Case report: Radiological features of a case of desmoplastic malignant mesothelioma of peritoneum

Our plain-English summary of Case report: Radiological features of a case of desmoplastic malignant mesothelioma of peritoneum, by J. Wang, H. Deng (Frontiers in Oncology, 2024).

The study

• Authors: J. Wang, H. Deng
• Journal: Frontiers in Oncology
• Published: 2024;14:1502105
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Desmoplastic malignant peritoneal mesothelioma (DMPM) is an extremely rare and aggressive subtype of sarcomatoid malignant mesothelioma, originating from the mesothelial lining of body cavities. It is characterized by significant local invasiveness and poor prognosis. The nonspecific symptoms of DMPM often result in delayed diagnosis. This case report presents the multimodality imaging findings of DMPM in a 58-year-old male, including ultrasound, CT, contrast-enhanced CT, magnetic resonance imaging (MRI), and 18-fluorodeoxy-glucose positron emission tomography combined with CT (18F-FDG PET/CT). These findings aim to enhance radiologists' understanding of the imaging features and differential diagnosis of DMPM. In this case, the tumor was located in the right subdiaphragm and the right anterior and left medial lobes of the liver. Due to the patient's history of alcoholic cirrhosis-a known risk factor for primary liver tumors-the initial diagnostic focus was on identifying a primary liver tumor with potential peritoneal invasion, overlooking other possible etiologies. However, histological results revealed that the liver lesion was secondary to invasion by DMPM. To the best of our knowledge, cases of DMPM invading the liver are exceedingly rare. This report underscores the importance of considering peritoneal tumors in the differential diagnosis when lesions involve both the peritoneum and adjacent organs, despite their rarity.

Copyright © 2024 Wang and Deng.

In plain English

This case report described one patient with desmoplastic malignant peritoneal mesothelioma (DMPM), which the authors called a rare and aggressive subtype of sarcomatoid malignant mesothelioma. The patient was a 58-year-old Chinese man with alcoholic cirrhosis and a one-year history of worsening pain in the right upper abdomen. He denied asbestos exposure. Ultrasound, CT, MRI and PET/CT showed lesions under the right diaphragm and in the right anterior and left medial lobes of the liver, with nodules in the nearby peritoneum. Chest CT also showed pleural thickening on both sides and calcifications of the pleura over both sides of the diaphragm. Because of his cirrhosis, doctors first suspected a primary liver tumor. A biopsy instead showed DMPM that had invaded the liver. He received chemotherapy with pemetrexed and cisplatin and was discharged after completing treatment. The authors concluded that no single imaging method gave definitive features and that a combination of methods was needed. They also concluded that peritoneal tumors should be considered when lesions involve both the peritoneum and adjacent organs.

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 58-year-old Chinese man with a history of alcoholic cirrhosis, admitted with a one-year history of progressively worsening right upper quadrant pain; authors at Hebei Medical University Third Hospital, Shijiazhuang, China
• Exposure: No asbestos exposure was reported; the patient denied asbestos exposure. He reported chronic alcohol abuse.
• Main results:
  • Ultrasound showed an ill-defined, heterogeneous, hypoechoic lesion involving the right subdiaphragm and the right anterior and left medial lobes of the liver.
  • Thoracic CT showed an elevated right diaphragm, bilateral pleural thickening, bilateral diaphragmatic pleural calcifications and enlarged anterior mediastinal lymph nodes, with no significant lung masses.
  • On PET/CT, the lesions under the right diaphragm and in the liver had a maximum standardized uptake value (SUVmax) of 11.2. The right peritoneum, which showed irregular nodular thickening, had an SUVmax of 7.7. The largest nodule in the right abdominal cavity had an SUVmax of 11.9.
  • Ultrasound-guided biopsy of the subdiaphragmatic lesion and the liver mass showed tumor cells involving both the peritoneum and the liver. The cells were positive for Ki-67 (20%), CK7, WT-1, vimentin, CK (pan), D2-40 (weakly) and calretinin, and negative for villin, CK20 and CDX-2. These findings supported a diagnosis of DMPM.
  • The initial suspicion was a primary liver tumor because of the patient's alcoholic cirrhosis. Histology showed the peritoneal lesion was the primary tumor, with liver invasion by DMPM.
  • The patient was treated with pemetrexed and cisplatin chemotherapy and was discharged after completing treatment.
• The authors' conclusion: The authors concluded that no single imaging modality provides definitive features of DMPM and that a combination of ultrasound, contrast-enhanced CT, MR and PET-CT is essential to support diagnosis. They also concluded that peritoneal tumors should be considered when lesions involve both the peritoneum and adjacent organs.

Topics

Medical terms in this study, explained in our Lexicon: Desmoplastic Mesothelioma, Mesothelioma, Peritoneum, Peritoneal Mesothelioma, Sarcomatoid, Prognosis, Ultrasound, Differential Diagnosis.

Related studies

• Desmoplastic malignant mesothelioma originating from the peritoneum — H. Takamaru, Y. Arimura, et al. (2012)
• Desmoplastic malignant mesothelioma of the peritoneum — B. Badak, O. Turk, et al. (2014)
• Radiological characteristics, histological features and clinical outcomes of lung cancer patients with coexistent idiopathic pulmonary fibrosis — K.A. Khan, M.P. Kennedy, et al. (2015)
• Radiological features of diffuse mesothelioma — A. Solomon (1970)
• Radiological features of asbestos-related visceral pleural changes — A. Solomon (1991)
• Clinical, Laboratory, Histological, Radiological, and Metabolic Features and Prognosis of Malignant Pleural Mesothelioma — Y. Zhang, R. Li, et al. (2022)

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