Malignant Peritoneal Mesothelioma as a Rare Cause of Dyspeptic Complaints and Ascites: A Diagnostic Challenge

Abstract

Introduction: Malignant peritoneal mesothelioma (MPM) is a rare malignancy of the mesothelial cells in the peritoneum. The best-defined risk factor is asbestos exposure, but germline mutations in BAP1 also increase susceptibility to this tumor. The diagnosis of MPM is challenging since clinical manifestations are often nonspecific. Case Presentation: We describe a case of MPM in a 53-year-old former construction worker with prior asbestos exposure. The clinical presentation was a 3-month history of dyspeptic complaints. As initial workup, abdominal ultrasound and upper gastrointestinal endoscopy were performed. Chronic gastritis due to Helicobacter pylori was detected, which was promptly treated but without symptom relief. Abdominal ultrasound showed small volume ascites with hyperechogenic foci, which was later confirmed on computed tomography scan showing the presence of peritoneal nodules in the greater omentum and mesentery. A thorough investigation was conducted based on the suspicion of peritoneal carcinomatosis. A non-peritoneal primary tumor was not found. Ascitic cytology and im-

Synchronous multiple primary malignant neoplasms: a case report of malignant peritoneal mesothelioma and neuroendocrine rectal tumor

“…According to the review of Kim J. et al Without treatment, patients with MPMP have a median survival time of under 5 months to a year after diagnosis [8].…”

“…Due to the nonspecific nature and late manifestation of these symptoms, the decease is often diagnosed at the advanced stages. The median time from clinical manifestation to the diagnosis is about 4 months [8].…”

Ascites with infrequent origin: peritoneal mesothelioma

“…El mesotelioma peritoneal es un tumor infrecuente y agresivo [1][2][3] . En Europa se estima una incidencia de 1,2-1,3 casos/ millón personas/año 3 .…”

“…En Europa se estima una incidencia de 1,2-1,3 casos/ millón personas/año 3 . En un 50% hay antecedente de exposición a asbesto y es más frecuente en pleura que en peritoneo 2,3 . El mesotelioma peritoneal papilar bien diferenciado es un subtipo aun más raro de mesotelioma.…”

“…Produce síntomas inespecíficos, lo que retrasa el diagnóstico 2,3 . Habitualmente se manifiesta como dolor y distensión abdominal y ascitis [1][2][3] . En ocasiones incluso se requiere una laparoscopia diagnóstica para toma de muestras 1 .…”