The diagnostic challenge of peritoneal mesothelioma

Our plain-English summary of The diagnostic challenge of peritoneal mesothelioma, by P. Krasuski, A. Poniecka, E. Gal (Archives of Gynecology and Obstetrics, 2002).

The study

• Authors: P. Krasuski, A. Poniecka, E. Gal
• Journal: Archives of Gynecology and Obstetrics
• Published: 2002;266(3):130-2
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The differential diagnosis of diffuse malignant intraabdominal process in women may be a strenuous and long process. We report such a challenging, problematic case of peritoneal mesothelioma and present review of literature in search for best differentiating technique.

In plain English

This article was a case report of one woman, followed by a short discussion of earlier published work. A 48-year-old woman had four months of abdominal swelling, bloating, heartburn, early fullness and frequent urination. Her CA-125 blood marker was raised at 49 (normal range 0 to 34.9), and a CT scan showed deposits on the peritoneum and omentum. At surgery, 4500 cc of fluid was removed, nodules up to 1 cm covered the abdominal and pelvic surfaces, and the omentum, uterus, tubes, ovaries and appendix were removed. The tissue was first diagnosed as consistent with carcinoma. Special staining was more consistent with mesothelioma, though serous carcinoma could not be ruled out. The Armed Forces Institute of Pathology favored mesothelioma. Despite the uncertain diagnosis, she received six courses of taxol and carboplatin, and no recurrence was found during 1.5 years of follow-up. The article did not report whether she had been exposed to asbestos. The authors called the diagnosis in cases like hers controversial and concluded that better screening, treatment and diagnostic tools are still needed.

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 published literature
• Who was studied: One 48-year-old woman with abdominal symptoms; the article does not state where or when she was treated
• Exposure: No asbestos exposure is reported for this patient; her medical and social history was described as negative. Asbestos is mentioned only in the discussion, as background from other literature.
• Main results:
  • The patient's CA-125 level was elevated at 49 (normal laboratory range 0 to 34.9)
  • CT scan showed peritoneal and omental deposits suspicious for metastatic disease
  • At surgery, 4500 cc of fluid was suctioned from the peritoneal cavity; surfaces were studded with nodules and plaques up to 1 cm
  • The initial final pathology diagnosis was a malignant papillary neoplasm consistent with carcinoma
  • Cytokeratin 5/6, calretinin and vimentin stained positive in both the ovarian cyst and the peritoneal tumor; the profile was judged more consistent with mesothelioma, although serous carcinoma could not be ruled out
  • The Armed Forces Institute of Pathology, consulted on the tissue, favored a diagnosis of mesothelioma
  • The patient received 6 courses of taxol and carboplatin; no recurrence was found during 1.5 years of follow-up
• The authors' conclusion: The authors stated that histological diagnosis was controversial in a large proportion of cases, including theirs, and concluded that better screening, treatment and diagnostic tools are still needed
• Limitations the authors state:
  • The authors note the patient was treated without an unequivocal diagnosis; serous carcinoma could not be ruled out

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, Differential Diagnosis.

Related studies

• PAX8 Expression in a Subset of Malignant Peritoneal Mesotheliomas and Benign Mesothelium has Diagnostic Implications in the Differential Diagnosis of Ovarian Serous Carcinoma — D.B. Chapel, A.N. Husain, et al. (2017)
• Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum — R.L. Attanoos, R. Webb, et al. (2002)
• Loss of BAP1 expression is very rare in peritoneal and gynecologic serous adenocarcinomas and can be useful in the differential diagnosis with abdominal mesothelioma — J. Andrici, J. Jung, et al. (2016)
• MicroRNA profiling in serous cavity specimens: Diagnostic challenges and new opportunities — L. Nicolè, F. Cappello, et al. (2019)
• The diagnostic and molecular characteristics of malignant mesothelioma and ovarian/peritoneal serous carcinoma — B. Davidson (2011)
• Loose mesothelial cysts in the peritoneal cavity — Y. Ramirez, J. Rosai, et al. (2010)

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