A rare presentation of peritoneal mesothelioma: Esophageal encasement and Sister Mary Joseph nodule

Our plain-English summary of A rare presentation of peritoneal mesothelioma: Esophageal encasement and Sister Mary Joseph nodule, by D.W.P. Loong, R. Smith, R. Rattan (Radiology Case Reports, 2025).

The study

• Authors: D.W.P. Loong, R. Smith, R. Rattan
• Journal: Radiology Case Reports
• Published: 2025;20(11):5407-5410
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPeM) is a rare malignancy that accounts for approximately 10%-30% of all mesothelioma cases, with the more common type being pleural mesothelioma. In this case report, we describe an atypical presentation of MPeM in a 73-year-old female presenting with periumbilical swelling and subacute chest pain. Imaging demonstrated a large periumbilical mass and a posterior mediastinal mass encasing, but not obstructing, the esophagus. A brief literature review examining the broad range of clinical and imaging manifestations of MPeM is presented.

Crown Copyright © 2025 Published by Elsevier Inc. on behalf of University of Washington.

In plain English

This case report described one patient, a 73-year-old woman who attended an emergency department with 4 days of pleuritic chest pain. A firm lump at her navel had been identified on ultrasound 7 months earlier as an umbilical hernia. A CT scan showed a large mass (102 × 47 × 139 mm) in the back of the chest encasing, but not blocking, the esophagus, and a small right pleural effusion without pleural plaques. A PET/CT scan also showed a 98 × 46 mm mass in the tissues around the navel. A biopsy of that mass showed well differentiated epithelioid malignant mesothelioma, and a specialist team diagnosed malignant peritoneal mesothelioma. When asked specifically, the patient reported occupational asbestos exposure in a textile factory. The article gave no fiber type. The authors suggested the navel mass may have been a "Sister Mary Joseph nodule" whose recognition was delayed by the hernia. She received palliative radiotherapy and immunotherapy. The authors concluded the disease can be extensive at presentation with only mild symptoms.

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 (single patient), with a brief review of the literature in the discussion
• Who was studied: one 73-year-old woman who attended an emergency department in Australia (Gosford Hospital, New South Wales, is the authors' radiology department); she was an active smoker with COPD
• Exposure: occupational asbestos exposure while working in a textile factory, reported by the patient on specific questioning; no fiber type, duration or dose given
• Main results:
  • The patient presented with a 4-day history of pleuritic chest pain
  • A periumbilical lump had been identified as an umbilical hernia on ultrasound 7 months before the emergency visit
  • CT showed a large (102 × 47 × 139 mm) posterior mediastinal soft-tissue mass encasing the esophagus
  • The mass encased but did not obstruct the esophagus, and the patient had no esophageal symptoms
  • CT showed a small right pleural effusion without pleural plaques or nodularity
  • PET/CT about 4 weeks later showed a poorly defined 98 × 46 mm periumbilical mass (SUV max up to 11.0); there was no pleural uptake, ascites or mesenteric mass
  • Core biopsy of the umbilical mass with immunohistochemistry was consistent with well differentiated epithelioid malignant mesothelioma, and the case was diagnosed as malignant peritoneal mesothelioma (MPeM)
  • The authors stated that the pre-existing umbilical hernia contributed to delayed recognition of the periumbilical mass
  • Palliative treatment was 20 Gy in 5 fractions of radiotherapy to the umbilical mass, plus immunotherapy (ipilimumab and nivolumab)
• The authors' conclusion: The authors concluded that MPeM requires a high index of suspicion for diagnosis and can be extensive at presentation with only mild presenting symptoms

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Mesothelioma, Pleural Mesothelioma.

Related studies

• Sister Mary Joseph's nodule as primary localized malignant mesothelioma. Report of a case — A. Papalambros, F. Sigala, et al. (2011)
• The sister Mary Joseph nodule — K. Zhang, C. Sankey (2015)
• Malignant peritoneal mesothelioma in a 16-year-old girl: presentation of a rare disease — I.B. Brecht, A. Agaimy, et al. (2012)
• A Case Report of Peritoneal Mesothelioma as an Acute Abdomen Mimic: A Rare Presentation and Diagnostic Challenges — L. Fadl, M. Fadl, et al. (2024)
• Bilateral diffuse pulmonary infiltrates secondary to malignant peritoneal mesothelioma - A rare clinical presentation — M. Haygarth, K.K. Zaw, et al. (2019)
• A rare etiology of pulmonary nodules — A. Rupal, H. Singh, et al. (2021)

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