Biphasic Peritoneal Mesothelioma: A Lethal Clinical Entity

Our plain-English summary of Biphasic Peritoneal Mesothelioma: A Lethal Clinical Entity, by A. Waheed, S. Foroutan, A. McCloskey, et al (Curēus, 2022).

The study

• Authors: A. Waheed, S. Foroutan, A. McCloskey, H. Randhawa, F.D. Cason
• Journal: Curēus
• Published: 2022;14(2):e22638
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesotheliomas are a rare malignancy of the serosal membrane. Mainly it affects the pleural surfaces followed by the second most common location, "peritoneum." The disease follows an aggressive pattern of spread, and by the time the diagnosis is established, the condition significantly spreads to distant locations. Diagnosis of malignant peritoneal mesothelioma is typically made by tissue biopsy. The standard treatment is radical resection; however, patients have benefited from several other modalities. The current case report describes a unique case of malignant mesothelioma, biphasic peritoneal mesothelioma (BPM), which comprises less than 25% of all peritoneal mesotheliomas. The diagnosis and treatment do not differ from other subtypes; however, the prognosis is poor, and if untreated, the survival is typically less than six months.

Copyright © 2022, Waheed et al.

In plain English

This case report described a 70-year-old woman with several days of upper-right abdominal pain, nausea and malaise, and weight loss over a couple of months. A CT scan showed a large mass near the hepatic flexure and ascending colon, contiguous with a 5 cm mass in segment VI of the liver, plus a smaller 2.5 cm liver mass. Surgeons removed the tumor in one piece with the right colon and segment VI of the liver. The tissue was diagnosed as biphasic peritoneal mesothelioma, with both spindle cell and epithelioid components. Recovery was complicated by failure to thrive and a drained fluid collection. The patient was discharged 15 days after surgery and died several weeks later, likely related, the authors wrote, to the aggressive disease. The authors wrote that, because the diagnosis came late, further treatments such as chemotherapy were not an option. Whether she had been exposed to asbestos was not established; her exposure risk was unknown to her family. The authors concluded that this cancer is rare and difficult to diagnose or treat.

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 70-year-old woman, originally from Puerto Rico, who came to an emergency room with right upper quadrant abdominal pain, nausea, malaise and weight loss. The text does not state the hospital or dates of care.
• Exposure: Not established. The article does not report whether the patient was exposed to asbestos or other hazards. It states only that her exposure risk was unknown to her family.
• Main results:
  • CT of the abdomen showed a large mass at the hepatic flexure and ascending colon, contiguous with a 5 cm mass in segment VI of the liver.
  • CT also showed a smaller 2.5 cm mass in the left lobe of the liver.
  • Preoperative carcinoembryonic antigen and liver function tests were normal.
  • The tumor was removed en bloc together with the right colon and segment VI of the liver.
  • Pathology showed biphasic peritoneal mesothelioma, with a spindle cell component merging with an epithelioid component.
  • After surgery, a fluid collection below the liver was found on postoperative day 11 and drained by CT guidance.
  • The patient was discharged on postoperative day 15.
  • The patient died several weeks after discharge. The authors considered the death likely related to the aggressive nature of the disease.
  • Because the diagnosis was late, cytoreductive surgery with HIPEC and chemotherapy or platinum agents were not an option for this patient.
• The authors' conclusion: The authors concluded that biphasic peritoneal mesothelioma is a rare disease that is difficult to diagnose or treat.

Topics

Medical terms in this study, explained in our Lexicon: Biphasic Mesothelioma, Peritoneal Mesothelioma, Mesothelioma, Peritoneum, Biopsy, Prognosis.

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• Primary Peritoneal Mesothelioma: Diagnostic Challenges of This Lethal Imposter — S.K. Dusseault, O.E. Okobi, et al. (2022)
• Asbestos pleural effusion: a clinical entity — G. Mårtensson, S. Hagberg, et al. (1987)
• EWSR1::YY1 fusion positive peritoneal epithelioid mesothelioma harbors mesothelioma epigenetic signature: Report of 3 cases in support of an emerging entity — J.K. Dermawan, D. Torrence, et al. (2022)
• Intra-Operative Diagnosis of Benign Multicystic Peritoneal Mesothelioma: A Case Report of Rare Entity and Lessons Learned — C.C. Wu, A. Bassi, et al. (2024)

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