Malignant peritoneal mesothelioma (MPM) is a rare, life-threatening malignant tumor. We present a report of a rare case of a 67-year-old male patient with MPM and severe abdominal pain, bloating, and bloody ascites as manifestations. The diagnosis was confirmed by cytology of ascites aspiration fluid and further verified by laparoscopic exploratory biopsy. The characteristics of signs and clinical manifestations in this case are less common. As everyone knows, asbestos exposure is usually associated with pleural mesothelioma, but only 6%–10% of malignant mesothelioma cases originate from the peritoneum, which is far less than pleural mesothelioma. Generally, its non-specificity provides a huge challenge to medical professionals in its diagnosis, and this is also the main reason for delayed diagnosis. Patients should be vigilant, even though no clear risk factor is observed.
Malignant mesothelioma is a rare tumor involving pleura, peritoneum, pericardium, and testicular sheath. Visceral organ pleura are the most common sites for such disease, followed by peritoneum.
Since Miller and Wayne reported the first case of peritoneal mesothelioma in 1908, cases have been reported successively. The incidence of peritoneal mesothelioma accounts for only 7 to 20% of mesothelioma, far lower than the incidence of pleura. Epidemiological studies have confirmed that exposure to asbestos is closely related to the incidence of malignant mesothelioma. However, unlike pleural mesothelioma, 80% of pleural mesothelioma was significantly associated with asbestos exposure, while only 8% of patients with malignant peritoneal mesothelioma (MPM) had a history of asbestos exposure, , suggesting that other factors such as chronic inflammatory peritonitis, carcinogenic viruses, etc. may cause the occurrence of MPM. MPM can occur at any age, the median age at diagnosis is mostly around 50, and it is more common in men. The clinical symptoms of MPM are very atypical and usually include abdominal pain, bloating, weight loss, ascites, and anorexia, and a few may manifest as unexplained, fever, microcirculatory hypercoagulable state, and intestinal obstruction. Nonspecific clinical manifestations may pose challenges to doctors in its diagnosis, especially in the absence of risk factors. In this paper, we report a case of MPM where the patient’s medical history did not indicate any exposure to asbestos or other risk factors.