title: Malignant peritoneal mesothelioma presenting with persistent high fever.
abstract: Malignant peritoneal mesothelioma (MPM) is a rare tumor that develops in the peritoneum. In this paper, we describe an extremely rare case of MPM metastasizing to the appendix in a 48-year-old female who initially presented with a persistent high fever. The woman reported a slight lower abdominal discomfort which had been relieved by urination for four months. She had lost 5 kg of weight. There was no nausea, vomiting, diarrhea, abdominal pain, or abdominal distension. Many broad spectrum antibiotics were given without relief of fever. Computed tomography (CT) scans revealed a thickened omentum majus and diffused multiple omental nodules. An omentectomy, appendectomy, and adnexectomy were carried out. A gross pathologic specimen of omentum tissue revealed a firm gray-white mass. Microscopic and immunohistochemical examinations confirmed the diagnosis of appendiceal and bilateral adnexal metastases of an MPM. These results suggest that MPM should be considered in the differential diagnosis of unexplained persistent high fever. Awareness of such atypical presentations of mesothelioma may help to make a correct diagnosis.
authors.affiliation: Department of Family Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Li-ying
authors.initials: LY
authors.lastname: Chen
authors.forename: Ling-xiu
authors.initials: LX
authors.lastname: Huang
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Yi
authors.initials: Y
authors.lastname: Qian
authors.forename: Li-zheng
authors.initials: LZ
authors.lastname: Fang
mesh_terms: D001063:Appendiceal Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D014408:Biomarkers, Tumor / Q000378:metabolism; D064032:Calbindin 2; D003937:Diagnosis, Differential; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis; D006801:Humans; D007150:Immunohistochemistry; D007633:Keratins / Q000378:metabolism; D008654:Mesothelioma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000556:secondary; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D064030:S100 Calcium Binding Protein G / Q000378:metabolism; D014057:Tomography, X-Ray Computed; D025721:WT1 Proteins / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D064032:Calbindin 2; D064030:S100 Calcium Binding Protein G; D025721:WT1 Proteins; D007633:Keratins