Presentation of a Malignant Peritoneal Mesothelioma in the Form of Rough

PICTURES IN DIGESTIVE PATHOLOGY

Presentation of a malignant peritoneal mesothelioma in the form of rough hepatic calcifications Carmen Lara-Romero, Aida Casado-Bernabéu and Eduardo Romero-Pérez Department of Digestive Diseases. Hospital Universitario Virgen de la Victoria. Málaga, Spain

The malignant peritoneal mesothelioma is a strange type of tumor that affects the peritoneal serosa, making up 10% of all mesotheliomas. Similar to the pleural mesothelioma, it is associated with industrial pollutants and asbestos, with a latency period of 30 years from exposure. There are no specific signs or symptoms, and it is usually diagnosed at an advanced stage. The most frequent symptoms are pain and abdominal distension, anorexia and weight loss. The localized form of the disease is less frequent and it usually presents itself as a heterogeneous intra-abdominal mass.

CASE REPORT Fig. 2. Abdominal TC. We present the case of a 60-year-old hypertensive male, without any other relevant medical history, who attended the Emergency Unit complaining about abdominal distension and asthenia for the past three months. On examination he presented an ascitic abdomen and what felt like a stony mass in the right hypochondrium. The chest X-ray showed other abnormalities (Fig. 1). The abdominal computed a calcified mass on the right hypochondrium, without any tomography (CT) showed a heterogeneous sub-phrenic mass, with calcifications that involved the right hepatic lobe (Fig. 2). Blood tests and tumor markers including alphafetoprotein were normal. The patient needed diuret- ics adjustments and several evacuative paracentesis during his stay in hospital in order to control the ascites. He had a positron emission tomography (PET) scan that showed a pathologic caption on the apical part of the voluminous tumor, with an important calcification and signs of hepatic infiltration on the right lobe. An exploratory laparoscopy was needed to achieve a histology sample, which finally gave the diagnosis: malignant peritoneal mesothelioma.

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