Peritoneal Carcinomatosis: When Everything Is Not What It Seems

Our plain-English summary of Peritoneal Carcinomatosis: When Everything Is Not What It Seems, by S. Perdigão, R. Cunha, C. Costa, et al (Curēus, 2024).

The study

• Authors: S. Perdigão, R. Cunha, C. Costa, C. Sousa, A. Teira
• Journal: Curēus
• Published: 2024;16(1):e52924
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare neoplasm with a low incidence rate worldwide but high morbidity and mortality rates. Due to its rarity, the studies are scarce. We present a case of a 73-year-old woman admitted to the internal medicine unit with constitutional syndrome, abdominal pain, and ascites. Throughout the investigation, aspects suggestive of peritoneal carcinomatosis were identified. An extensive study was then carried out in an attempt to identify the primary tumor, which proved to be unsuccessful. During the two weeks of hospitalization, the patient's clinical condition worsened, with an increase in ascites and a deterioration in her general health. This case was then discussed with an oncology consultant, and it was decided to biopsy a peritoneal implant with the support of interventional radiology. MPM was then diagnosed through histopathology. With this case, the authors intend to highlight that, although rare, this diagnosis should be considered when appropriate and that even in the suspicion of secondary disease, the primary tumor should always be identified, as localized MPM may be curable.

Copyright © 2024, Perdigão et al.

In plain English

This article is a case report from Portugal about one 73-year-old woman. She came to the emergency department with constitutional syndrome (general signs of illness), abdominal pain and diarrhea. The article states she had no risk of exposure to pollutants. During her hospital stay she was diagnosed with ascites, which is fluid in the abdomen. A CT scan, an abdominal ultrasound and an FDG PET scan showed findings suggestive of peritoneal carcinomatosis, meaning cancer spread over the lining of the abdomen, but no primary tumor was found. Her condition worsened. After consulting an oncologist, the team biopsied a peritoneal implant. The biopsy showed malignant peritoneal mesothelioma. The text calls it the epidermoid type, while the figure captions describe epithelioid cells. She later had surgery to remove tumor and heated chemotherapy given inside the abdomen (HIPEC). The disease was diffuse, and the authors reported that surgery and HIPEC did not eliminate it because of its extent. She continued palliative chemotherapy with a partial response. The authors concluded that asbestos exposure is a significant but not necessary risk factor, which they said was the case for this patient.

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 73-year-old woman treated at hospitals in Portugal (Chaves, then the Portuguese Institute of Oncology). Dates of care are not given.
• Exposure: No exposure was identified. The article states the patient had no risk of exposure to pollutants. It does not describe any asbestos exposure history or fiber type.
• Main results:
  • Ascites (fluid in the abdomen) was diagnosed during her hospital stay.
  • The FDG PET scan showed widespread abnormal peritoneal thickening with fluid, suggestive of peritoneal carcinomatosis.
  • Despite extensive testing, no primary tumor was found.
  • Her condition worsened during the investigation, with increased ascites.
  • A biopsy of a peritoneal implant showed malignant peritoneal mesothelioma, described in the text as the epidermoid type.
  • Immunohistochemistry (special staining) of the biopsy showed a mesothelial phenotype.
  • She underwent cytoreductive surgery and HIPEC.
  • The patient had diffuse disease.
  • Surgery and HIPEC, done in an attempt to eliminate the disease, did not eliminate it because of its extent.
  • She was then treated with palliative chemotherapy and had a partial response.
• The authors' conclusion: The authors concluded that asbestos exposure is a significant risk factor for this disease but not a necessary one, and they stated this was the case for this patient.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Neoplasm, Incidence, Ascites, Biopsy, Histopathology.

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