Malignant peritoneal mesothelioma-a diagnostic challenge

Our plain-English summary of Malignant peritoneal mesothelioma-a diagnostic challenge, by S. Abdul Razzak, F. Awan, S. Ahmed (Journal of Surgical Case Reports, 2022).

The study

• Authors: S. Abdul Razzak, F. Awan, S. Ahmed
• Journal: Journal of Surgical Case Reports
• Published: 2022;2022(12):rjac555
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma is a rare cancer originating primarily from the peritoneum with a poor prognosis and non-specific clinical presentation. We present a case of a 60-year-old male, retired metallurgy engineer who initially presented with shortness of breath, lethargy, weight loss, vague abdominal pain and night sweats. Extensive workup for almost 2 months finally leads to the diagnosis of primary malignant peritoneal mesothelioma based on immunohistochemical analysis of loss of BAP1 gene. The patient was deemed non-suitable for surgical management and started on palliative carboplatin and pemetrexed. In conclusion, histological diagnosis is essential for peritoneal diseases before considering it as a metastasis from other primary tumours. Furthermore, immunohistochemical analysis and genetic profiling may also guide towards the diagnosis and possible treatment.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2022.

In plain English

This case report, by authors at St. Luke's General Hospital in Kilkenny, Ireland, described one patient. He was a 60-year-old man, a retired metallurgy engineer and non-smoker. In early September 2021 he came to hospital with shortness of breath, weight loss, tiredness, vague abdominal pain, a swollen abdomen and night sweats. The article does not say whether he had been exposed to asbestos. A CT scan showed tumour deposits and fluid in the abdomen, but no primary tumour. A needle biopsy found no cancer. Later biopsies taken by laparoscopy showed growth of mesothelial cells that could not be classed as reactive or cancerous. A stain for the protein BAP1 was not available in the country, so samples were sent abroad. Loss of BAP1 and MTAP staining confirmed epithelioid mesothelioma. Because his disease was extensive, he was given carboplatin and pemetrexed chemotherapy and improved. About a year after diagnosis, scans showed some disease progression, but he could still maintain his functionality. The authors concluded that immunohistochemical testing and genetic profiling, especially for BAP1, are important in diagnosing primary peritoneal mesothelioma.

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 60-year-old man, a retired metallurgy engineer and non-smoker, seen in early September 2021; the authors are at St. Luke's General Hospital, Kilkenny, Ireland
• Exposure: No asbestos exposure is reported for this patient; the article gives only his occupation as a retired metallurgy engineer
• Main results:
  • CT scanning showed multiple mesenteric implants, omental caking and gross ascites, with no primary tumour identified
  • The first ultrasound-guided biopsy showed inflammatory and mesothelial cells but no malignancy
  • At laparoscopy, ascitic fluid cytology was negative for malignant cells
  • Omental tissue histology showed florid mesothelial proliferation that was uncertain for a reactive or neoplastic process
  • BAP1 staining was not available in the country, so samples were sent abroad
  • Loss of MTAP staining and nuclear loss of BAP1 confirmed epithelioid mesothelioma
  • Systemic chemotherapy with carboplatin and pemetrexed was chosen because of the extensive disease burden
  • After four cycles of chemotherapy, ascites was reduced, with new bilateral pleural effusion and sub-centimetre pulmonary nodularity
  • About a year after diagnosis, there was some disease progression, but the patient was able to maintain his functionality
• The authors' conclusion: The authors concluded that this case shows the importance of immunohistochemical testing and genetic profiling, especially for BAP1 mutation, in diagnosing primary peritoneal mesothelioma

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Peritoneum, Prognosis, BAP1, Palliative Care, Carboplatin, Pemetrexed (Alimta), Metastasis.

Related studies

• The diagnostic challenge of peritoneal mesothelioma — P. Krasuski, A. Poniecka, et al. (2002)
• Primary Peritoneal Mesothelioma: Diagnostic Challenges of This Lethal Imposter — S.K. Dusseault, O.E. Okobi, et al. (2022)
• Malignant Peritoneal Mesothelioma as a Rare Cause of Dyspeptic Complaints and Ascites: A Diagnostic Challenge — S. Marques de Sousa, F. Pereira, et al. (2020)
• Benign Multicystic Peritoneal Mesothelioma Presenting as Appendiceal Abscess: A Diagnostic and Therapeutic Challenge — C. Seretis, A.M. Elhassan, et al. (2020)
• Biphasic Peritoneal Mesothelioma Is a Rare Tumor and a Diagnostic Challenge: A Case Report — E.A. Subahi, A. Fadul, et al. (2024)
• A Case Report of Peritoneal Mesothelioma as an Acute Abdomen Mimic: A Rare Presentation and Diagnostic Challenges — L. Fadl, M. Fadl, et al. (2024)

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