Splenic localization of the peritoneal mesothelioma: case report and literature revue

Our plain-English summary of Splenic localization of the peritoneal mesothelioma: case report and literature revue, by D. D'Abbicco, A. Conversano, B.R. Epifania, et al (Updates in Surgery, 2012).

The study

• Authors: D. D'Abbicco, A. Conversano, B.R. Epifania, R. Indellicato, A. Margari
• Journal: Updates in Surgery
• Published: 2012;64(2):157-60
• Type of article: Case report, Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peritoneal mesothelioma is a rare form of malignant mesothelioma, making up <30% of diagnosed mesothelioma cases. Because of a lack of specific symptoms (abdominal pain, abdominal swelling), normally it is diagnosed in advanced stages, sometimes in a surgical emergency (intestinal obstruction, severe ascites) and occasionally during image procedures or laparoscopy which can show a mass developing from peritoneal mesothelium surfaces, or an accumulation of small irregularities that may be tumors or plaques. The reported case refers to a particular localization of a peritoneal mesothelioma, the spleen, discovered only after a splenectomy, due to the clinical and radiological suspect of a rupture.

In plain English

This was a case report, with a brief literature review, from a surgery unit at the University of Bari, Italy. It described a 64-year-old man admitted with anemia of unknown origin, abdominal pain for 3 months and a 10 kg weight loss. He had worked as a railwayman, but any asbestos exposure had not been investigated. Blood tests showed raised tumor markers CA 125 and CA 15.3. A CT scan showed a huge mass occupying almost the whole spleen, with bleeding suggesting rupture, and he had emergency removal of the spleen. Examination of the tissue found a malignant peritoneal mesothelioma of the biphasic type (epithelioid and sarcomatoid), spreading into the splenic capsule, omentum and mesocolon. Despite two cycles of cisplatin and gemcitabine chemotherapy, a CT scan three months after surgery showed recurrence. The authors concluded that this rare cancer should be considered among the causes of an enlarged or ruptured spleen. A single case report does not show how often this occurs.

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 one patient, with a brief review of previously published cases
• Who was studied: One 64-year-old man admitted to the General Surgery Unit, Policlinico-Bari, University of Bari, Italy, with anemia of unknown origin, weakness (asthenia), abdominal pain for 3 months and weight loss of 10 kg in 3 months; dates of care not given
• Exposure: No asbestos exposure was documented. The patient's occupation was railwayman, but the authors state that information about asbestos exposure had not been investigated.
• Main results:
  • In this patient, before surgery, the serum tumor markers were high: CA 125 was 367.4 U/ml (reference range 0 to 35) and CA 15.3 was 114.7 U/ml (reference range 0 to 32).
  • In this patient, the CT scan showed a huge soft mass with multiple abscesses occupying almost the whole spleen, with only the upper pole unaffected, and blood in the abdominal cavity (hemoperitoneum).
  • The patient had an emergency laparotomy and removal of the spleen (splenectomy) without surgical complications.
  • The removed mass measured 24 by 21 by 10 cm and weighed 800 g in total.
  • In this patient, microscopic examination showed a malignant peritoneal mesothelioma of biphasic type (epithelioid and sarcomatoid), infiltrating the splenic capsule, omentum and mesocolon.
  • Immunohistochemical staining of the tumor was positive for CK-pool, vimentin, calretinin and mesothelioma HBME.
  • The patient was in hospital for 10 days after surgery.
  • After two cycles of cisplatin and gemcitabine chemotherapy, each lasting 21 days, a CT scan three months after surgery showed that the cancer had recurred.
• The authors' conclusion: The authors concluded that, although malignant peritoneal mesothelioma is very rare, it should be considered when diagnosing conditions of the spleen that can cause enlargement or rupture of the spleen.
• Limitations the authors state:
  • The authors state that the patient's possible asbestos exposure had not been investigated.

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, Malignant Mesothelioma, Mesothelioma, Ascites, Mesothelium.

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