Peritoneal Mesothelioma Diagnosed on Frozen Section During Diagnostic Laparoscopy: A Case Report

Our plain-English summary of Peritoneal Mesothelioma Diagnosed on Frozen Section During Diagnostic Laparoscopy: A Case Report, by M. Visconti, J.M. Watts, W. Weston, et al (Curēus, 2025).

The study

• Authors: M. Visconti, J.M. Watts, W. Weston, J.F. Cimino, G. Englund, M. Jarosz
• Journal: Curēus
• Published: 2025;17(10):e94474
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is a rare neoplasm arising from the proliferation of mesothelial cells. When this proliferation involves the lining of the abdomen, the peritoneum, it is referred to as malignant peritoneal mesothelioma (MPM). We present a case of MPM identified during diagnostic laparoscopy, detailing the patient's symptoms and prior workup that prompted the procedure. This report describes a rare, rapidly progressive case in an elderly female patient, diagnosed via frozen section and immunohistochemistry, who experienced clinical deterioration over 24 days from initial presentation, highlighting both the diagnostic challenges and the aggressive nature of this disease.

Copyright © 2025, Visconti et al.

In plain English

This is a case report about one patient: an 85-year-old woman diagnosed with malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. After repeated emergency department visits for weakness, nausea, vomiting and abdominal pain, blood tests showed high calcium with raised PTH-related peptide, which raised suspicion of a cancer, and a CA-125 level of 142 U/mL. A CT scan showed fluid in the abdomen, and doctors first suspected ovarian cancer. During a diagnostic laparoscopy, surgeons found abdominal fluid, 'omental caking' and adhesions. A frozen section examined during the operation showed atypical mesothelial cells suspicious for mesothelioma. Further testing confirmed biphasic mesothelioma, 80% epithelioid and 20% sarcomatoid. Because of her age she was not a candidate for surgery combined with heated abdominal chemotherapy (HIPEC). She was moved to comfort care and died within four weeks of first presenting. The article does not report whether she had any asbestos exposure. The authors concluded that this disease should remain among the possible diagnoses for elderly patients with ascites and abdominal complaints.

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 85-year-old woman with a past history of hypertension, admitted after multiple emergency department visits for generalized weakness; setting given only through author affiliations (Joplin, USA)
• Exposure: Not reported: the article gives no asbestos or other exposure history for this patient
• Main results:
  • Blood tests in this patient showed high calcium of unknown origin with decreased PTH and elevated PTH-related peptide, raising suspicion of hypercalcemia of malignancy (plasma calcium 12.2 mg/dL; PTHrP 129.0 pg/mL)
  • CA-125 was elevated at 142 U/mL, and with the exam findings and ascites this led the gynecology team to suspect ovarian carcinoma
  • Abdominal CT showed widespread swelling (anasarca) with ascites, concerning for peritoneal carcinomatosis
  • Diagnostic laparoscopy found omental caking, red-green ascites and diffuse serosal adhesions
  • Frozen section analysis during the operation showed atypical mesothelial cells suspicious for peritoneal mesothelioma
  • Immunohistochemistry was positive for cytokeratin AE1/AE3 and D2-40, showed loss of nuclear MTAP staining, and was negative for GATA-3 and WT-1 (calretinin and CK5/6 were also negative)
  • The diagnosis was confirmed as biphasic malignant peritoneal mesothelioma, 80% epithelioid and 20% sarcomatoid
  • Because of her advanced age the patient was not a candidate for HIPEC
  • The patient was transitioned to in-hospital comfort care and died within four weeks of her initial presentation
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma, though rare, should remain in the differential diagnosis for elderly patients with ascites and abdominal complaints, and that this case highlights the disease's rapid progression and poor prognosis

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Frozen Section, Diagnostic Laparoscopy, Mesothelioma, Neoplasm, Mesothelial Cells, Peritoneum, Immunohistochemistry.

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