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Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 191-195

Malignant peritoneal mesothelioma in a young patient, diagnostic challenge

1 College of Medicine, Taif University; KAASH, Taif, KSA
2 KAASH, Taif, KSA; College of Medicine, Beni.Suef University, Beni Suef, Egypt
3 KAASH, Taif, KSA

Correspondence Address:
Dalal M Nemenqani
Consultant and Associate Professor of Pathology, College of Medicine, Taif University and King AbdulAziz Specialist Hospital, Taif, Kingdom of Saudi Arabia

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2278-0521.171438

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Malignant peritoneal mesothelioma (MPM) 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. Its diagnosis is challenging for both surgeon and pathologist. The clinical and radiological features of the disease are usually nonspecific, most of cases diagnosed after laparotomy; even the gross appearance during laparotomy is confusing. In this article, we report a case of a young patient who never been exposed to asbestos, presented with clinical picture of bowel obstruction, computed tomography scan with contrast was done for abdomen, showed rim of free fluid in Morrison pouch with localized collection in right lower abdomen and fat stranding. Laparotomized twice for acute abdomen, ended with right hemicolectomy and we could confirm the diagnosis of MPM after completion of immunohistochemical staining of specimens. Patients with peritoneal mesothelioma often present late, and as a result treatment is often palliative. Interventions include cytoreductive (debulking) surgery and intraperitoneal chemotherapy or radiotherapy. There are a number of factors that have been consistently recognized as important in predicting better outcome in patients undergoing cytoreduction and hyperthermic intraoperative intraperitoneal perfusion with chemotherapy, such as age, histology, and the ability to achieve a complete gross cytoreduction. We present this case to draw attention of both surgeons and pathologists to this rare type of malignancy, especially when patient comes in vague abdominal symptoms and signs.

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