Due to its relative rarity among the general population, mesothelioma is often misdiagnosed or remains entirely undiagnosed until its more advanced stages, when the disease’s outward form is likely to be the cause of significant physiological distress. Problems with mesothelioma diagnosis are especially likely for individuals who present without obvious asbestos exposure, such as women and those who did not work directly with the mineral, because these individuals do not meet the standard patient profile for people with pleural mesothelioma or peritoneal mesothelioma. However, we do know that environmental and secondary exposures are also proven causes of the disease, so patients who present without known exposures should still be taken seriously as potential candidates for mesothelioma. The literature on the disease is full of examples of these kinds of cases and doctors from the United Kingdom have recently added to the available articles on the subject.

In an article recently published in the Journal of Medical Case Reports, doctors presented a case study of a 75 year-old woman who presented with abdominal pain and ascites, which is an accumulation of fluid in the abdomen, but without any known asbestos exposure, which complicated their differential and extended the time before a diagnosis of peritoneal mesothelioma was returned.

Case Study

The article describes the presentation of a 75 year-old woman who suffered from dyspnea, ascites, leg edema and lethargy for at least five weeks prior to admission. The first round of blood tests and radiological examinations did not turn up anything remarkable in the abdominal area, but the ascites kept returning—even after multiple drainings—so more rounds of tests were scheduled to determine their cause. Subsequent CT scans revealed the existence of nodules along the abdominal surfaces, which a laparoscopy and biopsy eventually revealed to be malignant. Immunohistochemical staining then confirmed a diagnosis of peritoneal mesothelioma.

Conclusion

This case study highlights the importance of a physician’s mind remaining open to multiple possibilities during the differential diagnosis. Even as mesothelioma is a disease that is caused only by exposure to asbestos, in many cases, an individual may not have been aware of when this exposure was occurring, so he or she will not generally be considered a likely candidate for its development. This does not mean, however, that the patient’s unawareness will somehow save him or her from developing mesothelioma at some point after the exposure has ceased. In all cases, mesothelioma remains a very difficult disease and patients who present with symptoms related to it should be carefully worked-up to return as accurate a diagnosis as possible.

Labels: mesothelioma