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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Malignant peritoneal mesothelioma with massive ascites as the first symptom: A case report
Xi Huang, Yu Hong, Si-Ya Xie, Hui-Li Liao, Hao-Ming Huang, Jian-Hong Liu, Wen-Jie Long
Xi Huang, Jian-Hong Liu, Wen-Jie Long, Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
Yu Hong, Si-Ya Xie, Department of Chinese Internal Medicine, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
Hui-Li Liao, Department of Geriatrics, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
Hao-Ming Huang, Department of Emergency, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510006, Guangdong Province, China
Author contributions: Huang X and Hong Y are the co-first authors who contributed equally, organized the case content, and wrote the manuscript; Xie SY and Huang HM wrote the manuscript and organized the images; Liao HL wrote and reviewed the manuscript and organized the table; Long WJ and Liu JH were responsible for the supervision and review of the manuscript.
Supported by the National Traditional Chinese Medicine Clinical Research Base, No. 2018131; and the Guangzhou Science and Technology Program Key Projects, No. 202206080015.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that the study was conducted without any business or financial relationships that could be interpreted as potential conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jian-Hong Liu, Doctor, Chief Doctor, Department of Geriatrics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16 Jichang Road, Guangzhou 510006, Guangdong Province, China. ljh833@163.com
Received: May 31, 2022
Peer-review started: May 31, 2022
First decision: June 8, 2022
Revised: June 23, 2022
Accepted: August 16, 2022
Article in press: August 16, 2022
Published online: October 6, 2022
BACKGROUND
Malignant peritoneal mesothelioma (MPM) is an extremely rare tumor with nonspecific clinical manifestations, which is extremely difficult to diagnose. Herein, we reported a case of MPM in the abdominal cavity with massive short-term ascites as the first symptom.
CASE SUMMARY
A 65-year-old woman presented to the hospital with abdominal pain, distention, and shortness of breath that persisted for 15 d. The serum CA-125 level was 1075 U/mL. The abdominal computed tomography showed massive ascites and no obvious tumor lesions. The pathological examination of the ascitic fluid showed numerous heterotypic cells with some papillary structures. The immunohistochemistry and fluorescence in situ hybridization showed the deletion of CDX2 (-), WT-1 (-), Ki-67 (about 10% +), CEA (-), Glut-1 (+++), desmin (-), PD-L1 (-), and CDKN2A (P16). The final diagnosis was MPM. The patient refused tumor cytoreductive surgery and received two cycles of cisplatin plus pemetrexed bidirectional chemotherapy. In the second cycle, she received an additional cycle of hyperthermic intraperitoneal chemotherapy and immune checkpoint inhibitor therapy due to massive recalcitrant ascites. She died of disease progression 2 mo after diagnosis.
CONCLUSION
In case of massive unexplained ascites, the possibility of MPM should not be excluded to avoid misdiagnosis and delay in treatment.
Core Tip: Malignant peritoneal mesothelioma (MPM) is an extremely rare tumor with nonspecific clinical manifestations, which is extremely difficult to diagnose. Herein, we reported a case with massive ascites as the first symptom. The patient was diagnosed with MPM based on a combination of histological, immune, and imaging findings. The patient refused tumor cytoreductive surgery and then received bidirectional chemotherapy, hyperthermic intraperitoneal chemotherapy, and immune checkpoint inhibitor therapy. Unfortunately, she died of disease progression two months after diagnosis. This case report aims to provide clinical evidence for the diagnosis, treatment, and prognosis of rare MPM.
