Clapper, Patti, Schweizer and Mason

Malignant peritoneal mesothelioma is the second most common form of this deadly cancer caused by prior exposure to asbestos.  It represents roughly 30% of all mesothelioma cancers and is widely regarded as one of the most aggressive forms of the disease. 

Malignant peritoneal mesothelioma can sometimes be very difficult to diagnose.  Many of the symptoms are similar to those of more common diseases and ailments and can lead doctors – even specialists – on “wild goose chases” when trying to find the root cause of the problem.

Recently, a group of radiologists from the Department of Radiology, Sri Ramachandra University, in Chennai, India published their experiences treating a 28-year old woman with the disease in an article in Radiology Case Reports, an online medical journal.  The case study points out key difficulties the doctors had in determining just what the young woman was suffering from and how they overcame those difficulties during her treatment.

The woman first came to the doctor’s attention after she complained of abdominal symptoms such as pain, tenderness, loss of appetite, and abdominal distension.  Physical examinations, including a pervaginal exam, revealed a large mass not only in the abdominal cavity but also in the posterior fornix (the “arch” formed by the natural curve of the vagina as it passes behind the cervix.) 

The woman’s blood work showed nothing out of the ordinary except slightly abnormal levels of hemoglobin, red blood cells.  This is common in mesothelioma patients but also in many other illnesses.   Her doctors progressed with diagnostic treatment and administered a sonogram.  The scan showed a largely cystic mass throughout the patient’s abdomen – which lead to the false assumption that she was suffering from some form of ovarian cancer that had metastasized. 

Eventually she was given a CT scan which unveiled a complex nodular lesion throughout her entire abdominal cavity with concentrations at the periphery of the abdomen.  This lesion had grown to such a size that it had displaced the woman’s small intestine and portions of her peritoneal sac. 

The CT scan also showed ascites (accumulation of fluid in the peritoneum) around the liver.  All of these symptoms and discoveries were in line with the false assumption that the woman was suffering from ovarian cancer. 

The next step was to get the patient into surgery and physically examine the abnormal growth inside her.  She underwent a procedure known as a complete omentectomy (removal of the omentum – the peritoneal sac that usually sits in front of the stomach and other organs within the abdomen.)  The doctors also took further precautions and removed her uterus and ovaries as well, still thinking that the root cause of her massive tumor was ovarian cancer that had gotten out of hand.  Several other nodules were removed during cytoreductive surgery until all visible damaged tissue was gone. 

She was given multiple courses of chemotherapy to combat any nonvisible cancer cells that remained in the body and the treatment progressed onto the next phase – finding out what had caused this otherwise healthy woman to suffer such cancerous growth.

It wasn’t until histologists examined the tissue samples under a microscope that they discovered that the woman was suffering from advanced peritoneal mesothelioma.  The disease presented itself as highly cellular tumors “consisting of spindle cells arranged in interlacing bundles and sheets.”  Further chemical testing confirmed that the tumors matched the profile for malignant peritoneal mesothelioma. 

As this case shows, diagnosing mesothelioma can be very difficult indeed.  After days of testing, multiple forms of imaging techniques, and radical surgery, the woman’s doctors still didn’t know what was wrong with her.  As is the case with many mesothelioma patients, the true diagnosis is only confirmed after tumors or portions of them are removed and tested in a laboratory setting.

This case perfectly pinpoints the multiple difficulties doctors face when combatting mesothelioma:

• The symptoms often mimic those of other diseases
• Blood tests and non-invasive scanning methods often cannot be relied upon for diagnosis.
• Surgery and biopsy are really the only effective methods of detecting mesothelioma.
• Treatment options for the disease are often not applied as early as possible because doctors often operate under false assumptions and misdiagnoses.

The key to successful mesothelioma treatments is intervening early after symptoms are noticed.  Catching the disease while it is still in the early stages leads to a much better prognosis for all patients, especially younger ones.  And even as severe as the woman’s symptoms were, she still waited a full month before she sought treatment.

Thankfully the woman’s disease – though extensive – had apparently not yet metastasized to the lymph nodes or other portions of the body.  At the time the doctors recorded their findings, two months after the surgery, the patient was cancer free.  However, as is the case with peritoneal mesothelioma, the risk of recurrence is always there.

Clearly seeking treatment sooner than later is the way to go.  Given the difficulties of diagnosis, the best hope for receiving the correct form of treatment in a timely fashion is getting diagnosed accurately and as early as possible.

Source:  Malignant peritoneal mesothelioma presenting as a complex omental lesion