Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3156
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
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.
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.
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.