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A case of diffuse malignant peritoneal mesothelioma: case report and literature review
Qian Zhao1, Kangwei Xiong1, Qiaoyun Wang1
1Department of Gastroenterology, The Second Hospital of Anhui Medical University, Hefei, Anhui Province, 230601, China.
Introduction:
Diffuse malignant peritoneal mesothelioma (DMPM) is a very rare and life-threateningmalignant tumor.
Case:
We present a report of a rare case of a 70-year-old female patient with emaciation and poor appetite as manifestations. The characteristics of signs and clinical manifestations in this case were atypical. Abdominal CT scan revealed a large mass in the right retroperitoneal region beside the inferior vena cava. A neurogenic tumor was considered, and a ganglioneuroma was highly likely. There was no indication of multiple peritoneal implants/seedings in the peritoneum, omentum and liver. Subsequently, an endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed. The samples were processed into cell blocks, followed by hematoxylin-eosin (H&E) staining and immunohistochemical staining for observation. The results indicated a possible diagnosis of mesothelioma, while neurogenic tumors were ruled out.
Discussion:
During the operation, Multiplenodular tumor lesions were observed between the hepatogastric ligament, on the surface of the liver, inthe omentum, and at the splenic hilum, indicating that enhanced CT has certain limitations. If PET-CThad been performed preoperatively, the diagnosis might have been more comprehensive. The diagnosisof DMPM was further verified by laparotomy biopsy. EUS-FNA is a good auxiliary diagnostic method.
Insights
This case report highlights a rare instance of diffuse malignant peritoneal mesothelioma (DMPM) presenting atypically. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) proved valuable in diagnosing this rare cancer, despite initial imaging limitations.
Area of Science:
- Oncology
- Pathology
- Diagnostic Imaging
Background:
- Diffuse malignant peritoneal mesothelioma (DMPM) is an exceptionally rare and aggressive malignancy.
- Early diagnosis of DMPM can be challenging due to its rarity and often nonspecific symptoms.
Purpose of the Study:
- To report a rare case of DMPM with atypical clinical manifestations.
- To evaluate the diagnostic utility of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in DMPM.
Main Methods:
- A case study of a 70-year-old female with atypical symptoms.
- Diagnostic imaging including abdominal CT scan.
- Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with subsequent histological and immunohistochemical analysis.
- Laparotomy biopsy for definitive diagnosis.
Main Results:
- Initial CT scan suggested a retroperitoneal neurogenic tumor, masking peritoneal disease.
- EUS-FNA provided crucial preliminary diagnosis, ruling out neurogenic tumors and suggesting mesothelioma.
- Intraoperative findings revealed widespread peritoneal lesions not fully detected by CT, underscoring imaging limitations.
Conclusions:
- Enhanced CT has limitations in detecting the full extent of DMPM.
- PET-CT could offer more comprehensive preoperative staging.
- EUS-FNA is a valuable auxiliary diagnostic tool for DMPM.
- Laparotomy biopsy confirmed the DMPM diagnosis.
