Peritoneal mesothelioma presenting as a skin nodule

Abstract

Mesothelioma is a malignancy of the pleura, pericardium and peritoneum that is rarely seen in cutaneous biopsies. We present a case of a 75-year-old man with significant occupational exposure to asbestos who developed peritoneal mesothelioma that presented as a skin nodule in an old appendectomy scar. The patient presented with a complaint of increased hardness along his appendectomy scar. Physical examination revealed an anterior abdominal wall mass overlying the appendectomy scar, which was subsequently biopsied. Histologic examination of the abdominal wall mass revealed an infiltrating epithelioid and papillary neoplasm within the dermis and subcutaneous tissue. Immunohistochemical stains showed immunoreactivity for cytokeratin (CK) 7, CK 5/6, calretinin and vimentin. CK 20, monoclonal carcinoembryonic antigen, prostate-specific antigen and prostate-specific acid phosphatase were negative. The profile supported the diagnosis of mesothelioma. Cutaneous presentation of mesothelioma is rare but should be considered in the differential diagnosis of patients with significant asbestos exposure.

Epithelioid malignant mesothelioma metastatic to the skin: A case report and review of the literature

“…The diagnosis of MM can be challenging for several reasons, including delayed and non‐specific presentation, relative paucity of sensitive diagnostic techniques and histologic similarity to other neoplasms. Primary MM has a very long latency period, often presenting up to 4 or 5 decades post‐exposure, and is linked to asbestos exposure (including automobile brakes, which formerly contained asbestos) in up to 90% of cases of pleural MM . Due to the delay from exposure to onset of symptoms, the disease is typically far progressed at the time of diagnosis, with metastases typically appearing at a late stage of the disease .…”

“…Due to the delay from exposure to onset of symptoms, the disease is typically far progressed at the time of diagnosis, with metastases typically appearing at a late stage of the disease . Additionally, diagnosis can be delayed because the symptoms for both pleural and peritoneal MM are vague and non‐specific, including chest pain, dyspnea for pleural MM and abdominal pain, weight loss and increased abdominal girth for peritoneal MM . Recurrent pleural effusions and ascites are common in pleural and peritoneal MM, respectively.…”

“…There are 3 main histologic subtypes of MM: epithelioid (60%), sarcomatoid (10%‐20%) and biphasic or mixed (20%‐30%), which has both epithelioid and sarcomatoid components . The epithelioid subtype is comprised of trabecular cords of cuboidal, oval or polygonal cells that are usually clumped together with visible, elongated nuclei and abundant eosinophilic cytoplasm and may have various secondary patterns, including tubulopapillary, micropapillary, acinar, adenoid cystic, clear cell, signet ring, solid, small and large cell patterns and pleomorphic . The sarcomatoid subtype, the least common yet most aggressive subtype, is composed of spindle cells arranged in fascicles with enlarged and elongated nuclei, which may have desmoplastic, lymphohistiocytic, fibrosarcomatous, chondrosarcomatous, osteosarcomatous and malignant fibrous histiocytoma‐like secondary patterns .…”

“…Mesothelioma is a rare form of cancer arising from a monolayer of mesothelial cells that form the lining of the internal body cavities and organs, with the vast majority of cases arising from the pleura (65%-80%), less commonly from the peritoneum (10%-30%) and rarely from the pericardium and tunica vaginalis testis (1%-2%). [1][2][3] Malignant mesothelioma (MM) is aggressive and is known to be locally invasive and have a propensity for metastasis to distant organs, rarely including metastasizing to the skin. Cutaneous involvement by MM can occur through 3 main routes: regional spread via lymphatics, direct extension within surgical scars and distant metastasis via hematogenous spread.…”

“…[5][6][7][8][9][10] Few reports have noted true cutaneous metastasis of MM, with fewer than 20 cases found in the literature. 1,2,4,[6][7][8][9][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]…”