Primary Omental Mesothelioma: A Rare but Important Differential Diagnosis in Previous Asbestos Exposure

Abstract

Primary omental mesothelioma is a malignant tumour of the mesothelial cells of the omentum, related to asbestos exposure. It is an extremely rare condition that presents both diagnostic and therapeutic challenges. We present a review of the related literature and report on a fatal case of primary omental mesothelioma in a 70 year old man, presenting with a painful abdominal mass. Radiological imaging was not diagnostic but useful in excluding other pathologies. Diagnosis relied on specific immunohistochemical analysis. The difficulty in diagnosis and management and the advanced stage of disease meant that prognosis was very poor. Our patient died within 3 weeks of diagnosis.

Omental mesothelioma as a diagnostic and therapeutic challenge: A case report

“…Epidemiological trials have demonstrated an association between the occurrence of mesothelioma and environmental factors and carcinogens. The association between mesothelioma and asbestos was first demonstrated in 1960 by Wagner et al In most of the cases presented in literature, there is a history of apparent asbestos exposure and of living close to regions where asbestos is intensively used [4,8]. Asbestos exposure was present in our patient and a previous case [4] but not in another case [3].…”

“…Peritoneal involvement usually manifests as abdominal distention, anorexia, weight loss, and symptomatic malignant ascites. However, ascites was not reported in a previous case with omental mesothelioma [4]. Ascites was present in three out of four cases with primary omental mesothelioma.…”

“…The association between mesothelioma and asbestos was first demonstrated in 1960 by Wagner et al In most of the cases presented in literature, there is a history of apparent asbestos exposure and of living close to regions where asbestos is intensively used [4,8]. Asbestos exposure was present in our patient and a previous case [4] but not in another case [3]. We also detected pleural thickening in our case, which may be a radiological clue to the diagnosis of mesothelioma in patients with a concomitant omental mass or thickening.…”

“…At the time of diagnosis, the mean age is 60 years, and the female male ratio is 1:3 [7]. Most of the patients have a history of asbestos exposure [1,4]. However, this correlation is weaker in females [1].…”

“…It has been associated with chronic exposure to asbestos [1]. Omental mesothelioma is an extremely rare condition reported in only a few cases in the medical literature and presents both diagnostic and therapeutic challenges (Table 1) [2][3][4][5]. In this report, we present the clinical and radiological findings of a patient who had malignant mesothelioma originating from the omentum.…”