Metastatic spread of pleural mesothelioma to the peritoneum and gallbladder presenting as recurrent acute cholecystitis

Our plain-English summary of Metastatic spread of pleural mesothelioma to the peritoneum and gallbladder presenting as recurrent acute cholecystitis, by M. Fouad, A.M. Zaitoun, D.N. Lobo (Oxford Medical Case Reports, 2025).

The study

• Authors: M. Fouad, A.M. Zaitoun, D.N. Lobo
• Journal: Oxford Medical Case Reports
• Published: 2025;2025(6):omaf082
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma, a rare, aggressive cancer primarily associated with asbestos exposure, is characterised by poor prognosis and limited treatment options. Distant metastases are uncommon, and peritoneal involvement is rare, while metastasis to the gallbladder is extremely unusual. We report the case of a patient with malignant pleural mesothelioma undergoing immunotherapy with nivolumab and ipilimumab, who developed recurrent acute cholecystitis. Imaging revealed features of acute cholecystitis with gallstones. She eventually underwent a laparoscopic cholecystectomy because immunotherapy could not be continued in the presence of infection. Histopathological and immunohistochemical analysis confirmed metastatic epithelioid mesothelioma. The gallbladder metastasis was likely haematogenous or from peritoneal seeding, rather than direct spread. This case underscores the importance of a high index of suspicion when evaluating atypical presentations of mesothelioma, particularly in the context of immunotherapy.

© The Author(s) 2025. Published by Oxford University Press.

In plain English

In this case report, the authors described a 75-year-old woman with pleural mesothelioma who was receiving immunotherapy with nivolumab and ipilimumab when she developed repeated episodes of acute cholecystitis (gallbladder inflammation). A CT scan showed a large single gallstone in an inflamed, thick-walled gallbladder, with no mass. Each episode was treated with antibiotics. Because immunotherapy had been stopped due to infection, her gallbladder was eventually removed by keyhole surgery. At surgery, many small nodules were seen on the abdominal lining (peritoneum) and the falciform ligament, but the gallbladder had no visible nodules. Tissue tests on the nodules and the gallbladder wall showed metastatic epithelioid mesothelioma. The cystic duct margin and a lymph node were tumour free. The authors concluded that the gallbladder spread was likely through the blood or from peritoneal seeding rather than direct spread, and stated that gallbladder metastasis had not been reported before. She resumed immunotherapy and was alive and well 8 months after surgery. The report does not describe her 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 (one patient)
• Who was studied: One 75-year-old woman with pleural mesothelioma who was being treated with the immunotherapy drugs nivolumab and ipilimumab. The article does not say where or when she was treated.
• Exposure: Not reported. The article does not describe this patient's asbestos exposure, fiber type or occupation. Asbestos is mentioned only as general background in the introduction.
• Main results:
  • In this patient, CT imaging showed a large solitary gallstone in an inflamed, thick-walled gallbladder, without perforation or a mass lesion.
  • Each episode was managed without surgery, using antibiotics. She eventually had a laparoscopic cholecystectomy (keyhole removal of the gallbladder).
  • At laparoscopy, multiple miliary (tiny) nodules were seen on the peritoneum and falciform ligament. The gallbladder was acutely inflamed but had no visible nodules.
  • In the peritoneal biopsy, tumour cells stained positive for D2-40 (podoplanin), WT1, CK7 and CK5/6 and negative for BerEP4. The authors reported this as consistent with metastatic malignant epithelioid mesothelioma.
  • The gallbladder wall contained multiple foci of metastatic mesothelioma cells in the perimuscular fibrous tissue. D2-40 staining of the gallbladder matched that of the peritoneal nodules.
  • The cystic duct margin and a lymph node contained no tumour.
  • The patient recovered and restarted immunotherapy. She was alive and well 8 months after the cholecystectomy.
• The authors' conclusion: The authors concluded that the gallbladder metastasis was likely spread through the blood (haematogenous) or by peritoneal seeding rather than by direct spread. They stated that gallbladder metastasis has not been previously reported. They emphasised the need for histopathological evaluation in atypical presentations of cholecystitis, and noted that immune checkpoint inhibitors can complicate diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Peritoneum, Asbestos Exposure, Prognosis, Metastasis, Immunotherapy, Nivolumab (Opdivo), Ipilimumab (Yervoy).

Related studies

• Multicystic benign mesothelioma of the pelvic peritoneum presenting as acute abdominal pain in a young woman — J.H. Hong, S. Jeon, et al. (2013)
• Malignant pleural mesothelioma presenting as an acute surgical abdomen due to metastatic jejunal perforation — K. Gocho, K. Isobe, et al. (2010)
• Small cell carcinoma presenting with massive pleural spread mimicking malignant pleural mesothelioma — T. Takeda, M. Saitoh, et al. (2014)
• Benign multicystic mesothelioma of peritoneum complicating acute appendicitis in a man: a case report — S. Occhionorelli, D. Tartarini, et al. (2016)
• Acute severe abdominal pain in a young woman caused by a well-differentiated papillary mesothelioma of the peritoneum — J.E. Bousema, K.M. van de Luijtgaarden, et al. (2019)
• Metastatic peritoneal mesothelioma in the setting of recurrent ascites: a case report — V. Samedi, S. White, et al. (2010)

Browse more research in Oxford Medical Case Reports, or return to medical research.