Peritoneal Mesothelioma: An Unusual Cause of High-Protein Ascites

Our plain-English summary of Peritoneal Mesothelioma: An Unusual Cause of High-Protein Ascites, by M. Kaspar (ACG Case Reports Journal, 2015).

The study

• Author: M. Kaspar
• Journal: ACG Case Reports Journal
• Published: 2015;3(1):71-3
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We present a case illustrating the workup and diagnosis of peritoneal sarcomatous mesothelioma as an unusual etiology of intestinal obstruction and high-protein ascites in an otherwise healthy man. This rare disorder is diagnosed based on immunohistochemistry, which is necessary to differentiate it from other rare sarcomatous carcinomas. In many cases, localized disease can be treated to cure with surgery and intraperitoneal chemotherapy. Advanced disease is often treated for palliation of symptoms.

In plain English

This case report described one patient: a 45-year-old otherwise healthy African American man with fatigue, a growing abdomen and weight loss. His history was significant only for about 15 years as a construction and demolition laborer. The report did not say whether he had been exposed to asbestos. About 4 L of fluid was drained from his abdomen; it was high in protein, and no malignant cells were seen when the fluid was examined under the microscope (cytology). A CT scan raised concern for cancer on the abdominal lining, and he developed a picture consistent with small bowel obstruction. Laparoscopy showed a "frozen abdomen". Biopsies were most consistent with sarcomatous peritoneal mesothelioma, and a chest CT showed no disease in the chest. He received pemetrexed and cisplatin to relieve symptoms. After about 6 months his obstruction improved enough to resume eating by mouth. Citing other published work, the author wrote that most peritoneal mesothelioma is associated with asbestos exposure. The author also wrote that peritoneal biopsy reviewed by an experienced pathologist is essential for diagnosis.

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 45-year-old otherwise healthy African American man. The author is at Virginia Commonwealth University Medical Center, Richmond, VA. No dates of care are given.
• Exposure: Work as a laborer in construction and demolition for approximately 15 years. The report does not state whether this patient was exposed to asbestos, and it names no fiber types or products.
• Main results:
  • Paracentesis removed approximately 4 L of hazy yellow fluid from the patient's abdomen.
  • The abdominal fluid had a SAAG of 0.4 g/dL and a total protein of 5.6 g/dL.
  • No malignant cells were seen on fluid cytology.
  • Abdominal CT showed peritoneal enhancement concerning for carcinomatosis.
  • Upper endoscopy and colonoscopy found no evidence of malignancy.
  • Over 7 days the patient's symptoms progressed to a clinical picture consistent with small bowel obstruction.
  • Exploratory laparoscopy showed a frozen abdomen with thickening of the bowel wall and peritoneum.
  • Peritoneal biopsy staining was most consistent with sarcomatous peritoneal mesothelioma.
  • Chest CT after diagnosis did not reveal any thoracic disease.
  • The patient was treated with pemetrexed and cisplatin with the goal of symptom palliation.
  • After approximately 6 months of treatment, the obstructive symptoms improved somewhat. The gastrostomy tube was removed and oral feeding was reintroduced.
  • Background in the discussion, citing other published work and not a finding of this case: most peritoneal mesothelioma is associated with asbestos exposure.
• The authors' conclusion: The author concluded that peritoneal sarcomatous mesothelioma is a rare cause of high-protein ascites. The author also wrote that peritoneal biopsy reviewed by an experienced pathologist is an essential part of diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Ascites, Mesothelioma, Etiology, Immunohistochemistry, Carcinoma, Chemotherapy.

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• "Signet-ring" cells--a caveat in the diagnosis of a diffuse peritoneal mesothelioma occurring in a lady presenting with recurrent ascites: an unusual case report — B. Rekhi, S. Pathuthara, et al. (2010)
• An unusual case of ascites: pitfalls in diagnosis of malignant peritoneal mesothelioma — J.R. Clark, W.B. Ross (2000)
• Malignant peritoneal mesothelioma as a rare cause of ascites: a case report — I. Ahmed, A. Koulaouzidis, et al. (2008)
• Malignant Peritoneal Mesothelioma: A Rare Cause of Ascites — A.M. Ibrahim, M. Al-Akchar, et al. (2018)

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