Malignant Peritoneal Mesothelioma: Long-Term spontaneous Clinical Remission

Abstract

Prolonged spontaneous clinical remission in a patient with malignant peritoneal mesothelioma is described. The case is also unique because of the presence of high-spiking fevers as a symptom of tumor recurrence and the finding of an elevated titer of rheumatoid factor in the ascitic fluid. The caution needed in interpreting results of therapeutic interventions in this tumor is emphasized.

Case Details

Disease Location

Peritoneum

Personal Characteristics

No history of personal or environmental asbestos exposure

Clinical Characteristics

7 kg weight loss and abdominal distension of 2 months duration. Pe: ascites. On explorative laparotomy, 3 liters of exudative ascitic fluid was drained. The entire peritoneum, the omentum, and especially the left paracolic gutter were infiltrated with multiple small nodules. Further review of the same sections performed 3 months later revealed neoplastic proliferation of mesothelial cells and heavy infiltration of lymphoid cells with the formation of reactive germinal centers. Compatible with malignant peritoneal mesothelioma. Seven years later, he was readmitted for investigation of 10 kg weight loss, anorexia, and a spiking fever of 1 month duration. Broad-spectrum antibiotics, as well as multidrug antituberculous treatment, were ineffective. . Repeat explorative laparotomy disclosed a similar pattern of miliary nodularity disseminated over the entire peri- toneum and omentum.

Remission Characteristics

Repeat peritoneal biopsy performed one year later during right inguinal herniorrhaphy disclosed the same histological findings.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Exploratory laparomoty broad-spectrum antibiotics, as well as multidrug antituberculous treatment. High- dose steroids systemic chemotherapy