Mesothelioma in Elderly Patients: An Uncommon Case of Benign Multicystic Peritoneal Mesothelioma

Mesothelioma is a type of cancer caused by asbestos exposure. It often evokes thoughts of aggressive malignancies. But, there are benign forms of mesothelioma. While rare, these present unique challenges, especially in elderly patients.

One such form is benign multicystic peritoneal mesothelioma (BMPM). It is a rare tumor that is often difficult to diagnose preoperatively due to its nonspecific symptoms. A recent article from Belgium looked into an uncommon case presentation of BMPM in an elderly man.

Case Presentation

A recent study detailed the case of a 63-year-old man with multiple comorbidities. These included cryptogenic cirrhosis and chronic heart failure. The patient had a history of surgery to remove a giant cyst from their abdomen. They came in with recurring, off-and-on pain and vomiting.

These symptoms had begun several weeks before his hospital visit. An abdominal CT scan showed multiple diffusely localized cysts in the abdominal cavity.

The patient had a medical history and CT findings. So, they had surgery to remove twelve cysts from their abdomen. These cysts were identified as benign mesothelial cysts. The recurrence of these cysts following previous surgery raised concerns about the nature of BMPM.

While considered benign, BMPM carries a high risk of recurrence and potential for malignant transformation. This may suggest that it might be better classified as a borderline tumor.

Three months post-surgery, the patient developed two new intraperitoneal cysts. These increased in volume over time. The patient had many other health problems and no symptoms. So, they were advised to have check-ups instead of more surgery.

Implications for Elderly Patients and Caregivers

Complexity of Diagnosis: BMPM’s symptoms are nonspecific and can easily be mistaken for other gastrointestinal or abdominal issues. Elderly patients often have many health concerns. Finding the exact cause of symptoms in them can be hard. Caregivers should be vigilant and ensure comprehensive diagnostic evaluations when symptoms persist.

Risk of Recurrence: Even after surgical intervention, BMPM can recur, as seen in this case. Regular follow-up and monitoring are essential. Caregivers should expect the chance of many surgeries. These can take an emotional and physical toll on both the patient and the caregiver.

Management of Comorbidities: Elderly patients with BMPM often have other significant health issues, which can complicate both diagnosis and treatment. A holistic approach to patient care that addresses all comorbid conditions is crucial. This requires coordination among various healthcare providers to ensure optimal management.

Surveillance Over Surgery: In patients with substantial comorbidities, surveillance might be preferred over immediate surgical intervention if the cysts are not causing significant symptoms. This approach can help avoid the risks associated with surgery in older adults.

Benign multicystic peritoneal mesothelioma, though rare, presents significant challenges, particularly in elderly patients with multiple health issues. This article highlights the importance of comprehensive diagnostic approaches, vigilant monitoring, and personalized treatment strategies.

For caregivers, understanding the nature of BMPM and its management options can help in providing better support and care for their loved ones. As research continues, it is hoped that new insights and treatments will improve the quality of life for those affected by this uncommon condition.

Source:

Lete, Coralie, Tobias Schick, Mazen Takieddine, Eric Guerin, Patrizia Loi, and Julie Navez. “Benign Multicystic Peritoneal Mesothelioma in a Sexagenerian Man: An Uncommon Case Presentation.” Acta Chirurgica Belgica 124, no. 3 (June 2024): 243–47. https://doi.org/10.1080/00015458.2023.2251793.