A Forgotten Disease - Peritoneal Mesothelioma in an Older Adult

Mesothelioma is a rare malignancy often observed in the pleura of patients exposed to asbestos. Peritoneal mesothelioma is a rare malignancy accounting for less than 20% of all mesothelioma cases. Many older adults might have been exposed to asbestos in the past; therefore, they could still develop mesothelioma later. Due to its rarity and nonspecific presentation, peritoneal mesothelioma is often overlooked. We present the case of a 64-year-old man who had been exposed to asbestos for two year 40 years ago because he lived in an asbestos factory. He visited our emergency room because of acute abdominal pain for one day. Abdominal computed tomography showed many ascites with an irregularly thickened peritoneum, and ascites without portal hypertension were suspected. Esophagogastroduodenoscopy, small-bowel capsule endoscopy, and colonoscopy revealed no organic lesions. Diagnostic laparotomy revealed uniform epithelioid tumor cells with eosinophilic cytoplasm and a predominant tubular pattern infiltrating the peritoneal stroma. Therefore, peritoneal mesothelioma was diagnosed, and the patient received cytoreduction plus hyperthermic intraperitoneal chemotherapy (HIPEC) with a stable condition.