Incidental finding of metastatic mesothelioma in an inguinal hernia sac: a case report

Our plain-English summary of Incidental finding of metastatic mesothelioma in an inguinal hernia sac: a case report, by A. Al-Bitar, M. Shwin (Journal of Surgical Case Reports, 2025).

The study

• Authors: A. Al-Bitar, M. Shwin
• Journal: Journal of Surgical Case Reports
• Published: 2025;2025(2):rjaf099
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Inguinal hernias are the most common type of abdominal wall hernias, often requiring surgical intervention. Mesothelioma, a rare cancer associated with the linings of serous cavities, can occasionally be found in hernia sacs. This paper presents the case of a 38-year-old male with an incidental diagnosis of stage 4 pleural mesothelioma discovered during a routine inguinal hernia repair. Despite being asymptomatic, the patient's hernia sac examination revealed mesothelioma, which was confirmed through histopathological analysis and imaging. This rare finding underscores the importance of thorough examination and comprehensive oncological evaluation when unusual findings are encountered during routine surgeries. The case highlights the necessity for awareness and vigilance in similar scenarios to potentially improve patient outcomes.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2025.

In plain English

This article was a case report about one patient. A 38-year-old man, described as an educator and part-time farmer and a non-smoker, had swelling in his right groin and no other symptoms. During routine surgery to repair an inguinal (groin) hernia, the surgeon found a thickened hernia sac wall and cloudy fluid. Samples of the sac lining, the omentum (fatty tissue in the abdomen) and the fluid were sent for laboratory testing. The tissue showed an epithelioid malignant tumor, and staining for the markers calretinin and CK5/6 led to a diagnosis of malignant mesothelioma. A CT scan showed a 58 × 31 mm mass in the pleura (lung lining) of the left lower lobe and thickening of the abdominal lining. This was read as left pleural mesothelioma that had spread to the abdomen. Oncologists diagnosed stage 4 pleural mesothelioma and planned eight cycles of cisplatin with gemcitabine. The patient died during the fourth cycle. The report did not describe any asbestos exposure for this patient. The authors concluded that vigilance in similar situations could potentially improve patient outcomes.

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 38-year-old man, an educator and part-time farmer and a non-smoker, with no notable family cancer history. The article does not state where or when he was treated; the authors list affiliations in Damascus, Syria.
• Exposure: The article does not report any asbestos exposure history for this patient. His occupation is given only as educator and part-time farmer.
• Main results:
  • During the hernia operation, the hernia sac wall was thickened, and aspiration yielded cloudy, serous fluid indicating ascites (fluid in the abdomen), along with thickening of the omentum.
  • The peritoneal biopsy showed an epithelioid cell malignant tumor. Calretinin and CK5/6 (mesothelial cell markers) were diffusely positive, leading to a diagnosis of malignant mesothelioma.
  • A CT scan of the chest, abdomen and pelvis showed a 58 × 31 mm lobulated mass in the pleura of the left lower lobe, with thickening of the omentum, mesentery and peritoneum. This was consistent with left pleural mesothelioma with peritoneal and omental metastases.
  • Oncologists diagnosed stage 4 pleural mesothelioma and planned eight cycles of cisplatin with gemcitabine. The patient died during the fourth cycle.
• The authors' conclusion: The authors concluded that this case adds to the limited literature on mesothelioma and hernias, and that vigilance in similar scenarios could potentially improve patient outcomes. They also wrote that the finding underscores the need for thorough laboratory examination of hernia sacs.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Inguinal Hernia, Serous Cavities, Pleural Mesothelioma.

Related studies

• Peritoneal mesothelioma as an incidental finding during inguinal hernia surgery — J.R. Andresen, E.L. Monteiro, et al. (2026)
• Incarcerated inguinal hernia from metastatic pleural mesothelioma: PET/CT imaging — V.X. Nguyen, B.D. Nguyen, et al. (2012)
• An unusual presentation of malignant mesothelioma: the incidental finding of tumor in the hernia sac during herniorrhaphy — J. Brenner, P.P. Sordillo, et al. (1981)
• Fine-needle aspiration of a well-differentiated papillary mesothelioma in the inguinal hernia sac: A case report and review of literature — Y.Y. Wheeler, F. Burroughs, et al. (2009)
• Peritoneal mesothelioma masquerading as an inguinal hernia — S. Chakravartty, J.C. Singh, et al. (2011)
• Peritoneal mesothelioma masquerading as an inguinal hernia — S. Chakravartty, J.C. Singh, et al. (2012)

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