Pleural Mesothelioma Presenting as Periumbilical Metastasis: The First Clinical Documentation

Abstract

Introduction. Pleural mesothelioma with metastasis to the subcutaneous tissue of the abdominal wall at first diagnosis and without penetration into the peritoneum is an extremely rare clinical presentation. Methods. Patients with pleural mesothelioma have low survival rate. Usually, the disease at presentation is confined to its site of origin (most often the pleural cavity). A 55-year-old man was referred to our center due to increasing dyspnea and a painful periumbilical mass in the anterior abdominal wall. CT scan revealed both advanced mesothelioma of the pleura and a tumor mass confined to the subcutaneous fatty tissue without penetration through the peritoneum. Results. Video-assisted thoracoscopy confirmed the diagnosis of epithelioid pleural mesothelioma, which was also confirmed by a biopsy of the periumbilical mass. Systemic chemotherapy with cisplatin and pemetrexed was initiated. Under the ongoing systemic chemotherapy, the evaluation revealed partial remission of pleura mesothelioma and its subcutaneous manifestation of the abdominal wall. Conclusion. Mesothelioma of the pleura with a simultaneous metastasis to the subcutaneous fatty tissue of the abdominal wall at presentation without penetration of peritoneum is a rare clinical presentation of mesothelioma disease. The knowledge of its natural history is very limited. This is the first ever clinical documentation of a patient with pleura mesothelioma and simultaneous subcutaneous manifestation of abdominal wall.

Epithelioid malignant mesothelioma metastatic to the skin: A case report and review of the literature

“…The results of a literature search of cases of cutaneous metastasis of MM are summarized in Table 1. 2,4,[6][7][8][9]11,12,[17][18][19][20][21][23][24][25][26][27] There were 19 previously reported cases of MM metastatic to the skin, 3 of which predated the availability of immunohistochemical stains. We excluded cases in which the cutaneous presentation was due to direct extension or regional spread.…”

“…Mesothelioma is a rare form of cancer arising from a monolayer of mesothelial cells that form the lining of the internal body cavities and organs, with the vast majority of cases arising from the pleura (65%-80%), less commonly from the peritoneum (10%-30%) and rarely from the pericardium and tunica vaginalis testis (1%-2%). [1][2][3] Malignant mesothelioma (MM) is aggressive and is known to be locally invasive and have a propensity for metastasis to distant organs, rarely including metastasizing to the skin. Cutaneous involvement by MM can occur through 3 main routes: regional spread via lymphatics, direct extension within surgical scars and distant metastasis via hematogenous spread.…”

“…[5][6][7][8][9][10] Few reports have noted true cutaneous metastasis of MM, with fewer than 20 cases found in the literature. 1,2,4,[6][7][8][9][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]…”

Primary Pericardial Mesothelioma: A Rare Entity

“…About 65%–70% of malignant mesotheliomas arise from pleura and 30% from peritoneum, whereas mesothelioma originating from the pericardium or tunica vaginalis testis is rare and accounts for 1%-2% of all mesotheliomas [4]. Pericardial masses are usually metastatically spread originating from lung or breast cancer, melanoma, lymphoma, or acute leukemia [5].…”

Intra-abdominal manifestations of pleural mesothelioma

“…The clinician should be aware that hematogenous metastasis, especially from biphasic or sarcomatoid pleural mesothelioma, is a real possibility. In Table 3, the clinical manifestations of hematogenous metastases from pleural mesothelioma are listed (10)(11)(12)(13)(14)(15). For the most part, these metastases are to the highly vascularized portions of the gastrointestinal tract, the small bowel, stomach, and a single patient with colonic metastases.…”