Unusually Aggressive Presentation of Malignant Peritoneal Mesothelioma: Two Case Reports

Our plain-English summary of Unusually Aggressive Presentation of Malignant Peritoneal Mesothelioma: Two Case Reports, by D. Neff, B.C. Padberg Sgier, H. Dietze, et al (Case Reports in Oncology, 2022).

The study

• Authors: D. Neff, B.C. Padberg Sgier, H. Dietze, J. Müller, M. Früh
• Journal: Case Reports in Oncology
• Published: 2022;15(3):1001-1008
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma is a rare disease. Patients mainly present with abdominal distension, pain, nausea, and weight loss with or without an exposure history of asbestos. Diagnosis may be difficult from a clinical and histopathologic perspective. Treatment options are surgery in early stages, radiotherapy and/or intraperitoneal or systemic therapy. Prognosis depends on TNM stage and histologic subtype with epithelioid subtype being the most favorable one but in general remains poor. We present a 59-year-old male (patient 1) and a 79-year-old female (patient 2) with progressive dyspnea. PET-CT of patient 1 revealed metastatic spread in the pleura and extensive peritoneal carcinomatosis. PET-CT of patient 2 displayed FDG-avid lymph nodes on both sides of the diaphragm, polyserositis, and FDG uptake along the peritoneum. Both patients were eventually diagnosed with malignant peritoneal mesothelioma. Patient 1 was treated with carboplatin and gemcitabine, and patient 2 received no systemic therapy. Even though the epithelioid subtype was found, both patients succumbed due to rapid tumor progression in a matter of a few weeks only. Presentation with polyserositis even in the absence of relevant asbestos exposure may represent malignant peritoneal mesothelioma if ascites is present, and rapid invasive diagnostic (excision biopsy) should be performed. These two unusual cases emphasize that even in epithelioid subtype, clinicians ought to be aware of possible rapid clinical deterioration, and timely diagnosis with initiation of therapy is crucial. Further research is necessary to better understand tumor biology, establish predictive markers, and develop new treatment options.

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

In plain English

This case report described two patients with malignant peritoneal mesothelioma, a cancer of the abdominal lining, at the Cantonal Hospital St. Gallen, Switzerland. Patient 1, a 59-year-old male never-smoker, had worked with asbestos in the construction industry for 45 years. Scans showed spread to the pleura, lymph nodes, abdominal lining with fluid (ascites) and spine. The patient received one cycle of carboplatin and gemcitabine and died of rapid tumor progression four weeks after admission. Autopsy found epithelioid-subtype peritoneal mesothelioma, with abdominal tumor tissue weighing 4 kg in total. Patient 2 was a 79-year-old female with no history of asbestos exposure. Scans showed fluid in the chest, around the heart and in the abdomen. Diagnosis took several weeks and was difficult because a benign condition was considered. The patient was too ill to start chemotherapy and died within weeks; no autopsy was done. The authors reported both cases as epithelioid subtype. The authors concluded that polyserositis (involvement of several body linings) with ascites may represent this cancer even without relevant asbestos exposure, and that rapid excision biopsy should be performed.

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 two patients
• Who was studied: Two patients at the Cantonal Hospital St. Gallen, Switzerland: a 59-year-old male (patient 1) and a 79-year-old female (patient 2). No dates are given.
• Exposure: Patient 1 worked with asbestos in the construction industry for 45 years (fiber type not stated). Patient 2 had no history of asbestos exposure.
• Main results:
  • Patient 1: PET-CT showed spread to the pleura and lymph nodes, extensive peritoneal disease with ascites, and lesions throughout the spine
  • Patient 1: thoracoscopic biopsies showed a highly proliferative (Ki-67 70%), poorly differentiated tumor
  • Patient 1: tests for p16 deletion and BAP1 deletion were negative and did not confirm the diagnosis
  • Patient 1 died of rapid tumor progression four weeks after admission, despite one cycle of chemotherapy
  • Patient 1: autopsy diagnosed peritoneal mesothelioma of the epithelioid subtype with a large abdominal tumor burden (total tumor in the abdomen) weighing 4 kg, accompanied by multiple metastases
  • Patient 2 had no history of asbestos exposure
  • Patient 2: the final diagnosis took several weeks and was difficult because a benign lymph node mesothelial inclusion was considered, given the low proliferative index (10%)
  • Patient 2: declining condition prevented palliative chemotherapy
  • Patient 2 died within weeks; no autopsy was performed
  • Both patients were reported to have the epithelioid subtype, and both died of rapid tumor progression
• The authors' conclusion: The authors concluded that presentation with polyserositis should prompt a thorough exposure history, that even without relevant asbestos exposure it may represent peritoneal mesothelioma if ascites is present, and that rapid invasive diagnosis (excision biopsy) should be performed.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Exposure History, Systemic Therapy, Prognosis, Histological Subtype, Epithelioid, Dyspnea, PET-CT.

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