Definitive Diagnosis of Peritoneal Mesothelioma by Diagnostic Laparoscopy

Abstract

A57-year-oldmanwasreferredtoourhospitalafteranabdominalmasswasidentifiedbyultrasound scanningduringahealthcheckup.Upperandlowergastrointestinalendoscopyexaminationswereboth unremarkable. Contrast-enhanced computed tomography (CT) showed an irregular, 5-cm mass in the mesentericregionoftherightlowerabdomenthatwasdenselystainedfromtheearlycontrastphase,togetherwithfaintlycontrasted,thickenedperitoneumattheliversurface,nearthebilateraliliacarteries, andaroundtherectum.PositronemissiontomographyCT(PET-CT)showedabnormalfluorodeoxyglucose(FDG)uptakeatthesesites.Peritonealdisseminationofanunknownprimarycancerorperitoneal mesotheliomawassuspected,anddiagnosticlaparoscopyandtumorbiopsywereconductedtoreachadefinitive diagnosis. Detailed inspection of the entire peritoneal cavity showed numerous white peritoneal nodules,bothsolitaryandinclusters,rangingfromtherangingfromaround1mmto10mm.Themass intherightlowerabdomenwaspalereddishwhite,firmrubbery,andcontinuouswiththegreateromentum.Thismasswasresectedanddiagnosedasepithelialmalignantmesotheliomaonhistopathologicalexamination.ThepatientwasdischargedwithoutcomplicationsonpostoperativeDay2andreferredtoan oncologist.ThepathologicaldiagnosiswasconfirmedonpostoperativeDay13,andthepatientwasstarted ontherapywithpemetrexedsodiumhydrateandplatinumonpostoperativeDay23.