Biphasic Peritoneal Mesothelioma Is a Rare Tumor and a Diagnostic Challenge: A Case Report

Abstract

Malignant peritoneal mesothelioma (MPM) is a rare subtype of mesothelioma. There are three main histological subtypes of mesothelioma: epithelioid, sarcomatoid, and biphasic (mixed). Risk factors include asbestos exposure, previous radiation, and some germline mutations. Treatment includes surgical resection of amenable tumors or cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. We present a 34-year-old male who presented with weight loss, night sweats, and pleuritic chest pain and was found to have ascites with peritoneal nodularity on abdominal imaging. He had a history of tuberculosis contact, but no history of asbestos exposure. After a long challenging and interesting diagnostic process, he was subsequently diagnosed with biphasic MPM. The diagnostic challenge stems from not only the rarity of the tumor but also from the absence of risk factors, the unavailability of some special laboratory investigations, in addition to the potentially misleading effect of tuberculosis exposure history, a top differential diagnosis in the case. This is a case report of a really challenging and totally unexpected diagnosis of biphasic peritoneal mesothelioma in a patient with tuberculosis exposure, constitutional symptoms, but no history of asbestos exposure. It highlights the diagnostic process as well as the importance of early diagnosis to improve the overall survival of such malignancies.

Keywords: biphasic mesothelioma; case report; malignant mesothelioma; mesothelioma histopathology; peritoneal mesothelioma.

Figure 1. Abdominal CT scan showing diffuse omental thickening and cake (blue arrows) and peritoneal thickening (red arrows).

Figure 2. CT scan of the abdomen showing mesenteric thickening (blue arrow) and mesenteric nodularity (red arrow).

Figure 3. Peritoneal biopsy stained with hematoxylin and eosin (H&E).

The characteristic biphasic pattern is shown with 5x magnification (a) and 20x magnification (b); the epithelioid component is shown with 20x magnification (c).