Thrombocytosis as a paraneoplastic syndrome in metastatic malignant peritoneal mesothelioma of biphasic morphology mimicking ovarian adenocarcinoma: A case report

Our plain-English summary of Thrombocytosis as a paraneoplastic syndrome in metastatic malignant peritoneal mesothelioma of biphasic morphology mimicking ovarian adenocarcinoma: A case report, by M.S. Alhamadh, R.B. Alanazi, O.M. Wadaan, et al (Clinical Case Reports, 2023).

The study

• Authors: M.S. Alhamadh, R.B. Alanazi, O.M. Wadaan, A.Y. Alhabeeb, M. Alkaiyat, O.Z. Aljarbou, F. Sabatin
• Journal: Clinical Case Reports
• Published: 2023;11(3):e6974
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare malignancy, presenting with non-specific and potentially-misleading manifestations. It represents a diagnostic pitfall as it mimics ovarian carcinoma. Maintaining a low diagnostic threshold, obtaining a detailed history, and utilizing immunohistochemical markers to diagnose MPM is crucial as early diagnosis and treatment might improve survival.

© 2023 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.

In plain English

This case report described one patient, a 55-year-old Saudi woman and housewife, seen at the authors' hospital. She had had papillary thyroid cancer, treated with total thyroidectomy 15 years earlier and with radiotherapy. She denied prolonged exposure to carcinogens such as cigarette smoking, industrial smoke and asbestos. She arrived at the emergency department with 5 months of right upper abdominal pain, weight loss and a fluid-filled abdomen. Blood tests showed thrombocytosis (platelets 794 × 10^9/L) and a raised CA 125 (663 U/mL). Fluid cytology and scans first pointed to ovarian cancer. A needle biopsy was positive for mesothelial markers and negative for adenocarcinoma markers. Doctors diagnosed metastatic malignant peritoneal mesothelioma of biphasic morphology. She was judged unfit for chemotherapy or surgery, received palliative care, and died of cardiac arrest 2 days later. The authors judged a link between her neck radiation and the mesothelioma almost negligible, and noted that no genetic testing was done. They concluded that clinicians should keep a low threshold for diagnosing this cancer, especially in people with a history of radiation or asbestos exposure.

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 55-year-old Saudi woman, a housewife, with a past history including thyroid papillary adenocarcinoma treated by total thyroidectomy and radiotherapy, who presented to the authors' emergency department; the date is not given
• Exposure: No asbestos exposure was reported: the patient, a housewife, denied prolonged exposure to carcinogens including asbestos. Her known prior exposure was radiotherapy for thyroid cancer, which the authors describe as radiation to her neck.
• Main results:
  • Laboratory tests in the patient showed thrombocytosis, with a platelet count of 794 × 10^9/L
  • Tumor markers in the patient were markedly elevated: beta-hCG 30 IU/L, CA 125 663 U/mL and CA 15-3 229 U/mL
  • Fluid drawn from the abdomen showed a few highly atypical cells worrisome for ovarian adenocarcinoma, and CT showed thickening of the right adnexa suspicious of ovarian malignancy
  • Biopsy cells were positive for PAN CK, WT1, Calretinin, D2-40 and CK5/6, and negative for the adenocarcinoma markers MOC-31, Ber-EP4, ER, thyroglobulin and TTF-1
  • A diagnosis of metastatic malignant peritoneal mesothelioma of biphasic morphology was made
  • The patient was unfit for chemotherapy and debulking surgery, was referred to palliative care, and died of cardiac arrest 2 days later
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma is extremely rare, rapidly progressive and highly fatal, and that clinicians should maintain a low threshold for diagnosing it, especially in patients with a previous history of radiation or asbestos exposure, since early detection and treatment might improve survival
• Limitations the authors state:
  • The authors state that the case is limited by the absence of genetic testing and by the weak association between neck radiation and the development of malignant mesothelioma
  • The authors consider the possibility that the thyroid cancer (or its neck radiation) and the mesothelioma are related to be almost negligible

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Biphasic Mesothelioma, Adenocarcinoma, Carcinoma.

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