Mesothelioma mimics ovarian cancer in a new report by Radiology Case Reports.
Mesothelioma is a rare and very aggressive tumor of the peritoneum. Similar clinical and imaging presentations mean mesothelioma mimics ovarian cancer at times. Yet, a history of asbestosis exposure is key as the main risk factor for mesothelioma.
Imaging plays a key role in getting the diagnosis correct. It narrows down the diagnosis possibilities. Ultrasound-guided biopsy with histological study can confirm a mesothelioma diagnosis.
Case Report Misdiagnosis
The Bangladesh National Institute of Oncology recently published a case report. A 42-year-old woman reported pelvic pain and progressive abdominal distension.
An abdominal ultrasound revealed a high volume anechoic peritoneal effusion. Further investigation showed extensive peritoneal disease and bilateral ovarian tissue masses.
The diagnosis of ovarian cancer was initially suggested. A case where mesothelioma mimics ovarian cancer. Doctors performed an ultrasound-guided needle biopsy to make an accurate diagnosis.
The ultimate diagnosis was based upon histopathological analysis, mainly via immunohistochemistry.
Similarities When Mesothelioma Mimics Ovarian Cancer
Diffuse malignant peritoneal mesothelioma can masquerade as an ovarian epithelial neoplasm. It has a very similar clinical presentation and overlaps in imaging findings.
Diagnostic proof can be provided by pathological examination. There are a few clinical and imaging findings in favor of mesothelioma.
How to Confirm a Mesothelioma Diagnosis
A biopsy was able to correct and confirm the mesothelioma diagnosis. The standard in knowing between these two entities lies in histological analysis. Mainly in cases when mesothelioma mimics ovarian cancer.
Mesothelioma remains a diagnostic challenge. There is an overlap of clinical presentation and imaging features. This makes it difficult to distinguish this disease from its mimics.
So, histopathologic confirmation is required with an image-guided core needle biopsy.
No single immunohistochemical marker is specific for mesothelioma. Instead, panels of markers are used. These panels differentiate mesothelioma from other tumors that can have similar features. The current recommendation is to use two mesothelioma markers and two carcinoma markers.
The Standard in Confirming Diagnosis
When no other evident primary tumor is detected, mesothelioma should be considered.
Mesothelioma can be difficult to assess on histologic features. This makes immunohistochemical markers pivotal for diagnosis.
Mesothelioma mimics ovarian cancer sometimes. These two diagnoses are very similar on imaging. Yet, it is important to be able to consider the diagnosis of mesothelioma. Mostly when no evident primary tumor is found. And in patients with known exposure to asbestos.
The gold standard in differentiating between these two diagnoses remains in tissue examination.
Houssaini, Z. I., El Agouri, H., Amalik, S., Khouchoua, S., Jerguigue, H., Latib, R., … & Omor, Y. (2022). Diffuse malignant peritoneal mesothelioma mimicking ovarian cancer. Radiology Case Reports, 17(3), 779-783. https://doi.org/10.1016/j.radcr.2021.11.021