Malignant peritoneal mesothelioma with unresolving haemorrhagic ascites- A case report

Peritoneal mesothelioma being a rare tumor is difficult to diagnose and start treatment. Pleura is the most common area being affected by mesothelioma, peritoneum being the second common site, and in some cases synchronous pleural and peritoneal mesotheliomas are observed (30–45% of the cases). The presentation of mesothelioma is not up to mark leading to difficulty in diagnosis due to lack of specific symptoms and clinical findings. In addition, in the absence of previous asbestos exposure a delay in the diagnosis is not rare. Here we report a case of malignant peritoneal mesotheliomas. The diagnostic and therapeutic approaches for these rare neoplasms are discussed. A 24 year old male patient was admitted with complaints of pain abdomen (on & off) and abdominal distension since 15 days, with no inhalational exposure to asbestos, causing diagnostic confusion. He had history of unresolving haemorrhagic ascites. No drug allergy was noted. Diagnostic laproscopy was done, shows multiple omental nodules. Omental biopsy along with immunohistochemistry leads to diagnosis of malignant peritoneal mesothelioma. Peritoneal mesotheliomas are infrequent clinical entities. However, patients presenting with prolonged abdominal pain and ascitis should be considered to have atypical pathologies with peritoneal mesotheliomas being one of the differentials.