Abstract
Purpose: Malignant peritoneal mesothelioma is a highly lethal and aggressive tumor of the serosal membrane of peritoneum. Approximately 300-500 cases are diagnosed in USA every year and rarely do they involve the umbilicus. In most cases this is either due to metastatic disease or due to an umbilical hernia propagated by ascites and increased intrabdominal pressure in the course of diffuse malignant mesothelioma. We report a case of recurrent malignant peritoneal mesothelioma of epithelioid type presenting as a recurrent Sister Mary Joseph's nodule. A 50 year old Haitian male with a past medical history of gastric ulcer status post gastrojejunostomy who presented with recurrent periumbilical mass for 2-3 weeks with mild pain. The mass diameter size was 2 cm and slightly tender. 5 months prior to presentation, the patient had a similar mass at similar site which was surgically resected and sent for pathological examination which in addition to IHC staining (calretinin and CK5/6 Positivity) revealed malignant epithelioid mesothelioma. The patient subsequently received 4 cycles of permetrexed and cisplatin. PET scan revealed minimal change in size of the umbilical mass demonstrating hypermetabolic activity. There was an ametabolic region in the liver too. Patient was referred for direct inspection and underwent explorative laparotomy which showed invasive malignant peritoneal mesothelioma in right sided peritoneum, subdiaphragmatic peritoneum and right lateral peritoneum and patient underwent cytoreductive surgery, omentectomy, peritonectomy and hyperthermic intraperitoneal mitomycin c infusion. Patient is currently asymptomatic and doing well. Median survival for diffuse mesothelioma is 12-14 months but in recent trials, an intensive loco-regional treatment including cytoreductive surgery along with perioperative intra-peritoneal chemotherapy in the form of hyperthermic intra-peritoneal chemotherapy (HIPEC) with or without early post-operative intra-peritoneal chemotherapy (EPIC), were found to improve survival as evidenced in our interesting patient.Figure: Calretinin staining.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
