Papillary mesothelioma of the peritoneum in the absence of asbestos exposure

[Well differentiated papillary mesothelioma: description of three case reports and review of the literature]

Well Differentiated Papillary Mesothelioma (MPBD) is a very rare neoplasm that mainly affects women of reproductive age. The most common location is the peritoneum and it is an incidental finding, with a generally favorable prognosis. We present three cases diagnosed incidentally, in the course of a surgical intervention of various causes, which presented as peritoneal exophytic lesions not detected in the pre-surgical imaging study. It is important to keep this entity in mind, to differentiate it from other neoplasms with an unfavorable prognosis and evolution, such as Malignant Mesothelioma or primary and metastatic carcinomas. Recent studies give the MPBD a specific immunohistochemical and molecular profile that allow a greater diagnostic precision of the entity.

Adenomatoid tumor of adrenal gland. Case report and review of the literature

A mellékvese adenomatoid tumora igen ritka, benignus, aszimptomatikus, általában véletlenül felfedezett elváltozás. A szerzők esetismertetésükben egy 32 éves férfi kórtörténetét mutatják be, akit láz és deréktáji fájdalmak miatt vizsgáltak. A kivizsgálás részét képező hasi UH-, majd az ezt követő hasi CT-vizsgálat igazolta a jobb mellékvese térfoglaló elváltozását. A betegnél adrenalectomiát végeztek, a szövettani vizsgálat a jobb mellékvese adenomatoid tumorát véleményezte. Az eset kapcsán áttekintik – az irodalmi adatok alapján – az adenomatoid tumorok előfordulási gyakoriságát, tünettanát, a diagnosztika-differenciáldiagnosztika buktatóit, a kezelési lehetőségeket és a prognózist.

Benign multicystic peritoneal mesothelioma: A case report and review of the literature

Benign multicystic peritoneal mesothelioma (BMPM) is a rare tumor that occurs mainly in women in their reproductive age. The pathogenesis of BMPM is unclear and a controversy regarding its neoplastic and reactive nature exists.

The biological behavior of BMPM is characterized by its slowly progressive process and high rate of recurrence after surgical resection. In addition this lesion does not present a strong tendency to transform into malignancy. Today approximately 130 cases have been reported.

We here report a 62-year-old woman who had diffuse abdominal pain, nausea and vomiting. Physical examination revealed a painful mass in her upper abdomen. She reported a mild dehydration, but the vital signs were normal. Peristaltic rushes, gurgles and high-pitched tinkles were audible. Upright plain abdominal film revealed small bowel loops with air-fluid levels. She was diagnosed having an incarcerated incisional hernia that resulted in intestinal obstruction. The patient underwent surgery during which a cystic mass of the right ovary measuring 6 cm x 5 cm x 4 cm, four small cysts of the small bowel (1 cm in diameter) and a cyst at the retroperitoneum measuring 11 cm x 10 cm x 3 cm were found. Complete resection of the lesion was performed. The patient had an uneventful recovery and had no recurrence two years after surgery.

Benign Peritoneal Cystic Mesothelioma

BACKGROUND

Benign peritoneal cystic mesothelioma (BPCM) is a rare tumor of unknown origin, most frequently encountered in women of reproductive age. Etiology is unknown; definitions and terminology are confusing, and preoperative diagnosis is difficult. Several differential diagnoses must be considered.

METHODS

Based on our own clinical experience and a review of the relevant literature, we address clinical challenges and controversies of importance.

RESULTS

Current literature on BPCM is mostly based on small case reports. Complete surgical resection is recommended if possible. Nevertheless, recurrent disease is not uncommon. Clinical positive effects of various adjuvant medical treatments remain to be shown.

CONCLUSIONS

Lack of consistent definitions, various treatment approaches, and mostly short follow-up times make it difficult to draw any firm conclusions from published reports. The natural history of this rare disease is less than well clarified. When possible, in an individual patient, surgical resection with curative intent seems to be the treatment of choice.

Well-differentiated papillary mesothelioma of the peritoneum: A pathological analysis and review of the literature

BACKGROUND

Well-differentiated papillary mesothelioma (WDPM) of the peritoneum is a rare subtype of peritoneal epithelioid mesothelioma which typically has low malignant potential. It most commonly occurs in young women lacking a history of asbestos exposure. Only 38 female patients with peritoneal WPDM have been reported in the literature, and no uniform treatment recommendation has been established.

CASE REPORT

A 74-year-old asymptomatic woman without significant past medical history underwent workup and subsequent surgery for an adnexal mass with a normal serum CA-125 level. Exploratory laparotomy identified an ovarian serous cystadenoma and an incidental multifocal peritoneal neoplasm with extensive calcifications. Histology and cytology confirmed WDPM with extensive, intimately associated mesothelial cystic inclusions and zonal calcifications with osseous metaplasia. Our patient did not receive adjuvant therapy and was without clinical or radiologic evidence of disease 12 months after diagnosis.

CONCLUSION

WDPM of the peritoneum in women is frequently asymptomatic and associated with an indolent course. Patient outcomes are usually favorable after tumor-debulking surgery without adjuvant therapy.