Malign peritoneal mesothelioma with nephrotic syndrome

In malignant mesotheliomas, cases involving the peritoneum as the primary site are rare, accounting for approximately 10% of all mesothelioma cases. We report a case of medical-type peritoneal mesothelioma leading to death 2 months after the onset of fever of unknown origin, along with a review of the literature. A 76-year-old man presented with a fever of unknown origin over 4 weeks. Thoracoabdominal computed tomography (CT) scan showed increased mesenteric adipose tissue density. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan showed diffuse hyperaccumulation in the mesentery and hyperaccumulation in the intraperitoneal and parasternal lymph nodes. A thoracoscopic biopsy of the parasternal lymph nodes revealed metastatic peritoneal mesothelioma. The treatment plan was discussed with him and his family, and the best supportive care was provided. 2 months later, he died from multiple organ failure. Underlying malignant tumors cause 38% of mesenteric panniculitis cases. Symptoms accompanied by lymphadenopathy within the area of mesenteric panniculitis are highly suggestive of malignancy. Peritoneal mesothelioma can be classified as (1) classical, which is accompanied by abdominal pain, ascites, and abdominal masses; (2) surgical, which is accompanied by hernia incarceration and intestinal occlusion; and (3) medical, wherein systemic symptoms, such as fever and weight loss, are primarily observed. The medical-type peritoneal mesothelioma, wherein systemic symptoms are primarily observed, has a poorer prognosis than the other types. FDG-PET/CT is an effective diagnostic modality for peritoneal mesothelioma and typically shows diffuse hyperaccumulation along the peritoneal surface.

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“…[7] 10% of nephrotic syndrome cases have a malignant tumor complication, and peritoneal mesothelioma complications have also been reported. [8] …”

Section: Discussionmentioning

confidence: 99%

Medical-type peritoneal mesothelioma leading to death two months after onset of fever of unknown origin

Ishizuka

Uehara

Arai

et al. 2022

Radiology Case Reports

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“…Patients who developed nephrotic syndrome associated with asbestos-related pulmonary diseases are rare, but eight previous cases have been reported in the English-language literature. Table 2 shows cases of patients with asbestosrelated diseases who developed nephrotic syndrome [10][11][12][13][14][15][16][17]. Most patients had epithelioid mesothelioma, and minimal change disease (MCD) is a common renal pathology.…”

Section: Discussionmentioning

confidence: 99%

Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases

et al. 2020

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Here, we present a 67-year-old Japanese man who developed insidious-onset nephrotic syndrome. He had a history of occupational asbestos exposure for about 8 years during his 30s, and was found to have pleural effusion 3 years before his present illness. At that time, repeated cytology testing of his pleural effusion found no malignant cells, and pleural biopsy found fibrous pleuritis without evidence of malignant mesothelioma. Percutaneous kidney biopsy found massive deposits of AA-type amyloid in the glomeruli, small arteries, and medulla. Computed tomography showed a calcified mass in the right lower lung that was positive for 67 Ga uptake, but transbronchial lung biopsy and bronchoalveolar lavage found no evidence of malignancy. He was diagnosed with rounded atelectasis and diffuse pleural thickening. As these benign asbestos-related diseases have no standard treatment, we administered low-dose angiotensin II receptor blocker to preserve kidney function. Unfortunately, his nephrotic syndrome persists, with progressive chronic kidney failure. Kidney involvement in patients with asbestos-related disease is rare. To our knowledge, this is the first case to present with secondary amyloidosis. Kidney biopsy should be considered for patients with existing asbestos-related pleuropulmonary diseases who have urinary abnormalities or renal dysfunction, to clarify the incidence and pathophysiology of renal manifestations.

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“…However, a review of the English literature identified seven reported cases of malignant mesothelioma associated with nephrotic syndrome (3)(4)(5)(6)(7)(8)(9). Among these seven cases, the primary site of mesothelioma was the pleura in five cases, peritoneum in one case and tunica vaginalis testis in one case.…”

Section: Discussionmentioning

confidence: 99%

An Autopsy Case of Malignant Pleural Mesothelioma Associated with Nephrotic Syndrome

et al. 2014

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A 64-year-old man who had been exposed to asbestos was referred to our hospital for a detailed examination of left pleural effusion. A laboratory examination of the urine and blood revealed nephrotic syndrome. A thoracoscopic examination did not yield a definitive diagnosis. Twenty months later, a left pleural tumor became apparent, and the patient died of respiratory failure and cachexia. An autopsy revealed epithelioid malignant pleural mesothelioma. The glomeruli appeared normal under light microscopy. A review of the English literature revealed only three reports of malignant mesothelioma associated with minimal-change nephrotic syndrome. The natural course of malignant mesothelioma with nephrotic syndrome has not been previously reported.

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Malign peritoneal mesothelioma with nephrotic syndrome

Cited by 7 publications

References 5 publications

Medical-type peritoneal mesothelioma leading to death two months after onset of fever of unknown origin

Medical-type peritoneal mesothelioma leading to death two months after onset of fever of unknown origin

Secondary renal amyloidosis associated with asbestos-related pleuropulmonary diseases

An Autopsy Case of Malignant Pleural Mesothelioma Associated with Nephrotic Syndrome

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