Abstract: This case report highlights the diagnostic challenges in distinguishing between metastatic peritoneal mesothelioma with duodenal involvement and synovial sarcoma of the duodenum, two rare and complex entities. A 59-year-old woman presented with nonspecific abdominal symptoms, and imaging revealed a heterogeneous lesion between the right hepatic lobe and duodenum. Endoscopic ultrasound-guided biopsy and subsequent histopathological analysis initially suggested synovial sarcoma, but further examination, including a FISH assay, confirmed the diagnosis of malignant peritoneal mesothelioma. This case underscores the importance of integrating detailed medical history, imaging, and advanced diagnostic techniques to achieve an accurate diagnosis in rare conditions. Early and precise identification of such diseases is crucial for appropriate therapeutic management and has significant implications for patient prognosis.
Introduction: This case report highlights the diagnostic challenges encountered in distinguishing between two rare entities: metastatic peritoneal mesothelioma with duodenal involvement and synovial sarcoma of the duodenum [1,2]. We underscore the importance of combining a detailed medical history, imaging findings, and histopathological results to improve diagnostic accuracy, including the role of endoscopic ultrasound (EUS)-guided tissue acquisition in the evaluation of complex and unusual cases.
Case Presentation: A 59-year-old oligosymptomatic woman with no history of asbestos exposure presented with a nonspecific condition of abdominal pain and discomfort, accompanied by bloating and abdominal distension for approximately 60 days. In accordance with the policy of the institutional research ethics committee, case reports are exempt from research ethics committee approval. Written informed permission was obtained from the patient to publish the case report and images for scientific purposes. During routine diagnostics, a magnetic resonance imaging (MRI) scan showed a heterogeneous expansive lesion between the right hepatic lobe and duodenum, with partially defined margins, measuring approximately 6.0 x 5.0 cm. The lesion exhibited a hypovascular pattern and was predominantly peripheral to the contrast medium, with several small nodules interpositioned between the surface of the right hepatic lobe and diaphragm (Figure 1).
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