Malignant peritoneal mesothelioma presenting as a mass in a Spigelian hernia. Report of a case

Our plain-English summary of Malignant peritoneal mesothelioma presenting as a mass in a Spigelian hernia. Report of a case, by P.H. Sugarbaker (International Journal of Surgery Case Reports, 2020).

The study

• Author: P.H. Sugarbaker
• Journal: International Journal of Surgery Case Reports
• Published: 2020;68:239-241
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Gastrointestinal cancer, gynecologic cancer and malignant peritoneal mesothelioma may disseminate widely to the surfaces of the abdomen and pelvis. In some patients this spread of the disease may find its way into a hernia sac.

Methods: The Spigelian hernia is caused by a protrusion of the peritoneum of the anterior abdominal wall into the abdominal wall muscle. This peritoneal defect occurs through the semilunar line of Spiegel in or closely associated with the semicircular line of Douglas.

Results: A patient presented with a large (11 cm greatest diameter) mass in the left lower quadrant. The mass was composed of malignant peritoneal mesothelioma and was anatomically located within the Spigelian hernia belt. At the time of cytoreductive surgery numerous other sites of malignant peritoneal mesothelioma were present within the abdomen and pelvis.

Conclusions: The left lower quadrant mass was a malignant peritoneal mesothelioma presenting within a Spigelian hernia defect. This phenomenon has not been previously reported.

Copyright © 2020 The Author. Published by Elsevier Ltd.. All rights reserved.

In plain English

This article is a case report about one patient. In November 2002, a 70-year-old white woman complained of a painful mass in her lower left abdomen. A CT scan showed an 11 cm mass in the front abdominal wall and a second mass, 5 cm by 2.9 cm, near the right colon. No disease was seen outside the abdomen and pelvis. A biopsy of the wall mass showed malignant peritoneal mesothelioma. The mass sat at the site of a Spigelian hernia, an uncommon abdominal wall hernia. In March 2003 she had a 9-hour operation removing all visible tumor, then heated chemotherapy inside the abdomen (HIPEC). The only large tumor mass, 15 by 12 by 7 cm, was in the hernia defect, though tumor was also widespread, with a large volume in the omentum. Lung metastases appeared 18 months after surgery, and she died of progressive disease in July 2005, 29 months after treatment. The author concluded this was the first such report and wrote that the cause of the tumor's location was not obvious. The article does not mention asbestos exposure.

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 70-year-old white woman with a painful left lower quadrant abdominal mass, first seen in November 2002 and followed until her death in July 2005
• Main results:
  • CT showed a mass in the anterior abdominal wall measuring 11 cm in diameter, plus a second 5 cm by 2.9 cm mass associated with the right colon. No disease was seen outside the abdomen and pelvis.
  • Biopsy of the abdominal wall mass showed malignant peritoneal mesothelioma.
  • The only large tumor mass (15 cm by 12 cm by 7 cm) was within the hernia defect.
  • Mesothelioma was widely distributed on the peritoneal surfaces of the abdomen and pelvis, with a large volume of tumor in the omentum.
  • After complete cytoreduction, the patient was treated with hyperthermic intraperitoneal chemotherapy (HIPEC).
  • Multiple lung metastases were seen by CT 18 months after surgery.
  • The patient died of progressive disease in July 2005, 29 months after cytoreductive surgery and HIPEC.
• The authors' conclusion: The author concluded that this was the first report of malignant peritoneal mesothelioma presenting in a Spigelian hernia.
• Limitations the authors state:
  • The author stated that the reason for the mesothelioma mass forming in the abdominal wall was not obvious.
  • The author stated that the cause of a large tumor mass forming inside a hernia sac is not immediately apparent.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Peritoneum, Cytoreductive Surgery.

Related studies

• Peritoneal inclusion cyst presenting as an umbilical hernia: case report and systematic review of the literature — K. Nightingale, E. Clough, et al. (2024)
• Peritoneal mesothelioma presenting as an adnexal mass — R.A. Komorowski, D.H. Bobert (1975)
• Extra-gastrointestinal stromal tumor presenting as a huge peritoneal mass and mimicking as mesothelioma - A case report — D. Ghartimagar, A. Ghosh, et al. (2021)
• Benign multicystic peritoneal mesothelioma presenting as a ghost abdominal mass — H. Jerraya, W. Ghariani, et al. (2016)
• Benign Multicystic Peritoneal Mesothelioma Presenting as a Colonic Mass — K. Pierre, N.F. Gomez, et al. (2021)
• Malignant peritoneal mesothelioma presenting as a splenic mass — M. Podberezin, M.J. Fitzpatrick, et al. (2020)

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