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Abstract
Introduction/Background Peritoneal diffuse carcinomatosis is a common presentation of advanced-stage ovarian cancer. Clinico-laboratory and radiologic characteristics also contribute to distinguishing between carcinomatosis arising from primary ovarian/fallopian tube/primary peritoneal cancers, secondary malignant diseases, and nonmalignant conditions. Peritoneal mesothelioma (PeM) is a rare malignant tumour that can be misdiagnosed as other cancers commonly involving the peritoneum, such as ovarian cancer. Here, we present a case with a clinical presentation typical of advanced ovarian malignancy but with a final diagnosis of peritoneal mesothelioma.
Methodology A 52-year-old patient (body mass index 29.75 kg/m2), nullipara, nulligravida, complained of episodes of fever, weakness, abdominal distention, and discomfort. Notably, the patient had no known history or exposure to asbestos; both the patient‘s mother and grandmother were diagnosed with breast cancer.
Diagnostic evaluation revealed a right ovarian mass up to 7 cm with metastatic lesions to the omentum, peritoneum, liver, aortic, peripancreatic, pelvic, and cardiophrenic lymph nodes; ascites; elevated CA-125 (1247 U/mL); CEA and CA-19–9 levels within the normal range.
Results A diagnostic laparoscopy was performed. By the immunohistochemical examination, the positivity of Calretinin, WT1, CK5, and CK7 clarified the mesothelial differentiation of atypical cells. The possibility of serous carcinoma as a main entity in the differential diagnosis of mesothelioma has become less possible based on the negativity of ER, PR, and PAX8 antibodies.
Conclusion This case underscores the challenges posed by PeM mimicking advanced ovarian malignancy. Peritoneal mesothelioma remains an understudied disease, with prevailing research focusing on the more common pleural variant. The mutated tumour suppressor gene, BRCA-associated protein 1, identified in a subset of mesotheliomas, adds intricacy to PeM. The absence of asbestos exposure in the patient, along with a family history of breast cancer, raises intriguing connections. Further investigation is needed to refine diagnostic and therapeutic approaches for PeM, exploring potential targeted strategies.
Disclosures The authors declare no conflicts of interest related to this case report.
