Abstract:
A case report to highlight the clinical presentation of malignant peritoneal mesothelioma (MPM) and illustrate the role of
fluorodeoxyglucose (FDG) positron emission tomography-CT (PET-CT) imaging in the management of this rare carcinoma. A
middle-age male with chronic ascites and acute intestinal obstruction was initially diagnosed with metastatic adenocarcinoma
to the porta hepatic nodes and omentum. However, CT scan done after completion of chemotherapy still demonstrated gross
ascites, omental caking, peritoneal nodules and enlarged porta hepatic nodes. Thus, a review of the earlier histology slides
was requested. Evaluation and consensus interpretation by pathologists concluded that the overall histological features and
immunostaining were in favour of mesothelioma than metastatic adenocarcinoma. Subsequent FDG PET-CT to further assess
the patient and exclude other possible primary malignancy has revealed a metabolically active porta hepatic lesion with
multiple peritoneal and nodal deposits in the absence of other abnormal lesion in the thorax or solid organs, in keeping with
the clinical diagnosis of peritoneal mesothelioma.
