Primary Peritoneal Mesothelioma Resulting in Small Bowel Obstruction: A Case Report and Review of Literature

Abstract

Patient: Female, 76Final Diagnosis: Peritoneal mesothelioma epithelioid typeSymptoms: Alternating bowel habits • ascites • small bowel obstruction • weight lossMedication: —Clinical Procedure: Exploratory laparotomy • excisional biopsySpecialty: SurgeryObjective:Rare diseaseBackground:Peritoneal mesothelioma is a rare malignancy that affects the serosal surfaces of the peritoneum. The peritoneum is the second most common site of mesothelium affected following the pleura. The aggressive nature and vague presentation pose many obstacles in not only diagnosis but also the treatment of patients with this disease.Case Report:We present a case of a 76-year-old woman who presented with small bowel obstruction secondary to carcinomatosis secondary to primary peritoneal mesothelioma. The patient had multiple risk factors with asbestos exposure and prior therapeutic radiation.Conclusions:We discuss the highly varied and elusive presentation of peritoneal mesothelioma. Cumulative asbestos exposure, either directly or indirectly, remains the leading cause of mesothelioma. However, there are other non-asbestos etiologies. Small bowel obstruction often is a late-presenting symptom of widespread tumor burden. A concise review of the current diagnostic and surgical treatment of primary peritoneal mesothelioma demonstrates that early diagnosis and implementation remains vital.

Malignant Peritoneal Mesothelioma: A Rare Cause of Ascites

“… 1 , 2 As the case in other forms of mesotheliomas, the cumulative asbestos exposure remains the leading cause of MPM. 3 Other etiologies include para-exposure, such as laundering the clothes of an exposed person, therapeutic irradiation, chronic inflammatory peritonitis, and simian virus-40. 3 …”

“… 3 Other etiologies include para-exposure, such as laundering the clothes of an exposed person, therapeutic irradiation, chronic inflammatory peritonitis, and simian virus-40. 3 …”

“…CT scan of the abdomen can help make the diagnosis and usually can show diffuse peritoneal masses invading the omentum, pleural thickening, nodularity, and/or omental caking. 3 , 4 Diagnosis should be confirmed through omental biopsy.…”

“…The overall prognosis of MPM remains poor, with a median survival time of 12 months at time of diagnosis. 3 Treatment modalities offered in the United States include chemotherapy alone, CRS alone, and CRS/chemotherapy combination. In a recently published study, poor prognostic variables included advanced age, male gender, uninsured/Medicaid insurance, and sarcomatoid/biphasic histology.…”

Positive TTF-1 Expression in Malignant Mesothelioma: A Case Report

“…Malignant mesothelioma is a rare malignant disease, but its incidence is increasing worldwide, strongly associated with amphibole asbestos exposure [ 1 – 3 ]. It is thought that the parietal pleura are the basis for malignant mesothelioma; however, there are rare cases of primary peritoneal mesothelioma [ 4 – 6 ]. The localized malignant mesothelioma is a very rare tumor that grossly appears as a distinctly localized nodular lesion without gross or microscopic evidence of diffuse pleural spread.…”