Incidentally detected peritoneal Mesothelioma in an Inguinalhernia Sacafter an Urgentoperation: Repo

Clinics of Oncology

Incidentally detected peritoneal Mesothelioma in An İnguinalhernia Sacafter An Urgentoperation: Report of A Case

Department of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, 34093 Fatih, Istanbul, Turkey

Volume 1 Issue 5- 2018

Received Date: 15 Sep 2018

Accepted Date: 18 Oct 2018

Published Date: 24 Oct 2018

1. Abstract Purpose

Malignmesotelioma can be causedbyserozalleaves of pleura, pericard, peritoneum, tunicavaginalisor testis. Inthe United States, about 2500 newcases of mesothelioma are reported each year. Most frequent type is pleural mesotelioma, second frequent type is peritoneal mesotelioma. The annual incidence of malignant peritoneal mesothelioma is one in about 1,000,000 people.

Intheetiology of malignant mesothelioma, prevalence of as best osex posure, as well as othere nviro nmental agents, radiation, chronic pleural and peritoneal inflammation and irritation, viralagents can be thecause. Malignmeso the liomadetection in theinguinalhernia sac islimitedonly in casereports in theliterature. Theaim of thisstudy is topresent a patient, whoneededurgentoperationbecause of an etrangulatedinguinalherniaanda casewithmalignmesotelioma in hernia sac.

2. Case Presentation

A55 yeras old patient with no know ncommon disease and no family history admitted to emergency clinic with complaints of painful swelling in ther ightinguinal region. There was a working history in the dyefactory. When the etrangule right inguinal hernia findings were detected on the physicalexamination of the right inguinal region an emergency operation decision was made for the patient [1-4]. During surgery, massive degenerative elastic mass lesions were detected in the right inguinal hernia sac and in dimensions of approximately 3x2 cm (Figure 1) Mass excision was performed and the inguinal hernia was repaired with prolen graft.The pathologic ezamination result was epitheloid type malignant mesothelioma (Figure 2). The patient was consulted to medical oncolopgy section and pemetrexed and cisplatin treatment started to the patient. At the 6th month computed tomography (CT) revealed a few hypodense nodular lesions in the liver, splenic flexure, mild wall thickening in the transverse colon, and free fluid between the intestins. No further pathology was detected except Positron eemission tomography / CT except mild hypermetabolic nodular lesions in thelung (noduleswithSUDmax: 3.70, 12 mm in size). The patient was diverted to medical oncology for further continued therapy of palliative chemotherapy.

3. Discussion

Most mesothelioma soccur in the pleural or peritoneal space. Mesotheliomas, which are arising from cell slining hernia sutures are very rare [5]. It has been reported that only%7 of all peritoneal mesothe liomasaccompany inguinal and umbilical hernia [6]. The absence of specific findings makes it difficult toidentify in a pre-operative process. Most of these tumors are detecting during surgery [7].

The presence of abdominal pain and ascites with a rapidly growing hard lesion in thehernia sac should make the surgeon suspect the possibility of the tumor. Preoperative ultrasonography can help by showing non-homogeneffüsionorexophytictumor for more information. It should be kept in mind tha tliquid cytology mayalso be descriptive. If there is a suspicion for a tumor, hystologic frozensecti onexamination must be performed [7]. It is necessary to distinguish the primary mesothelioma of the hernia sac from the diffuse peritoneal malignant meso the lioma and metastatic carcinomas. Appropriate radiological, surgical, and pathologic identification tecniques differential diagnosis (Figure 1). It has been reported that mesotheliomas with minimal peritoneal spread localized with in the herni sac have a better prognosis than diffuse peritoneal or pleural mesotheliomas (Figure 2) [7]. It is emphasized that asbestos exposure plays an important role in both pleural and peritoneal mesothelioma. Peritoneal mesotheliom asassociated with as best osexposurea remorecommon in malesthan in females [8]. Mesothelioma has also been observed in patients who havebeen exposed to radiation due to over orcervical cancer orano the rcause [9]. Contrast agents such as thorotrast and some viral agents such as SV40 have also been reported to cause peritoneal mesothelioma formation [10,11].

Peritoneal and inguinal canal mesothelioma cases due to familial mediterian fever and recurrent diverticulitis due to prolonged peritoneal irritation and inflammation have beenreported in the literatüre [12-14].

Malignant peritoneal mesothelioma is an aggressive tumor with poorprognosis. The effects of aggressive surgery, abdominal radiotherapy and systemic chemotherapy, whichwe can use in thetreatment of malignant peritoneal mesothelioma, arelimitedto this disease. The effectiveness of the treatment options depends on theage of the patient, overall performance, andhistology of thetumor [15,16]. In the literatüre, that systemicchemo therapy combined with surgical debulking affects the patient’s survival positively, was reported. It was also emphasized that debulking is an effective combination of intra abdominal chemotherapy in patients with minimized tumor volume. However, the specified treatment combin ations have not beenst and ardized [17,18].

4. Conclussion

Malignantmesothelioma is a raremalignant disease that is difficult to diagnoseand treat. One of the most rare anatomic regions of the mesothelioma is the inguinal canal. It is possible to suspect the inguinal canal mesothelioma based on patient history, clinical findings, and rigorous radiological examination (such as ultrasonography, computerized tomography). However, inguinal canal meso the liomasare usually detected during the incisional / etrangule inguinal hernia diagnosis and definitive diagnosis is the

result of pathologic examination. Combination of systemicchemo therapy and radio therapy given by debulking aimed at reducing the tumor burden in malignmeso the liomas and considering the age and performance of the patient and the pathology result may contribute to the survival time of thepatient

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