Lief Sean, Patibandla Srihita, Ansari Ali Z, Bhatt Nilay, Gulraiz Azouba, Beauti Samer M, Ali Rashad
Department of Internal Medicine, William Carey University College of Osteopathic Medicine, Hattiesburg, USA.
Department of Internal Medicine, Trinity Health Grand Rapids, Grand Rapids, USA.
Cureus. 2024 Oct 7;16(10):e70982. doi: 10.7759/cureus.70982. eCollection 2024 Oct.
Malignant peritoneal mesothelioma (MPM) is an aggressive neoplasm that originates from the mesothelial cells lining the parietal peritoneum or visceral peritoneum and extensively spreads within the abdominal cavity. It is a rare malignancy characterized by an insidious onset and poor prognosis. We present the case of a 79-year-old Caucasian male who experienced escalating abdominal pain for six weeks and acute abdominal distension. His medical history was significant for hypertension, gastroesophageal reflux disease (GERD), hypercholesterolemia, and prior coronary artery bypass grafting (CABG). The patient had a 30-pack-year smoking history and worked as a plumber and roofer until retirement. We also confirmed with the patient that he has never been diagnosed with asbestosis. He reported no family history of mesothelioma or related conditions. A computed tomography (CT) scan revealed a prior sternotomy, mild pleural calcifications, mild hepatic steatosis, diffuse peritoneal ascites, diffuse omental edema, and pelvic phleboliths. MPM was confirmed through histopathological examination, which revealed atypical mesothelial cells with high nucleus-to-cytoplasm ratios, prominent nucleoli, and irregular nuclear membranes. It also revealed tumor cells positive for p53, calretinin, WT1, and podoplanin (D2-40). This case highlights the importance of considering MPM in the differential diagnosis for patients with ascites and possible asbestos exposure, particularly with respect to occupational hazards, as it is a rare manifestation of the disease.
恶性腹膜间皮瘤（MPM）是一种侵袭性肿瘤，起源于覆盖壁层腹膜或脏层腹膜的间皮细胞，并在腹腔内广泛扩散。它是一种罕见的恶性肿瘤，起病隐匿，预后不良。我们报告一例79岁的白种男性患者，他经历了六周的腹痛加剧和急性腹胀。他的病史包括高血压、胃食管反流病（GERD）、高胆固醇血症以及既往冠状动脉搭桥术（CABG）。该患者有30年的吸烟史，退休前从事水管工和屋顶工工作。我们还向患者确认他从未被诊断为石棉肺。他报告没有间皮瘤或相关疾病的家族史。计算机断层扫描（CT）显示既往有胸骨切开术、轻度胸膜钙化、轻度肝脂肪变性、弥漫性腹腔积液、弥漫性网膜水肿和盆腔静脉石。通过组织病理学检查确诊为MPM，检查发现非典型间皮细胞，核质比高，核仁突出，核膜不规则。还发现肿瘤细胞p53、钙视网膜蛋白、WT1和足板蛋白（D2-40）呈阳性。该病例强调了在腹水患者和可能接触石棉的患者的鉴别诊断中考虑MPM的重要性，特别是考虑到职业危害，因为这是该疾病的一种罕见表现。
