Malignant peritoneal mesothelioma with massive ascites as the first symptom: A case report

Our plain-English summary of Malignant peritoneal mesothelioma with massive ascites as the first symptom: A case report, by X. Huang, Y. Hong, S.Y. Xie, et al (World Journal of Clinical Cases, 2022).

The study

• Authors: X. Huang, Y. Hong, S.Y. Xie, H.L. Liao, H.M. Huang, J.H. Liu, W.J. Long
• Journal: World Journal of Clinical Cases
• Published: 2022;10(28):10317-10325
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant peritoneal mesothelioma (MPM) is an extremely rare tumor with nonspecific clinical manifestations, which is extremely difficult to diagnose. Herein, we reported a case of MPM in the abdominal cavity with massive short-term ascites as the first symptom.

Case Summary: A 65-year-old woman presented to the hospital with abdominal pain, distention, and shortness of breath that persisted for 15 d. The serum CA-125 level was 1075 U/mL. The abdominal computed tomography showed massive ascites and no obvious tumor lesions. The pathological examination of the ascitic fluid showed numerous heterotypic cells with some papillary structures. The immunohistochemistry and fluorescence in situ hybridization showed the deletion of CDX2 (-), WT-1 (-), Ki-67 (about 10% +), CEA (-), Glut-1 (+++), desmin (-), PD-L1 (-), and CDKN2A (P16). The final diagnosis was MPM. The patient refused tumor cytoreductive surgery and received two cycles of cisplatin plus pemetrexed bidirectional chemotherapy. In the second cycle, she received an additional cycle of hyperthermic intraperitoneal chemotherapy and immune checkpoint inhibitor therapy due to massive recalcitrant ascites. She died of disease progression 2 mo after diagnosis.

Conclusion: In case of massive unexplained ascites, the possibility of MPM should not be excluded to avoid misdiagnosis and delay in treatment.

©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

In plain English

This case report described one 65-year-old woman who sought care for abdominal swelling and shortness of breath lasting 15 days. She had no history of asbestos exposure. At first diagnosis her blood CA125 level was 1075 U/mL. CT scanning showed a large amount of abdominal fluid (ascites) but no visible tumor. A later MRI showed mild thickening of the abdominal lining. Fluid drawn from her abdomen contained many abnormal cells, and a genetic test of those cells found a CDKN2A (P16) gene deletion. She was diagnosed with malignant peritoneal mesothelioma from these cell, staining and imaging tests. She and her family declined further staining tests and laparoscopy, and she declined surgery. She received two cycles of cisplatin plus pemetrexed chemotherapy. Heated chemotherapy into the abdomen and immunotherapy were added in the second cycle, after which her ascites lessened markedly. She died at home of disease progression about 2 months after her first visit. The authors concluded that clinicians should consider this cancer when large unexplained ascites appears.

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 65-year-old woman in China with abdominal distention and shortness of breath for 15 days; first diagnosis November 8 (year not stated in the table), death January 12, 2022
• Exposure: no asbestos exposure; the article reports she had no history of asbestos exposure
• Main results:
  • Serum CA125 was 1075 U/mL at first diagnosis
  • CT showed a large volume of ascites with no abdominal wall thickening or soft-tissue shadow; pelvic MRI later showed mild peritoneal thickening
  • Examination of the ascitic fluid showed numerous atypical cells, some with papillary structures
  • FISH on cells from the ascitic fluid detected CDKN2A (P16) gene deletion (41% of counted cells missing the signal); PD-L1 was negative
  • The diagnosis of malignant peritoneal mesothelioma was based on cytological, immune and imaging tests
  • The patient refused cytoreductive surgery and received two cycles of cisplatin plus pemetrexed bidirectional chemotherapy, with HIPEC and immune checkpoint inhibitor therapy added in the second cycle
  • The ascites resolved substantially after one course of HIPEC
  • She died at home on January 12, 2022, of disease progression, about 2 months after the first visit
• The authors' conclusion: The authors concluded that clinicians should consider the possibility of malignant peritoneal mesothelioma in case of massive unexplained ascites
• Limitations the authors state:
  • The recommended additional immunohistochemistry and laparoscopy were not done because the patient and her family refused
  • The mesothelial markers calretinin and WT-1 gave inconsistent results on the cell blocks and did not establish mesothelial origin
  • The authors could not determine whether the slightly thickened pleura seen on CT represented pleural metastasis
  • No tissue histology was obtained because the patient refused surgery

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Ascites, CA-125, Immunohistochemistry, Fluorescence In Situ Hybridization (FISH), CDX2, Wilms Tumor 1 (WT-1), Ki-67.

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