Unraveling Peritoneal Mesothelioma: A Case-Based Discussion on Diagnosis and Management

Our plain-English summary of Unraveling Peritoneal Mesothelioma: A Case-Based Discussion on Diagnosis and Management, by O. Zouiten, L. Azarou, H. Hadiri, et al (Curēus, 2025).

The study

• Authors: O. Zouiten, L. Azarou, H. Hadiri, H. Rais, R. Belbaraka
• Journal: Curēus
• Published: 2025;17(10):e94653
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Peritoneal mesothelioma is a rare and aggressive tumor, and its management remains poorly standardized in the literature. This case highlights the diagnostic and therapeutic challenges through a 56-year-old woman with no significant medical history or known asbestos exposure, who presented with progressive abdominal distension and postprandial vomiting. Imaging revealed diffuse nodular peritoneal thickening and large-volume ascites. A laparoscopic biopsy confirmed malignant epithelioid mesothelioma, supported by immunohistochemical positivity for cytokeratin 7 (CK7), calretinin, and Wilms tumor 1 (WT1). Treatment was based on systemic chemotherapy with platinum (cisplatin/carboplatin) and pemetrexed, which elicited a rapid initial response. However, the long-term efficacy remains uncertain due to the aggressive nature of the disease. The absence of standardized treatment underscores the necessity for multidisciplinary management.

Copyright © 2025, Zouiten et al.

In plain English

This article is a case report from a university hospital in Marrakech, Morocco, describing one woman with peritoneal mesothelioma, a cancer of the lining of the abdomen. The patient was 56 years old (the discussion gives 53), came from a rural area, and was described as having no exposure to asbestos. She had a one-year history of increasing abdominal swelling and vomiting after meals. MRI showed a large amount of fluid in the abdomen and diffuse nodular and cystic thickening of the abdominal lining, up to 28 mm thick. Blood tumor markers, including CA-125 (below 4 U/mL), were within normal ranges. A laparoscopic biopsy, with staining positive for CK7, calretinin, WT1 and CK5/6, confirmed malignant epithelioid mesothelioma. A tumor board judged the disease unresectable. She started cisplatin, pemetrexed and bevacizumab. After two cycles she tolerated treatment well and her abdominal symptoms improved. A scan to assess response was still planned. The authors concluded that peritoneal mesothelioma should be considered in any patient with unexplained ascites, irrespective of asbestos exposure history.

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 56-year-old woman from a rural area with no significant medical history, treated at Mohammed VI University Hospital of Marrakech, Morocco; dates of care not stated
• Exposure: No asbestos exposure was reported for this patient
• Main results:
  • MRI showed large-volume ascites and diffuse nodular and cystic peritoneal thickening, with a maximal thickness of 28 mm at the left posterior parietal peritoneum
  • Tumor markers were not elevated in this patient, including CA-125 below 4 U/mL (normal range below 25 U/mL)
  • The laparoscopic biopsy stained strongly positive for CK7, calretinin, WT1 and CK5/6 and negative for CK20, TTF-1 and GATA3, confirming malignant epithelioid mesothelioma
  • A multidisciplinary tumor board deemed the disease unresectable and recommended systemic therapy
  • The patient was started on cisplatin, pemetrexed and bevacizumab
  • After two cycles the patient tolerated treatment well and her abdominal symptoms improved. A clinical and radiological evaluation was planned after the third cycle.
• The authors' conclusion: The authors concluded that peritoneal mesothelioma should be considered in any patient with unexplained ascites, irrespective of asbestos exposure history

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Asbestos Exposure, Ascites, Biopsy, Epithelioid, Mesothelioma, Calretinin, Wilms Tumor 1 (WT-1).

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• Application of immunohistochemistry in diagnosis and management of malignant mesothelioma — D.B. Chapel, J.J. Schulte, et al. (2020)
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