Abstract: Here, we present a unique case involving a female patient in her 40s with synchronous malignant pleural and peritoneal mesothelioma, despite lacking a history of asbestos exposure. The patient’s initial symptoms included dyspnoea, chest pain, cough, fever, appetite loss, and weight loss over a month. Clinical evaluation led to the identification of right-sided pleural effusion, prompting consideration of differential diagnoses, such as tubercular or malignant pleural effusion. A thoracoscopy-guided biopsy, followed by histopathological examination and immunohistochemical staining, confirmed the diagnosis of mesothelioma. Chemotherapy was initiated as part of the treatment plan. The prognosis for this condition is generally bad; however, unusual cases of extended survival have been documented. The complexities of our case underscore the critical necessity for a thorough and aggressive evaluation of pleural effusion cases to unveil rare underlying causes, such as mesothelioma.
Introduction: The incidence of mesothelioma, a rare cancer, was a mere 0.17% of all estimated cancer cases in 2020. It is widely acknowledged that inhalational exposure to asbestos is the primary cause of malignant mesothelioma in humans. This cancer originates from mesothelial cells of serosal membranes, particularly in the pleura (75%), peritoneum (10-0%), pericardium (1%), or tunica vaginalis (1%). Concurrent pleural and peritoneal mesothelioma is exceedingly rare. The disease is typically diagnosed in individuals aged between their fifth and seventh decades, with a higher prevalence in men, accounting for approximately 70-80% of cases. This gender disparity is attributed to the greater presence of men in industries with elevated asbestos exposure, such as mining, shipbuilding, and construction.
Pleural mesothelioma commonly presents with symptoms like worsening dyspnea, weight loss, and chest wall discomfort, often accompanied by unilateral hemorrhagic pleural effusion and pleural thickening. Conversely, peritoneal mesotheliomas often manifest with abdominal pain, nausea, vomiting, ascites, and accelerated weight loss. Radiographic findings, such as pleural effusion or pleural thickening on plain chest X-rays, necessitate confirmation through contrast-enhanced computed tomography. Although magnetic resonance imaging (MRI) is an option, it typically does not offer significant advantages over CT scans. CT or MRI scans may reveal chest wall invasion, providing additional evidence of malignancy. Fluorodeoxyglucose positron emission tomography (FDG-PET) has proven valuable in diagnosis, particularly in differentiating between benign and malignant conditions. Microscopic differentiation of malignant pleural mesothelioma (MPM) from other tumors, such as adenocarcinoma and other spindle cell tumors, is crucial. Calretinin and WT-1 markers, when combined with other carcinoma markers, are particularly valuable, offering high specificity for MPM.
The efficacy of systemic anticancer therapy for MPM has been limited until now although there are growing interest and data supporting the potential of immunotherapy with immune checkpoint inhibition. Between 2011 and 2017, individuals diagnosed with mesothelioma had a five-year relative survival rate of 12%, significantly lower than the 62.7% five-year survival rate observed for all cancers. This article presents a comprehensive case report detailing such an instance in a female, shedding light on the diagnostic challenges encountered in addressing this complex medical condition. [Footnotes omitted]
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