Peritoneal mesothelioma – a case report

SummaryBackgroundPeritoneal mesothelioma is a very rare diagnosis with an incidence of 1 case per 4–5 million of the population. It accounts for 20–30% of all mesothelioma type cancers. There is great interest in this disease entity amongst the medical community and indeed the general population due to the well-substantiated link between asbestos related exposure and mesothelioma.Case presentationIn this article we report a case of a 77 year old man who presented with a one week history of breathlessness and a right pleural effusion. An incidental right upper quadrant abdominal mass was noted leading to ultrasound and subsequent CT scans. A large subhepatic mass was identified, in addition to pleural calcification and thickening. Biopsy and histological examination of the abdominal mass suggested a spindle cell tumour, most likely a mesothelioma. Thoracocentesis and cytology of the pleural fluid confirmed the diagnosis of a malignant mesothelioma. Our patient is a retired dairy farmer. A detailed occupational history revealed likely asbestos exposure when he worked as a plumber, approximately 50 years ago.DiscussionPatients with peritoneal mesothelioma often present late, and as a result treatment is often palliative. Interventions include cytoreductive (debulking) surgery and intraperitoneal chemotherapy or radiotherapy. Peritoneal mesothelioma is a very rare disease entity, yet a diagnosis to be considered in a patient with an abdominal mass, previous asbestos exposure, and pleural calcification.