A rare presentation of peritoneal mesothelioma: Esophageal encasement and Sister Mary Joseph nodule

Abstract

Malignant peritoneal mesothelioma (MPeM) is a rare malignancy that accounts for approximately 10%-30% of all mesothelioma cases, with the more common type being pleural mesothelioma. In this case report, we describe an atypical presentation of MPeM in a 73-year-old female presenting with periumbilical swelling and subacute chest pain. Imaging demonstrated a large periumbilical mass and a posterior mediastinal mass encasing, but not obstructing, the esophagus. A brief literature review examining the broad range of clinical and imaging manifestations of MPeM is presented.

Keywords: Malignant peritoneal mesothelioma; Mediastinal mass; Mesothelioma; Periumbilical mass; Sister Mary Joseph nodule.

Fig. 1

Erect posterior- anterior (PA) view and lateral view images of patient’s chest X-ray showing a retrocardiac mass with slight blunting of costophrenic angle.

Fig. 2

CTPA images demonstrating large soft-tissue posterior mediastinal mass and small right pleural effusion.

Fig. 3

PET-CT demonstrating FDG avid umbilical mass (SUVmax up to 11.0 measuring up to 98 × 46 mm) and mediastinal mass encasing the esophagus and descending thoracic aorta (SUVmax 6.9, measuring up to 127 × 11 mm). There was no pleural avidity.

Fig. 4

Sections of the core biopsy from the umbilical mass (hematoxylin and eosin stain) showing large atypical epithelioid cells lining multiple tiny cystic spaces/large glandular spaces with papillary proliferation.

Fig. 5

Sections of core biopsy positive for Calretinin (left) and loss of nuclear staining of BRCA1-associated protein 1 (BAP1) (right).