Mesothelioma is a rare neoplasm arising from mesothelial cells that line the serous membranes. The pleura is the most commonly affected site, whereas the peritoneum is the second most frequent location, accounting for approximately 10-15% of all mesotheliomas, equivalent to only a few hundred new cases annually in the United States. Unlike pleural mesothelioma, which predominantly affects men, peritoneal mesothelioma occurs in men and women with a more balanced sex distribution and typically presents in middle-aged and older adults. Asbestos exposure remains the most well-established risk factor, although its association with the peritoneal form is less pronounced than that observed in pleural mesothelioma; in addition, prior therapeutic abdominal or pelvic radiation has also been implicated.
Peritoneal mesothelioma typically presents as diffuse disease, characterized by widespread nodular or plaque-like peritoneal involvement and ascites. In contrast, the localized variant – a solitary, sharply circumscribed tumor that is histologically identical to the diffuse form but lacks serosal dissemination – is exceptionally rare and has been reported only in isolated cases. Its clinical and imaging features closely resemble those of ovarian and primary peritoneal serous carcinoma, and these entities can be reliably distinguished only through a targeted immunohistochemical panel.
We present this case report to raise awareness of [peritoneal mesothelioma variant] localized epithelioid peritoneal mesothelioma (LEPM) as an uncommon and often under-recognized cause of a solitary pelvic mass and to demonstrate how preoperative MRI combined with a focused immunohistochemical panel can distinguish it from gynecological malignancies. This distinction is clinically important, as accurate diagnosis may significantly influence prognostic assessment and therapeutic decision-making. [Footnotes omitted]
[Article continues at original source]
Asbestos & Mesothelioma Information
Asbestos-Mesothelioma Case Evaluation
Free. Confidential. No Obligation