Benign multicystic mesothelioma of peritoneum complicating acute appendicitis in a man: a case report

Our plain-English summary of Benign multicystic mesothelioma of peritoneum complicating acute appendicitis in a man: a case report, by S. Occhionorelli, D. Tartarini, G. Pascale, et al (Journal of Medical Case Reports, 2016).

The study

• Authors: S. Occhionorelli, D. Tartarini, G. Pascale, S. Maccatrozzo, R. Stano, G. Vasquez
• Journal: Journal of Medical Case Reports
• Published: 2016;10:44
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Benign multicystic mesothelioma is a rare pathology. Few cases are reported in the medical literature and acute presentation is extremely uncommon.

Case Presentation: We describe an acute clinical presentation of the neoplasm that revealed itself with signs and symptoms attributable to acute appendicitis in a 41-year-old white man. Abdominal echography and computed tomography scans demonstrated the presence of a mass in direct contiguity with cecal fundus, but diagnosis remained unclear. Our patient underwent surgery and complete removal of the neoplasm. Only a definitive histological examination defined the nature of the lesion. No signs of relapse were demonstrated 1 year after the operation.

Conclusions: We showed that an acute presentation of a benign neoplasm represents a diagnostic and therapeutic challenge for the surgeon, because of the difficult differential diagnosis that acute presentation can sometimes pose and the trouble that an emergence treatment can imply.

In plain English

This was a case report about one 41-year-old white man admitted to the authors' emergency surgery department with a diagnosis of acute appendicitis after a week of pain in the lower right abdomen. Ultrasound showed an oval lump 72 mm across. A CT scan showed a 61 by 42 mm fluid-filled mass next to the cecum, the start of the large bowel, but the diagnosis remained unclear. Three days after admission, surgeons opened his abdomen and found a grape-like cluster of cysts and a similar cyst on the omentum. They removed his appendix and the whole mass. Examination of the tissue found it compatible with benign multicystic mesothelioma of the peritoneum, the lining of the abdomen, and confirmed acute appendicitis. He went home 8 days after surgery and showed no recurrence one year later. The article did not report whether he had been exposed to asbestos. In their discussion of earlier literature, the authors wrote that this tumour has no correlation with asbestos exposure. The authors concluded that only histological examination gives a definitive diagnosis, and that no well-defined, evidence-based treatments exist.

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)
• Who was studied: One 41-year-old white man admitted to the authors' emergency surgery department (authors based in Ferrara, Italy); dates of care not stated
• Exposure: No exposure was studied, and the article does not report the patient's asbestos exposure history. In the discussion, citing other literature, the authors state as general background that this tumour type has no correlation with asbestos exposure.
• Main results:
  • Ultrasound showed an oval lump of 72 mm diameter.
  • CT confirmed an oval mass of 61×42 mm with fluid content next to the cecum.
  • Fluid drawn from the mass was an inflammatory effusion without significant abnormal cells.
  • At surgery a grape-like multicystic mass was found. The surgeons removed the appendix and excised the whole mass.
  • Final histology was compatible with benign peritoneal multicystic mesothelioma. The omental mass was of the same nature, and acute catarrhal appendicitis was confirmed.
  • All tumour markers tested in this patient (CEA, CA 19-9, alpha-fetoprotein) were negative.
  • The patient was discharged 8 days after surgery, with no recurrence or residual disease at one year.
• The authors' conclusion: The authors concluded that an acute presentation of this rare benign tumour makes diagnosis and treatment difficult. Imaging can raise suspicion, but only histological examination gives a definitive diagnosis, and there are no well-defined, evidence-based treatments.

Topics

Medical terms in this study, explained in our Lexicon: Multicystic Mesothelioma (MCM), Peritoneum, Pathology, Neoplasm, Differential Diagnosis.

Related studies

• Multicystic mesothelioma of the peritoneum — L.T. Bui-Mansfield, G. Kim-Ahn, et al. (2002)
• Benign cystic mesothelioma of the peritoneum in a male child — Z. Stojsic, R. Jankovic, et al. (2012)
• Benign cystic mesothelioma of the peritoneum in a child-case report and review of the literature — V.C. Shakya, C.S. Agrawal, et al. (2011)
• Incidental benign cystic mesothelioma of the peritoneum: A case report — M.M. Ianieri, D.I. Buca, et al. (2016)
• Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management — A.M.C. Rapisarda, A. Cianci, et al. (2018)
• Imaging appearance of benign multicystic peritoneal mesothelioma: a case report and review of the literature — V. Mehta, V. Chowdhary, et al. (2017)

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