Diffuse peritoneal mesothelioma presenting with the appearance of mesenteric panniculitis: A case report

Our plain-English summary of Diffuse peritoneal mesothelioma presenting with the appearance of mesenteric panniculitis: A case report, by Y. Chen, Q. Fu, J. Xu, et al (Oncology Letters, 2026).

The study

• Authors: Y. Chen, Q. Fu, J. Xu, R. Wang, Y. Mo, Y. Liu
• Journal: Oncology Letters
• Published: 2026;32(2):340
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Diffuse peritoneal mesothelioma (DPM) is a rare and aggressive malignancy of the peritoneum. Early symptoms are non-specific and the condition is liable to misdiagnosis. In the present case, a 54-year-old man was misdiagnosed between April 2020 and October 2021 with mesenteric panniculitis. The patient later presented with a 2-month history of persistent upper-middle abdominal pain and weight loss in April 2022. A laparoscopic biopsy was performed and the sample was positive for Wilms tumor protein, Hector Battifora mesothelial-1 and podoplanin. Therefore, a diagnosis of DPM was made. A total of six cycles of pemetrexed-cisplatin chemotherapy were given and elicited a partial response. The disease progressed and intraperitoneal bevacizumab-cisplatin therapy was administered, which was ineffective. The patient died 13 months post-diagnosis. DPM often has a similar presentation to benign conditions, such as mesenteric panniculitis. Correct diagnosis is facilitated by an awareness of occupational exposure risk, such as that of asphalt exposure for the present case, and early histopathological evaluation. The prognosis for DPM remains poor despite multimodal therapy, and novel therapeutic strategies are needed.

Copyright: © 2026 Chen et al.

In plain English

This case report described one 54-year-old man in China, a highway maintenance worker with 28 years of unprotected work with hot asphalt, who developed diffuse peritoneal mesothelioma, a cancer of the lining of the abdomen. No asbestos testing was done at his workplace, and the authors reported that he had no history of asbestos exposure. Between April 2020 and October 2021 he was diagnosed, based on CT scans, with mesenteric panniculitis, a benign condition. In April 2022 a laparoscopic biopsy showed epithelioid-type mesothelioma, supported by staining for several mesothelioma markers. He refused surgery. Six cycles of pemetrexed-cisplatin chemotherapy reduced the measured abdominal tumors by 55%, but he developed grade III bone marrow suppression. The disease progressed at 11 months. A cisplatin-bevacizumab treatment given directly into the abdomen did not work. He died in September 2023, with cachexia (severe wasting). The authors concluded that asphalt exposure may have contributed to his disease. They also said that causal evidence is lacking and that further studies are needed.

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
• Who was studied: One 54-year-old male highway maintenance worker, admitted to The First People's Hospital of Xiaoshan District, Hangzhou, China, in April 2022
• Exposure: Occupational exposure to hot-mix modified asphalt (fumes and skin contact) for 28 years (1994 to 2022), without respiratory protection or gloves, 4 to 6 hours per day and at least 22 days per month. No asbestos testing was done at the workplace, and the authors state the patient had no history of asbestos exposure.
• Main results:
  • Between April 2020 and October 2021 the patient was diagnosed at several hospitals with mesenteric panniculitis on the basis of abdominal CT scans.
  • At admission in April 2022 the tumor marker CA125 was elevated at 160.60 U/ml (normal range 0 to 35 U/ml).
  • Biopsies of the abdominal wall and omentum showed features consistent with malignant epithelioid-type mesothelioma.
  • Tumor cells stained positive for calretinin and for the mesothelioma markers WT-1, HBME-1 and D2-40 (podoplanin).
  • Testing with a 120-gene panel found no disease-causing gene changes and no targets for targeted therapy.
  • The peritoneal cancer index score was 27 points, and the patient refused surgery.
  • After six cycles of pemetrexed-cisplatin chemotherapy, the sum of the largest diameters of the peritoneal masses fell by 55% from baseline (6.0 to 2.7 cm), a partial response.
  • The chemotherapy was accompanied by grade III myelosuppression (bone marrow suppression) and grade II gastrointestinal reactions.
  • At 11 months the disease progressed. The masses increased by 26% (2.7 to 3.4 cm), ascites increased and CA125 rose to 923.3 U/ml.
  • One month after surgery, a tumor nodule was found at the laparoscopic port site in the abdominal wall.
  • The intraperitoneal cisplatin-bevacizumab therapy was ineffective, and the patient died in September 2023.
• The authors' conclusion: The authors concluded that occupational exposure to potential carcinogens such as asphalt may have contributed to the patient's disease, but that causal evidence is lacking and further epidemiological and mechanistic studies are needed.
• Limitations the authors state:
  • The patient received only chemotherapy and intraperitoneal therapy, not surgery with heated intraperitoneal chemotherapy, so the outcome cannot be extrapolated to patients eligible for that treatment.
  • The authors state that the intraperitoneal bevacizumab-cisplatin regimen did not undergo institutional review board approval.
  • The purulent abdominal fluid was not examined by cytology or culture, so a concurrent infection cannot be ruled out.
  • Assessing the peritoneal cancer index by laparoscopy may underestimate the true tumor burden.
  • There is no high-level evidence for intraperitoneal bevacizumab in this disease, and the lack of response in this case underscores that uncertainty.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Peritoneum, Misdiagnosis, Biopsy, Podoplanin (D2-40), Pemetrexed (Alimta), Cisplatin, Chemotherapy.

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