The rare occurrence of unifocal peritoneal mesothelioma: a case report, literature review, and future directions

Our plain-English summary of The rare occurrence of unifocal peritoneal mesothelioma: a case report, literature review, and future directions, by S. Ghabra, A.J. Dinerman, C.A. Sitler, et al (Journal of Gastrointestinal Oncology, 2024).

The study

• Authors: S. Ghabra, A.J. Dinerman, C.A. Sitler, D. Ahn, S.R. Joyce, A. Satterwhite, M.A. Sullivan, A.M. Blakely
• Journal: Journal of Gastrointestinal Oncology
• Published: 2024;15(4):1939-1947
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Mesothelioma is a rare, aggressive disease originating from mesothelial cells and carries a poor prognosis. Mesothelioma may arise from the pleura, pericardium, or peritoneum. Peritoneal mesothelioma (PM) usually spreads in a diffuse manner; however, a localized unifocal form of PM may occur. Literature on unifocal mesothelioma remains scarce.

Case Description: Herein, we highlight a case of localized epithelioid PM in an 81-year-old gentleman with the unique challenges faced during management. The pelvic mass was 7 cm, well-circumscribed, and hyper-vascular with fibrous attachments to the abdominal wall. The patient had a peritoneal cancer index (PCI) of 4 on initial diagnostic laparoscopy. Diagnosis was confirmed by histology. Resection of the mass with a partial omentectomy was performed. Months later, the patient developed recurrence detected on follow-up imaging in the peri-splenic region. The patient underwent cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for 60 minutes using mitomycin C and cisplatin followed by an uneventful recovery. Our case report is followed by a review of literature on disease pathophysiology, treatment options, and recently promising immunotherapy approaches.

Conclusions: CRS and HIPEC remains the standard treatment regimen for patients with PM. Nonetheless, a more nuanced approach might be indicated in specific patients with localized unifocal PM. Disease distribution and burden may impact the decision on surgical management in selected patients.

2024 Journal of Gastrointestinal Oncology. All rights reserved.

In plain English

This article reported one patient's case and then reviewed published literature on peritoneal mesothelioma, a cancer of the abdominal lining. The patient, an 81-year-old man, had secondhand asbestos exposure in childhood from his father, who worked in a shipyard. The authors wrote that it was unclear whether this exposure contributed to his disease. A CT scan done for sudden abdominal pain found a single, well-defined mass in the lower right abdomen, and a biopsy showed epithelioid mesothelioma. Biopsies from four other areas of the abdominal lining were benign. Surgeons removed the mass and part of the omentum without heated chemotherapy (HIPEC). They cited his older age, his preference for less extensive surgery, the lack of visible spread and the negative biopsies. Five months later, scans showed two small new lesions near the spleen. After these grew, he had cytoreductive surgery, removal of the spleen and HIPEC with cisplatin and mitomycin C, which left no visible disease. The authors concluded that treatment of single-mass peritoneal mesothelioma should be tailored to each patient, and they called for further studies.

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 a single patient, followed by a literature review on disease biology, diagnosis and treatment
• Who was studied: One 81-year-old male patient with hypertension and coronary artery disease, treated at the National Institutes of Health (USA)
• Exposure: Secondhand asbestos exposure during childhood from his father, who worked in a shipyard; no fiber type is named
• Main results:
  • A CT scan showed a mass in the right lower quadrant measuring 5.5 cm by 7.9 cm by 7.3 cm.
  • Diagnostic laparoscopy found a peritoneal cancer index (PCI) of 4. The empiric four-quadrant peritoneal biopsies showed benign tissue.
  • The resected mass was malignant epithelioid mesothelioma measuring 10 cm by 7.5 cm by 5 cm. There were no tumor cells in the omental specimen.
  • Genomic sequencing of the tumor found an NF2 R341 mutation and a TP53 R175H mutation.
  • HIPEC was left out of the first operation for this single lesion.
  • Follow-up CT at 5 months showed two small new lesions near the spleen.
  • The recurrence was treated with cytoreductive surgery, splenectomy, completion omentectomy and HIPEC with cisplatin and mitomycin C for 60 minutes.
  • The completeness of cytoreduction score was CC-0, meaning no remaining residual disease.
  • The authors stated it was unclear whether the secondhand asbestos exposure was a contributing factor in this patient's peritoneal mesothelioma.
• The authors' conclusion: The authors concluded that, although CRS and HIPEC are commonly used as standard treatment, management of unifocal peritoneal mesothelioma should be tailored to the clinical presentation and the patient's characteristics. They also stated that further studies and guideline updates are needed.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Mesothelioma, Mesothelial Cells, Prognosis, Pleura, Pericardium, Peritoneum, Epithelioid.

Related studies

• Malignant Peritoneal Mesothelioma: An In-Depth and Up-to-Date Review of Pathogenesis, Diagnosis, Management and Future Directions — J.B. Karpes, R. Shamavonian, et al. (2023)
• Peritoneal mesothelioma: current status and future directions — T.C. Chua, C.H. Chong, et al. (2012)
• Malignant peritoneal mesothelioma literature review: past, present, and future — S.N. Gregory, A.L. Sarvestani, et al. (2022)
• Benign Multicystic Peritoneal Mesothelioma (BMPM) as a rare cause of abdominal pain in a young male: case report and review of the literature — S. Gussago, P. Spina, et al. (2019)
• Sclerosing encapsulating peritonitis as a rare cause of intestinal obstruction after the treatment of peritoneal mesothelioma: a case report and review of the literature — Z. Ni, Q. Chen, et al. (2021)
• Benign Multicystic Peritoneal Mesothelioma (BMPM) as a rare cause of abdominal pain: a case report and review of the literature — H.B. Hassine, M. Touati, et al. (2025)

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