Benign Multicystic Peritoneal Mesothelioma Presenting as Appendiceal Abscess: A Diagnostic and Therapeutic Challenge

Our plain-English summary of Benign Multicystic Peritoneal Mesothelioma Presenting as Appendiceal Abscess: A Diagnostic and Therapeutic Challenge, by C. Seretis, A.M. Elhassan, L. Kretzmer, et al (Gastroenterology Research, 2020).

The study

• Authors: C. Seretis, A.M. Elhassan, L. Kretzmer, P. Lim, A.S. Menon, A. Awodiya, S.R. Kanchustambam
• Journal: Gastroenterology Research
• Published: 2020;13(3):117-120
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Primary peritoneal tumors are rarely encountered and their management is usually challenging for the clinicians. Especially when the patients with advanced peritoneal malignancy present as surgical emergencies, usually with symptoms of obstruction, perforation or gross space-occupying lesions, the on-call surgical team has to weigh the pros and cons of urgent versus delayed treatment and plans a safe and simultaneously oncologically beneficial therapeutic approach. Herein, we present a case of a Caucasian man who was referred as suspected complicated appendicitis by his primary care physician, with the final diagnosis being benign multicystic mesothelioma. We describe the challenges of the clinical decision making for the emergency general surgeon and relevant diagnostic and therapeutic pitfalls, which can be potentially minimized by early liaison with tertiary units specializing in the treatment of disseminated peritoneal malignancy.

Copyright 2020, Seretis et al.

In plain English

This article is a case report about one patient, written by surgeons at George Eliot Hospital in Nuneaton, UK. The patient was a 61-year-old Caucasian man with no medical comorbidities or prior surgery. He had about 10 days of pain in the right iliac fossa (lower right abdomen) and was referred with suspected acute appendicitis. A CT scan showed a 17 cm fluid collection in the right iliac fossa and a 5 cm collection in the pelvis, which looked like an appendiceal abscess. During keyhole surgery, the surgeons instead found a large gelatinous mass with deposits on the abdominal lining and in the pelvis. They switched to open surgery, removed the right side of the colon and the visible tumor, and reported a complete removal of visible tumor. Recovery was uneventful, and the patient went home on the 10th day after surgery. Tissue examination was consistent with benign multicystic peritoneal mesothelioma. The specialist teams agreed on yearly CT scans and periodic tumor marker tests. The article does not mention asbestos or any other exposure. The authors concluded that the case highlights the need for high clinical suspicion of primary peritoneal tumors, and they advocated early contact with specialist centers.

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 61-year-old Caucasian man with no medical comorbidities or prior surgical history, treated by the Department of General Surgery, George Eliot Hospital NHS Trust, Nuneaton, UK
• Exposure: Not reported: the article does not mention asbestos or any occupational or environmental exposure
• Main results:
  • The CT scan showed a 17 cm fluid collection in the right iliac fossa and a 5 cm collection in the pelvis. These findings were judged suggestive of an appendiceal abscess.
  • At laparoscopy, a large gelatinous mass was found in the right iliac fossa, with nodular deposits on the right parietal peritoneum and gelatinous cystic deposits in the pelvis.
  • The operation was converted to a midline laparotomy with right hemicolectomy and maximal tumor debulking. The authors reported achieving a complete cytoreduction (infracolic omentectomy, right parietal and pelvic peritonectomy).
  • The patient had an uneventful post-operative recovery and was discharged on the 10th post-operative day. Colonoscopy was normal, and staging CT of the thorax showed no metastases.
  • Histology was consistent with primary peritoneal benign multicystic mesothelioma. Immunohistochemistry was positive for cytokeratin MNF116 and calretinin and negative for CD31.
  • After discussion at colorectal, regional mesothelioma and supra-regional peritoneal specialist meetings, the plan was annual CT of the thorax, abdomen and pelvis plus periodic tumor markers. The patient was reviewed 6 months after the operation.
• The authors' conclusion: The authors concluded that the case highlights the need for high clinical suspicion of primary peritoneal tumors in patients with clinically detectable or radiologically suggested multifocal intra-abdominal masses. Where there is doubt, they advocated early liaison with a tertiary referral center for peritoneal surface malignancies.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Multicystic Mesothelioma (MCM).

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• Benign multicystic peritoneal mesothelioma presenting as a ghost abdominal mass — H. Jerraya, W. Ghariani, et al. (2016)
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