Case of Peritoneal Desmoplastic Mesothelioma Reveals a New Misdiagnosis

Mesothelioma cases often aren’t considered mesothelioma cases right away. They’re frequently mistaken for other conditions, usually due to the commonality of mesothelioma symptoms.

Misdiagnosing mesothelioma costs the patient time getting aggressive treatment. The disease is more advanced by the time it’s correctly identified, and the survival odds have decreased.

A case report of a unique peritoneal mesothelioma case reveals a new condition that could trick doctors into a misdiagnosis.

Doctors from the American College of Gastroenterology misdiagnosed a 40-year-old man with encapsulating peritoneal sclerosis. Doctors later discovered, through a biopsy, evidence of a rare type of peritoneal mesothelioma.

 

Confusing Peritoneal Mesothelioma for Peritoneal Sclerosis

Peritoneal mesothelioma forms in the peritoneum, a narrow sheet of fluid and tissue wrapping around the abdominal cavity. This membrane protects many of the organs within the abdomen, including the:

• Stomach
• Small intestine
• Large intestine
• Liver
• Spleen
• Ovaries
• Gallbladder
• Pancreas
• Kidneys
• Bladder

Cancer that forms in the peritoneum can spread and put these organs at risk.

However, detecting peritoneal mesothelioma based on symptoms is a challenge. Even primary physicians don’t consider peritoneal mesothelioma as a possibility.

In this case study, the patient complained of three key symptoms: stomach pain, stomach swelling and loss of appetite. He said they persisted for nine months.

These are symptoms of peritoneal mesothelioma, but they can be confused for irritable bowel syndrome, groin hernia or ovarian cancer. Now we’ll add peritoneal sclerosis to the list.

Encapsulating peritoneal sclerosis is a rare disease but — similar to peritoneal mesothelioma — also a devastating one. Researchers from Frontiers in Physiology described this disease as “extensive thickening and fibrosis of the peritoneum.” The result is fibrous cocoon-like encapsulations around the bowel, which leads to intestinal obstruction.

Peritoneal sclerosis looks like a form of peritoneal mesothelioma called desmoplastic mesothelioma. This type of mesothelioma, which is a subset of the sarcomatoid mesothelioma cell type, involves a patternless makeup of dense tissue fibers called “collagen.”

The lack of structure to the tissue makes desmoplastic mesothelioma challenging to identify from scans and biopsies.

“To our knowledge,” the study authors wrote, “primary peritoneal desmoplastic mesothelioma presenting as encapsulating peritoneal sclerosis has not been described in the literature.”

In the case study, the patient had samples of these tissue fibers removed during biopsies. Only after immunohistochemical staining did doctors correctly label the condition as peritoneal mesothelioma. The tissue samples showed positive stains for the proteins cytokeratin, calretinin and WT1. These proteins are identifiers for mesothelioma.

 

Why to Seek Expert Medical Help Right Away

Unfortunately, the patient passed away after multiorgan failure approximately four months after he initially presented his symptoms. He only had time following his correct diagnosis to receive two rounds of mesothelioma chemotherapy.

People who have mesothelioma can take steps to maximize their time for treatment. The first is responding to persistent symptoms. When you recognize that your abdominal pain hasn’t subsided, report it to your primary physician immediately. There’s no downside to taking precautions.

The second step is finding a mesothelioma specialist. Many general practice doctors don’t have experience looking at mesothelioma on scans. They may assume your symptoms are of a less severe condition. Ask to receive a second opinion from a cancer center. Your doctor should respect your wishes and help you find a cancer specialist.

If you’d like to learn more about treatment for your peritoneal mesothelioma, contact our medical expert Jenna Campagna. Jenna is a patient advocate and registered nurse, and she specializes in helping people with mesothelioma. Jenna is available by email at jenna@mesotheliomaguide.com.