Malignant Peritoneal Mesothelioma with Latent Tuberculosis Infection

Our plain-English summary of Malignant Peritoneal Mesothelioma with Latent Tuberculosis Infection, by N. Inoue, K. Takumi, D. Sone, et al (Internal Medicine, 2021).

The study

• Authors: N. Inoue, K. Takumi, D. Sone, A. Shirakawa, T. Kawamura, K. Uno
• Journal: Internal Medicine
• Published: 2021;60(21):3409-3412
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare malignant tumor with peritoneal thickening. Tuberculous peritonitis also shows peritoneal thickening, so differentiating between the two is important but difficult if latent tuberculosis infection (LTBI) is present. We herein report a patient with MPM and LTBI. A 79-year-old man was diagnosed with peritoneal thickening on computed tomography. Interferon gamma release assay (IGRA) results were positive, suggesting tuberculous peritonitis. He underwent a laparoscopic omental biopsy and was diagnosed with MPM, which can occur together with LTBI. If peritoneal thickening is observed, an IGRA should be performed early, and the possibility of LTBI should be considered.

In plain English

This case report described a man in Japan with malignant peritoneal mesothelioma (cancer of the abdominal lining) and latent tuberculosis infection. He was 79, had no known history of tuberculosis, and his father had had pulmonary tuberculosis. He had run a timber carrier and managed a gas station. The authors reported no history of asbestos exposure and no pleural plaques on chest CT. In 2020, CT showed thickening of the abdominal lining, and a tuberculosis test (T-Spot) was positive. Three sputum tests were negative, and chest CT showed no signs of lung tuberculosis. During a laparoscopic omentum biopsy, white nodules were seen throughout the abdomen. Tissue staining supported epithelial mesothelioma, and no caseous necrosis or epithelioid cell granulomas were found. The authors define latent tuberculosis as a positive test without symptoms or imaging signs of tuberculosis. He was diagnosed with both conditions and began cisplatin and pemetrexed chemotherapy. The latent tuberculosis was not treated, so that mesothelioma treatment came first. The authors concluded that this mesothelioma can co-exist with latent tuberculosis and that early checks for active tuberculosis help distinguish it from tuberculous peritonitis.

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 79-year-old man whose medical history showed no previous tuberculosis infection and whose father had had pulmonary tuberculosis. The authors considered it possible that he had been infected when young and recovered spontaneously. He was seen at Kyoto Second Red Cross Hospital, Japan, in 2020.
• Exposure: The authors reported no history of asbestos exposure. He had previously run a timber carrier (ages 20 to 35) and managed a gas station (ages 35 to 75).
• Main results:
  • In this patient, the medical history showed no previous tuberculosis infection. The authors considered it possible that he had been infected when young and recovered spontaneously.
  • In this patient, no pleural plaque was seen on chest CT.
  • In this patient, the interferon gamma release assay (T-Spot) was positive, suggesting tuberculosis.
  • In this patient, sputum tests for Mycobacterium tuberculosis were done three times and all were negative.
  • In this patient, chest CT showed no acinar nodule or cavities, and pulmonary tuberculosis was negative.
  • During a laparoscopic omentum biopsy, white nodules were found throughout the abdominal cavity, especially in the upper right abdomen.
  • In this patient's biopsy, immunostaining was positive for calretinin, D2-40 and WT-1 and negative for Ber-EP4 and CEA.
  • No caseous necrosis or epithelioid cell granulomas were found in this patient's biopsy tissue.
  • The authors describe latent tuberculosis infection as a positive tuberculin reaction or IGRA without symptoms or imaging findings of tuberculosis.
  • The patient was diagnosed with epithelial malignant peritoneal mesothelioma combined with latent tuberculosis infection.
  • The patient was started on chemotherapy with cisplatin and pemetrexed in October 2020.
  • Treatment for the latent tuberculosis was considered but not given, so that mesothelioma treatment could come first.
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma can co-exist with latent tuberculosis infection. They concluded that early examination for active tuberculosis is important to tell it apart from tuberculous peritonitis. To their knowledge, this was the first reported case of the two together.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Biopsy.

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• Primary Malignant Mesothelioma of the Peritoneum Mistaken for Peritoneal Tuberculosis due to Elevated Cancer Antigen 125 — J.H. Oh, M.J. Oh (2019)
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