Lin LC, Kuan WY, Shiu BH, Wang YT, Chao WR, Wang CC. Primary malignant peritoneal mesothelioma mimicking tuberculous peritonitis: A case report. World J Clin Cases 2022; 10(10): 3156-3163 [PMID: 35647134 DOI: 10.12998/wjcc.v10.i10.3156]
Corresponding Author of This Article
Chi-Chih Wang, PhD, Assistant Professor, Director, Division of Endoscopy, Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec.1, Jianguo Rd., Taichung 402, Taiwan. bananaudwang@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Li-Cheng Lin, Wen-Yen Kuan, Department of Education, Chung Shan Medical University Hospital, Taichung 402, Taiwan
Bei-Hao Shiu, Department of Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan
Yu-Ting Wang, Wan-Ru Chao, Department of Pathology, Chung Shan Medical University Hospital, Taichung 402, Taiwan
Chi-Chih Wang, Division of Endoscopy, Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
Chi-Chih Wang, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
Author contributions: Lin LC and Kuan WY reviewed the literature and contributed to manuscript drafting; Wang CC was responsible for the revision and final approval of the manuscript; Shiu BH performed the laparoscopy; Wang YT and Chao WR contributed to histopathological testing, interpreted the histopathological and immunohistochemical findings; All authors issued final approval for the version to be submitted.
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 they have no conflict 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: Chi-Chih Wang, PhD, Assistant Professor, Director, Division of Endoscopy, Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, No. 110, Sec.1, Jianguo Rd., Taichung 402, Taiwan. bananaudwang@gmail.com
Received: July 13, 2021 Peer-review started: July 13, 2021 First decision: October 3, 2021 Revised: October 8, 2022 Accepted: February 22, 2022 Article in press: February 22, 2022 Published online: April 6, 2022 Processing time: 259 Days and 7.8 Hours
Abstract
BACKGROUND
Malignant peritoneal mesothelioma (MPM) is a rare malignancy arising in mesothelial cells in the peritoneum. It can be mistaken for many other diseases, such as peritoneal carcinomatosis and tuberculous peritonitis (TBP), because its clinical manifestations are often nonspecific. Therefore, the diagnosis of MPM is often challenging and delayed.
CASE SUMMARY
A 42-year-old man was referred to our hospital with lower abdominal pain for 1 wk and ascites observed under abdominal sonography. His laboratory findings revealed an isolated elevated tumor marker of carcinoma antigen 125 (167.4 U/mL; normal, < 35 U/mL), and contrast enhanced computed tomography showed peritoneal thickening. Thus, differential diagnoses of TBP, carcinomatosis of an unknown nature, and primary peritoneal malignancy were considered. After both esophagogastroduodenoscopy and colonoscopy produced negative findings, laparoscopic intervention was performed. The histopathological results revealed mesothelioma invasion into soft tissue composed of a papillary, tubular, single-cell arrangement of epithelioid cells. In addition, immunohistochemical staining was positive for mesothelioma markers and negative for adenocarcinoma markers. Based on the above findings, TBP was excluded, and the patient was diagnosed with MPM.
CONCLUSION
It is important to distinguish MPM from TBP because they have similar symptoms and blood test findings.
Core Tip: Malignant peritoneal mesothelioma (MPM) is an uncommon malignant neoplasm that arises from peritoneum. We present a case of malignant peritoneal mesothelioma mimicking tuberculous peritonitis (TBP). This case highlights the difficulty to distinguish MPM from TBP only based on unspecific clinical manifestations, laboratory tests and images especially in high prevalence area of TB, and therefore sheds light on the importance of laparoscopy which finally helps us confirm the diagnosis in this patient with unexplained ascites.
