# Biphasic Peritoneal Mesothelioma Is a Rare Tumor and a Diagnostic Challenge: A Case Report

## TL;DR

This case report describes a rare and challenging diagnosis of biphasic peritoneal mesothelioma in a young man without typical risk factors.

## Contribution

The novelty lies in presenting a rare case with no asbestos exposure and highlighting diagnostic difficulties in similar clinical contexts.

## Key findings

- Biphasic peritoneal mesothelioma was diagnosed in a 34-year-old male with no asbestos exposure history.
- The case highlights the diagnostic challenges due to the tumor's rarity and misleading tuberculosis exposure history.
- Early diagnosis is emphasized as critical for improving survival in such rare malignancies.

## Abstract

Malignant peritoneal mesothelioma (MPM) is a rare subtype of mesothelioma. There are three main histological subtypes of mesothelioma: epithelioid, sarcomatoid, and biphasic (mixed). Risk factors include asbestos exposure, previous radiation, and some germline mutations. Treatment includes surgical resection of amenable tumors or cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

We present a 34-year-old male who presented with weight loss, night sweats, and pleuritic chest pain and was found to have ascites with peritoneal nodularity on abdominal imaging. He had a history of tuberculosis contact, but no history of asbestos exposure. After a long challenging and interesting diagnostic process, he was subsequently diagnosed with biphasic MPM. The diagnostic challenge stems from not only the rarity of the tumor but also from the absence of risk factors, the unavailability of some special laboratory investigations, in addition to the potentially misleading effect of tuberculosis exposure history, a top differential diagnosis in the case.

This is a case report of a really challenging and totally unexpected diagnosis of biphasic peritoneal mesothelioma in a patient with tuberculosis exposure, constitutional symptoms, but no history of asbestos exposure. It highlights the diagnostic process as well as the importance of early diagnosis to improve the overall survival of such malignancies.