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Published on: December 21, 2019
[A case of peritoneal mesothelioma without a history of asbestos exposure]
Jae Hyong Lee1, Eun Ju Lim, Eun Sil Lee
1Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
Abstract:
Peritoneal mesothelioma is an unusual disease which diffusely involves the peritoneal surface. The incidence is approximately one per 1,000,000, and one fifth to one third of all mesothelioma are peritoneal in origin. Asbestos exposure is linked to the development of peritoneal mesothelioma as a significant etiology, but further investigation should be conducted. Abdominal sonography, abdominal CT and cytologic examination of ascitic fluid are used to confirm the diagnosis, but rarely provides proper diagnosis. Laparoscopy with biopsy is the most common diagnostic method for definite diagnosis of mesothelioma. Cytoreductive surgery and intraperitoneal chemotherapy have been suggested for better survival since the median survival after the initial diagnosis is near to 50 months. This report describes a case of 73-years-old male patient presented with abdominal pain and distension. This patient had not been exposed to asbestos. Abdominal sonography and CT showed massive ascites, multiple omental masses and peritoneal thickening. It was difficult to distinguish peritoneal mesothelioma from carcinomatosis. Laparoscopy and peritoneal biopsy was conducted and immunostaining examination confirmed the diagnosis of peritoneal mesothelioma.
Insights
Peritoneal mesothelioma, a rare cancer, often presents with ascites and omental masses. Diagnosis typically requires laparoscopy and biopsy, even without asbestos exposure history.
Area of Science:
- Oncology
- Pathology
Background:
- Peritoneal mesothelioma is a rare malignancy affecting the peritoneum, accounting for 20-33% of all mesotheliomas.
- Asbestos exposure is a known risk factor, though not always present.
- Diagnostic challenges exist, with imaging and cytology often insufficient for definitive diagnosis.
Observation:
- A 73-year-old male presented with abdominal pain and distension, exhibiting massive ascites, omental masses, and peritoneal thickening on imaging.
- The patient had no history of asbestos exposure.
- Initial imaging made it difficult to differentiate from carcinomatosis.
Findings:
- Laparoscopy with peritoneal biopsy and subsequent immunostaining confirmed the diagnosis of peritoneal mesothelioma.
- This case highlights that peritoneal mesothelioma can occur in the absence of known asbestos exposure.
Implications:
- Accurate and timely diagnosis of peritoneal mesothelioma is crucial for patient management.
- Laparoscopy with biopsy remains the gold standard for definitive diagnosis.
- Further research into non-asbestos-related etiologies and improved diagnostic modalities is warranted.
