# Malignant peritoneal mesothelioma presenting with bilateral hydronephrosis and renal insufficiency: a case report and literature review

## TL;DR

A rare case of malignant peritoneal mesothelioma presented with kidney issues, highlighting the difficulty in diagnosing this uncommon cancer.

## Contribution

This case report adds to the limited literature on MPM presenting with bilateral hydronephrosis and renal insufficiency.

## Key findings

- MPM can present with nonspecific symptoms such as bilateral hydronephrosis and renal insufficiency.
- Diagnosis required laparoscopic exploration and biopsy due to the insidious onset and lack of clear symptoms.
- Percutaneous nephrostomy or metal stents were effective in managing malignant ureteral obstruction.

## Abstract

Malignant peritoneal mesothelioma (MPM) is an extremely rare tumor with nonspecific clinical manifestations, making diagnosis challenging.

Herein, we report a case of MPM with occult onset presenting with bilateral hydronephrosis and renal insufficiency. A 30-year-old man was admitted to the Urology Department because of recurrent bilateral lower back pain. The etiology was unclear after a series of laboratory tests, imaging examinations, bone marrow aspiration, renal puncture biopsy, ascites examination, ureteroscopy, and so on. Finally, MPM was diagnosed by laparoscopic exploration and biopsy. Moreover, during the course of the disease, the patient's bilateral ureters were compressed, and the obstruction could not be relieved after the placement of ordinary ureteral stents. Percutaneous nephrostomy or metal ureteral stenosis was appropriate in managing malignant ureteral obstruction as it could improve renal function.

The onset of this case was insidious, and the diagnosis was difficult, with a poor prognosis. To date, only a handful of cases have been reported. We hope this case can provide some enlightenment for our clinical work.