An Interesting Case of Synchronous Low-Grade Peritoneal Mesothelioma and Ovarian Endometrioid Adenocarcinoma

Case Report

Austin Oncol Case Rep. 2022; 5(1): 1016.

An Interesting Case of Synchronous Low-Grade Peritoneal Mesothelioma and Ovarian Endometrioid Adenocarcinoma

Chao ES¹ and Abu-Shahin FI²*

¹College of Medicine, Texas A&M Health Science Center, USA

²Department of Hematology/Oncology, Houston Methodist Hospital, USA

*Corresponding author: Eugene S Chao, College of Medicine, Texas A&M Health Science Center, 12330 N. Gessner Rd Apt 124, Houston TX 77064, USA

Received: February 01, 2022; Accepted: February 25, 2022; Published: March 04, 2022


Synchronous mesothelioma with other primary malignancies has previously been reported. However, the finding of a low-grade peritoneal mesothelioma with a synchronous ovarian endometrioid adenocarcinoma remains unreported. We report a case of a 57-year-old woman presenting with distended abdomen. CT abdomen and pelvis and subsequent MRI revealed a large pelvic mass. On pathology of the exploratory laparotomy specimen, stage IIIB FIGO grade 3 right ovarian endometrioid adenocarcinoma, as well as stage 1A left ovarian endometrioid borderline tumor, were discovered. Incidentally, a low-grade mesothelioma, epithelioid type, was discovered spanning omentum, right upper paracolic gutter left upper paracolic gutter, and umbilicus. Post-surgery, chemotherapy was initiated primarily to treat the ovarian adenocarcinoma.

Keywords: Peritoneal mesothelioma; Ovarian adenocarcinoma


Mesothelioma is a rare primary tumor of serosal membranes, with around 3,300 cases diagnosed in the United States each year. Most commonly arising from the pleura, mesothelioma can also arise from the mesothelium of peritoneum, pericardium, and tunica vaginalis [1,2]. Between 10 and 15 percent (around 600 cases diagnosed in the US) of mesothelioma are peritoneal [3,4]. Most peritoneal mesothelioma is high grade and aggressive, presenting with diffuse, extensive spread throughout the abdomen3. Low-grade peritoneal mesothelioma involving few peritoneal surfaces are yet rarer, usually arising from women with no history of asbestos exposure [4,5]. Furthermore, the synchronous appearance of indolent peritoneal mesothelioma along with other primary malignancies remains unknown.

Case Presentation

A 57-year-old woman presented to her primary care physician (6/28) with concerns about tachycardia and abdominal swelling. She had episodes of elevated heart rate, shortness of breath, and fatigue. Additionally, she reported abdominal swelling, lower extremities edema, and significantly distended abdomen. Patient was in her baseline state of health prior, with only history of endometriosis and uterine cysts. Family history significant for pancreatic cancer from maternal grandfather at age 50.

A CT of abdomen and pelvis with contrast (6/28) was performed, multiple pulmonary nodules were present in the lung bases, the largest measuring 1.7cm anteriorly in the lingula, 1.8cm in the right lower lobe (Figure 1a). Diffuse centrilobular emphysematous changes were present. Marked, severe, extensive ascites were found throughout the abdomen and pelvic. The liver, gallbladder, biliary duct, spleen, pancreas, adrenal glands, kidneys, abdominal aorta, retroperitoneal or mesenteric lymph nodes, and bowels were negative for any significant pathology. On pelvis, a large, ill-defined solid and cystic mass with extensive septations appearing to originate in the right lower pelvic and extending superiorly into the midline of the pelvis and upper abdomen was discovered (Figure 1b). Subsequent MRI of pelvis (7/7) confirmed a large septated solid and cystic midline pelvic mass measuring 14x15x21cm.