Navigating Fertility Preservation in Epithelioid Peritoneal Mesothelioma: A Case Study

Our plain-English summary of Navigating Fertility Preservation in Epithelioid Peritoneal Mesothelioma: A Case Study, by D.W. Qiu, Y.J. Lin Lee, G. Tripathi, et al (The American Journal of Case Reports, 2025).

The study

• Authors: D.W. Qiu, Y.J. Lin Lee, G. Tripathi, D. Anurogo, C.F. Ni, W.C. Chang, H.S. Fu, J.T. Qiu
• Journal: The American Journal of Case Reports
• Published: 2025;26:e946585
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare and aggressive neoplasm, with low-grade epithelioid subtypes presenting diagnostic and therapeutic challenges. With nonspecific symptoms and diagnostic challenges, definitive diagnosis relies on histopathological and immunohistochemical analysis. This study reviews the current research on the epidemiology, diagnosis, and treatment of MPM, focusing on preserving fertility and achieving successful childbirth following surgery, chemotherapy, and immunotherapy, despite immune-related adverse events. CASE REPORT We report the case of a 44-year-old nulliparous woman, initially diagnosed with a uterine leiomyoma, who was incidentally found to have MPM during surgery. Diagnostic laparoscopy and subsequent imaging revealed extensive peritoneal involvement, confirmed by histopathology and immunohistochemistry. The patient's desire to preserve fertility complicated the treatment approach, leading to chemotherapy followed by immunotherapy, with complete disease control. Without evidence of disease recurrence or metastasis, the patient proceeded with in vitro fertilization (IVF) and embryo transfer. During an emergency cesarean section at 30 weeks 2 days of gestation, performed due to preterm premature rupture of membranes, intraabdominal residual tumors were discovered and excised. No evidence of malignancy was found elsewhere. CONCLUSIONS MPM is a rare disease, often with a delayed diagnosed due to nonspecific symptoms. Treatments like cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) improve survival for operable cases, while systemic therapies and immune-checkpoint inhibitors (ICIs) are options for inoperable cases; however, further research on early-detection biomarkers and the impact of ICIs on fertility is needed to enhance clinical practice. This case highlights the intricate balance between oncologic control and fertility preservation in MPM, illustrating the need for individualized treatment strategies.

In plain English

This was a case report, with a literature review, from Taipei Medical University Hospital in Taiwan. A 44-year-old woman who had never given birth, thought to have a uterine fibroid, was found by chance during surgery in February 2020 to have tumor spread in her pelvis. Tissue tests led to a final diagnosis of low-grade epithelioid peritoneal mesothelioma, stage IIIB. The article does not report whether she had any asbestos exposure. Wishing to preserve fertility, she declined the recommended debulking surgery with heated abdominal chemotherapy (HIPEC). She received 5 cycles of carboplatin and paclitaxel, during which a scan showed progression. She then had fertility-sparing surgery with HIPEC, followed by 3 cycles of nivolumab and ipilimumab, which she tolerated well. After IVF she became pregnant in May 2022. After early rupture of membranes, she had an emergency cesarean at 30 weeks 2 days and delivered a 1378 g girl. Remaining tumors found afterwards were removed and confirmed as mesothelioma. The authors concluded the case highlights the importance of personalized treatment plans.

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 of one patient, with a review of published literature on diagnosis and treatment of malignant peritoneal mesothelioma
• Who was studied: One 44-year-old woman who had never given birth (nulliparous) and had no symptoms, treated from 2020 to 2022; referred to Taipei Medical University Hospital, Taiwan
• Exposure: The article does not report any asbestos exposure history for this patient. In the discussion, citing other studies, the authors state that the association with asbestos is less pronounced in peritoneal than in pleural mesothelioma.
• Main results:
  • The pelvic tumor was discovered incidentally during a laparotomic myomectomy (surgery to remove a uterine fibroid) on February 17, 2020
  • After the first findings, the patient declined the recommended debulking surgery followed by HIPEC because she wished to preserve fertility
  • After diagnostic laparoscopy, the final diagnosis was low-grade epithelioid peritoneal mesothelioma, staged pT3NxMx (IIIB), with tissue staining positive for calretinin and BAP1
  • The patient received 5 cycles of carboplatin and paclitaxel (August to November 2020). A PET-CT scan on October 15, 2020, during this chemotherapy, indicated disease progression.
  • On November 5, 2020, she had laparoscopic fertility-sparing surgery with HIPEC using paclitaxel (175 mg/m2) for 90 minutes. The PCI (a score of how much of the abdominal lining is involved) was 14.
  • She then received 3 cycles of nivolumab (100 mg) and ipilimumab (50 mg) every 4 weeks, from December 2020 to February 2021. She had no significant adverse effects reported, and her estrogen and FSH levels stayed within normal ranges.
  • After IVF and embryo transfer, she became pregnant in May 2022
  • After preterm premature rupture of membranes at 29 weeks, she had an emergency cesarean section at 30 weeks 2 days on December 12, 2022. She delivered a female infant weighing 1378 g, with Apgar scores of 7 and 9 at 1 and 5 minutes.
  • Surgical exploration after delivery found multiple tumor seedings 0.5 to 1.5 cm in size. These were excised, and pathology confirmed epithelioid peritoneal mesothelioma. She received no further anticancer treatment and was discharged.
  • The most recent CT and MRI showed a 4.5 cm uterine myoma, with no further evidence of malignancy elsewhere
• The authors' conclusion: The authors concluded that the case illustrates the balance between managing a serious cancer and preserving fertility, and highlights the importance of personalized treatment plans

Topics

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

Medical terms in this study, explained in our Lexicon: Epithelioid, Peritoneal Mesothelioma, Neoplasm, Epidemiology, Chemotherapy, Immunotherapy, Immune-Related Adverse Events, Diagnostic Laparoscopy.

Related studies

• Fertility preservation in a patient with benign multicystic peritoneal mesothelioma — Z.A. Al-Safi, B.H. Edil, et al. (2014)
• Benign Multicystic Peritoneal Mesothelioma Complicating Fertility Preservation — S. Shikanai, T. Mariya, et al. (2022)
• A comprehensive review of childbearing after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — D. Papageorgiou, D.K. Manatakis, et al. (2020)
• Navigating the Foggy Landscape of Epithelioid Peritoneal Mesothelioma: A Proposed Standardized Institutional Algorithm for Multimodal Management — G. D'Annibale, F. Santullo, et al. (2026)
• Emergency IVF for embryo freezing to preserve female fertility: a French multicentre cohort study — B. Courbiere, C. Decanter, et al. (2013)
• A new policy regarding ovarian resection in young women treated for peritoneal carcinomatosis — D. Elias, E. Duchalais, et al. (2013)

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