Differential Diagnosis of Peritoneal Mesothelioma
Mesothelioma is cancer of the mesothelium, which is the tissue surrounding the chest cavity, abdominal cavity and heart. Peritoneal mesothelioma affects the mesothelium around the abdominal cavity. Since the symptoms of peritoneal mesothelioma can also be indicative of other conditions, many clinical tests are necessary to obtain a differential diagnosis; meaning, a systematic comparison of clinical findings to determine the exact condition causing the symptoms.
Symptoms
Peritoneal mesothelioma is often not diagnosed until it has progressed significantly and this is due to the fact that many patients do not exhibit symptoms in the early stages. Many of the symptoms, including abdominal pain, increased abdominal girth, fatigue, weight loss and digestive disturbances, may not seem severe enough to cause the patient to seek medical attention. Other symptoms include abdominal mass, distention of the abdomen and anemia. In fact, symptoms can be so general that many cases of peritoneal mesothelioma are only found when the patient seeks medical attention for another condition.
Similar Conditions
For workers with known exposure to asbestos (long, thin fibers that are the leading cause of mesothelioma), it can be difficult to determine if the mesothelioma is peritoneal, pleural (mesothelioma of the chest cavity) or pericardial (mesothelioma of the tissues around the heart). In addition, peritoneal carcinomatosis (multiple tiny tumors in the abdominal cavity) symptoms are similar to peritoneal mesothelioma.
Computed Tomography
Many patients going in with complaints of the abdominal region will undergo a computed tomography (CT) test which can effectively detect abnormalities. However, advanced pleural mesothelioma (from the lungs) often spreads to the peritoneum and the CT test can not differentiate which type of mesothelioma was the initial infection.
Sonography
A sonogram is often performed in conjunction with the computed tomography. The sonogram can reveal the presence of ascites which is fluid in the abdominal cavity. In the case of peritoneal carcinomatosis, the ascites is very prominent, but in peritoneal mesothelioma, it is present, but in lower amounts.
Needle Aspiration Biopsy
A test that can provide a conclusive diagnosis of peritoneal mesothelioma is the needle aspiration biopsy. This test requires some of the ascites fluid to be drawn by a needle inserted into the abdominal cavity. Once the sample is obtained, it is studied under the microscope and the kind of cells present indicates the disease present. However, this technique is not always enough to provide a differential diagnosis especially when the doctor cannot obtain sufficient fluid to analyze.
Laparotomy
Laparotomy is a procedure where an incision is made into the abdomen allowing examination of the organs of the abdominal cavity. This procedure may be necessary if the needle aspiration biopsy fails to provide enough sample for examination and diagnosis. During this procedure not only can ascities be collected, but a sample of abnormal tissue can be taken for a biopsy. Although this is much more invasive, it will provide the differential diagnosis.
Tags: abdominal cavity, peritoneal mesothelioma, aspiration biopsy, chest cavity, Diagnosis Peritoneal