sided talc pleurodesis. Eleven months after diagnosis he came to the emergency department with sudden, diffuse abdominal pain. Ultrasound and CT showed tumor spread through the greater omentum (a layer of tissue in the abdomen) and fluid in all four abdominal quadrants. CT showed that the pleural tumor had grown through the right diaphragm into the abdomen. Needle sampling and biopsy found mesothelioma cells resembling those of the pleural tumor. The authors called this secondary peritoneal mesothelioma and said they knew of no other descriptions of it. They suggested such spread is rare because patients usually die before it can happen. They concluded that pleural mesothelioma could progress locally into the abdomen.

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 69-year-old man with histologically proven epithelioid-type primary malignant pleural mesothelioma of the right thorax; dates of care not given
• Exposure: No known previous asbestos exposure was reported for this patient; the treatment described was palliative right-sided talc pleurodesis
• Main results:
  • At initial diagnosis, CT showed a localized tumor of the right pleura without mediastinal lymphadenopathy, pulmonary metastasis or abdominal involvement
  • The large pleural effusion was treated palliatively with right-sided talc pleurodesis
  • Eleven months after diagnosis, the patient presented to the emergency department with sudden diffuse abdominal pain
  • CT confirmed diffuse tumor infiltration of the greater omentum and free fluid in all 4 abdominal quadrants
  • The abdominal tumor originated from progressive infiltration of the right pleural mesothelioma through the right diaphragm
  • Fine needle aspiration of the omental infiltration showed malignant mesothelial cells similar to those aspirated from the right pleura
  • Biopsy showed the omental tumor had the same histological architecture as the patient's pleural mesothelioma
  • The authors stated that, to their knowledge, there were no other descriptions of secondary peritoneal mesothelioma in the literature
  • The authors assumed that infiltration by pleural mesothelioma into the abdomen is very rare because the disease usually causes death before such local progression can occur
• The authors' conclusion: The authors concluded that pleural mesothelioma could progress locally into the abdomen, and that secondary peritoneal mesothelioma should be considered

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Omentum, Pleural Mesothelioma, Mesothelioma, Pleura, Malignant Mesothelioma, Asbestos Exposure, Palliative Care.

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• Gray scale sonographic presentation of a mesothelioma of the greater omentum — J.M. Shah, D.L. King (1979)
• Primary diffuse malignant peritoneal mesothelioma: case report and update of therapy — D. Piazza, F. Caruso, et al. (2000)
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• Bilateral diffuse pulmonary infiltrates secondary to malignant peritoneal mesothelioma - A rare clinical presentation — M. Haygarth, K.K. Zaw, et al. (2019)

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