Primary Biphasic Peritoneal Mesothelioma Encountered during Myomectomy for Symptomatic Fibroid Uterus

Background: Malignant mesothelioma (MM) is an aggressive neoplasm whose pathogenesis is conventionally associated with occupational and environmental respiratory exposure to asbestos. MM affects derivatives of the embryologic coelomic epithelium, the: pleura; peritoneum; pericardium; and tunica vaginalis testis. Primary peritoneal mesothelioma generally presents with vague abdominal symptoms and usually presents late in the disease's course. Frequently, patients are diagnosed in advanced stages, and the prognosis is very poor. Case: A 40-year-old premenopausal woman, gravida 3, para 1, presented for an abdominal myomectomy to address her history of a symptomatic fibroid uterus. Exploration of the pelvis revealed diffuse suspected metastatic cancer of an unknown origin; therefore, pelvic washings and biopsies of the lesions were performed. Results: Pathology testing showed that this patient had biphasic peritoneal mesothelioma. Ultimately, the patient refused all conventional treatments and decided to seek alternative medicine options. Conclusions: Biphasic peritoneal mesothelioma is a rare malignancy with a poor prognosis and requires aggressive management with the current "gold standard" of cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy. Despite extensive research survival has not improved in recent decades.