CT imaging of malignant peritoneal mesothelioma: A case report

Our plain-English summary of CT imaging of malignant peritoneal mesothelioma: A case report, by A.T. Basja, M.H.S. Atmaja (Radiology Case Reports, 2022).

The study

• Authors: A.T. Basja, M.H.S. Atmaja
• Journal: Radiology Case Reports
• Published: 2022;17(4):1256-1260
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The peritoneal cavity is the second most common location for mesothelioma with only 10.5% of 10,589 mesothelioma cases reported in the United States between 1973 until 2005 and known with poor prognosis. Diagnosing malignant peritoneal mesothelioma is a challenge for many clinicians because the symptoms are often non-specific. Therefore, the emergence of computer tomography (CT) features knowledge and another finding is an essential aspect in establishing the diagnosis. We present a case 43-years-old man with no history of malignancy presented with abdominal distention, weight loss, and decreased appetite for 2 months. To pursue the proper diagnosis an abdominal CT was performed and revealed diffuse, irregular thickening of the parietal peritoneum with multiple nodules, and the chest CT revealed a left-sided pleural effusion with multiple nodules in both lungs. Concomitant with the imaging result, histopathological examination and immunohistochemical analysis of a core biopsy of the peritoneal nodule showed a malignant round cell tumor indicating the source of the mesothelioma.

© 2022 The Authors. Published by Elsevier Inc. on behalf of University of Washington.

In plain English

This case report described one 43-year-old man, seen at a hospital in Surabaya, Indonesia, with malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. He had no history of cancer and, according to the authors, no history of asbestos exposure. For 2 months he had a swollen abdomen, weight loss and poor appetite, and examination found a very large amount of abdominal fluid (ascites). Blood tumor markers (alpha-fetoprotein, CA-125 and CA-19.9) were normal. Abdominal CT scans showed diffuse, irregular thickening of the abdominal lining, up to 1.8 cm, with multiple nodules and a large volume of fluid in the abdomen and pelvis. The authors classed this as the mixed CT type. Chest CT showed fluid around the left lung and multiple nodules in both lungs. The authors noted that the CT picture could also have fitted peritoneal carcinomatosis. Biopsy with immunohistochemical testing showed peritoneal mesothelioma. Intraperitoneal chemotherapy was in progress. The authors concluded that CT can diagnose and categorize this cancer, although immunohistochemical examination is the gold standard.

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 (one patient)
• Who was studied: One 43-year-old man with no history of malignancy, seen at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia (the authors' institution). The article does not give the date he was seen.
• Exposure: The authors state that the patient had no history of asbestos exposure. No fiber type, product or job is described.
• Main results:
  • Physical examination of the patient found ascites permagna (a very large amount of abdominal fluid).
  • The patient's tumor markers were normal.
  • The patient's abdominal CT showed diffuse, irregular thickening of the parietal peritoneum with multiple nodules.
  • In this patient the thickening measured up to 1.8 cm.
  • The patient had a large volume of fluid in both the abdominal and pelvic cavities.
  • The authors classified the patient's CT appearance as the mixed type.
  • The patient's chest CT showed a left-sided pleural effusion and multiple nodules in both lungs.
  • The authors noted that the patient's CT images could also have been features of peritoneal carcinomatosis.
  • In this patient, immunohistochemical examination of the biopsy showed mesothelioma of the peritoneum.
  • The patient was receiving intraperitoneal chemotherapy at the time of the report.
• The authors' conclusion: The authors concluded that CT images can diagnose and categorize the type of malignant peritoneal mesothelioma, although immunohistochemical examination is the gold standard. They also concluded that awareness and knowledge of imaging and other investigations is essential for diagnosis.

Topics

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

Related studies

• From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation — A.D. Levy, J. Arnáiz, et al. (2008)
• CT imaging of peritoneal carcinomatosis and its mimics — A.D. Diop, M. Fontarensky, et al. (2014)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)
• Malignant peritoneal mesothelioma in two pediatric patients: MR imaging findings — M. Haliloglu, F.A. Hoffer, et al. (2000)
• Imaging appearance of benign multicystic peritoneal mesothelioma: a case report and review of the literature — V. Mehta, V. Chowdhary, et al. (2017)
• In vivo imaging of human malignant mesothelioma grown orthotopically in the peritoneal cavity of nude mice — M. Feng, J. Zhang, et al. (2011)

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