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Price MD, Nair S, Harris J. Primary splenic multicystic peritoneal mesothelioma in a young healthy male. J Surg Case Rep 2023; 2023:rjad551. [PMID: 37846422 PMCID: PMC10576986 DOI: 10.1093/jscr/rjad551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023] Open
Abstract
Multicystic peritoneal mesothelioma (BMPM) is a rare, usually benign tumor that arises from peritoneal mesothelial cells that most commonly occurs in women of reproductive age. Pathogenesis of these tumors is thought to come from chronic inflammation from prior surgery, endometriosis, trauma, or recurrent peritonitis. Here we report a case of primary splenic BMPM in a 20-year-old male with no past medical or surgical history and without any typical risk factors for this condition. He underwent an open splenectomy without complication. Pathology revealed an 18 × 4 × 11 cm3 spleen with a cyst occupying 75% of the splenic surface. Sections revealed a multilocular cyst with trabeculated walls and immunohistochemical staining positive for cytokeratin (AE1/AE3) consistent with BMPM. One year post operatively he remains asymptomatic; however, his interval computed tomography (CT) scan revealed several sub centimeter nodules that either represents small splenules or neoplastic implants. These will be followed with close interval imaging.
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Affiliation(s)
- Matthew D Price
- Department of Surgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
| | - Shuait Nair
- The Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - James Harris
- Department of Surgery, Johns Hopkins School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States
- Department of Surgery, The Johns Hopkins Howard County General Hospital, Howard County, MD 21044, United States
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Vimercati L, Cavone D, Delfino MC, Bruni B, De Maria L, Caputi A, Sponselli S, Rossi R, Resta L, Fortarezza F, Pezzuto F, Serio G. Primary Ovarian Mesothelioma: A Case Series with Electron Microscopy Examination and Review of the Literature. Cancers (Basel) 2021; 13:2278. [PMID: 34068638 PMCID: PMC8126134 DOI: 10.3390/cancers13092278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 01/12/2023] Open
Abstract
Primary ovarian mesothelioma is a rare, aggressive neoplastic disease with a poor prognosis. At onset, the tumor is only rarely limited to the ovaries and usually already widespread in the peritoneum. The rarity of this entity and the difficulties differentiating it from either ovarian carcinoma or peritoneal mesothelioma may lead to frequent misdiagnoses and may raise some concerns about its histogenesis. Thus, reporting such rare cases is fundamental to gain greater awareness of this neoplasm and try to answer unsolved questions. Herein, we described four cases of histological diagnoses of ovarian mesothelioma extrapolated by the regional mesothelioma register of Apulia (southern Italy). In all cases, a detailed medical history was collected according to national mesothelioma register guidelines. A broad panel of antibodies was used for immunohistochemistry to confirm the diagnoses. Moreover, ovarian tissue samples were also examined by transmission and scanning electron microscopy, detecting asbestos fibers and talc crystals in two cases. Because of the few cases described, we reviewed the English literature in the Medline database, focusing on articles about ovarian mesothelioma "misclassification", "misdiagnosis", "diagnostic challenge" or "diagnostic pitfall" and on unsolved questions about its histogenesis and possible risk factors.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine, Occupational Medicine-Section Ramazzini, University of Bari Aldo Moro, 70124 Bari, Italy; (L.V.); (D.C.); (M.C.D.); (L.D.M.); (A.C.); (S.S.)
| | - Domenica Cavone
- Interdisciplinary Department of Medicine, Occupational Medicine-Section Ramazzini, University of Bari Aldo Moro, 70124 Bari, Italy; (L.V.); (D.C.); (M.C.D.); (L.D.M.); (A.C.); (S.S.)
| | - Maria Celeste Delfino
- Interdisciplinary Department of Medicine, Occupational Medicine-Section Ramazzini, University of Bari Aldo Moro, 70124 Bari, Italy; (L.V.); (D.C.); (M.C.D.); (L.D.M.); (A.C.); (S.S.)
| | - Biagio Bruni
- Ultrastructure Laboratory, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Luigi De Maria
- Interdisciplinary Department of Medicine, Occupational Medicine-Section Ramazzini, University of Bari Aldo Moro, 70124 Bari, Italy; (L.V.); (D.C.); (M.C.D.); (L.D.M.); (A.C.); (S.S.)
| | - Antonio Caputi
- Interdisciplinary Department of Medicine, Occupational Medicine-Section Ramazzini, University of Bari Aldo Moro, 70124 Bari, Italy; (L.V.); (D.C.); (M.C.D.); (L.D.M.); (A.C.); (S.S.)
| | - Stefania Sponselli
- Interdisciplinary Department of Medicine, Occupational Medicine-Section Ramazzini, University of Bari Aldo Moro, 70124 Bari, Italy; (L.V.); (D.C.); (M.C.D.); (L.D.M.); (A.C.); (S.S.)
| | - Roberta Rossi
- Department of Emergency and Organ Transplantation (DETO), Pathological Anatomy Section, University of Bari Aldo Moro, 70124 Bari, Italy; (R.R.); (L.R.)
| | - Leonardo Resta
- Department of Emergency and Organ Transplantation (DETO), Pathological Anatomy Section, University of Bari Aldo Moro, 70124 Bari, Italy; (R.R.); (L.R.)
| | - Francesco Fortarezza
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, 35121 Padova, Italy;
| | - Federica Pezzuto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, 35121 Padova, Italy;
| | - Gabriella Serio
- Department of Emergency and Organ Transplantation (DETO), Pathological Anatomy Section, University of Bari Aldo Moro, 70124 Bari, Italy; (R.R.); (L.R.)
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Chand MT, Edens J, Lin T, Anderson I, Berri R. Benign multicystic peritoneal mesothelioma: literature review and update. AUTOPSY AND CASE REPORTS 2020; 10:e2020159. [PMID: 33344293 PMCID: PMC7703464 DOI: 10.4322/acr.2020.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Benign multicystic peritoneal mesothelioma (BMPM) is a rare peritoneal tumor diagnosed predominantly in pre-menopausal women. Associated risk factors include endometriosis and pelvic inflammatory disease in women, and prior abdominal surgery in both genders. To date, the pathogenesis of this disease remains controversial with possible etiologies, including a neoplastic versus a reactive process. Given the risk factors, some authors believe that this disease is secondary to a reactive process. However, because some studies describe cases where there is no prior surgical history or inflammatory milieu present, and because of this entity’s predilection for recurrence, some authors believe the origin to be neoplastic. Some genetic and familial associations have also been reported. Malignant transformation is extremely rare, with only two cases reported in the literature, despite the recurrence potential. Like the etiology, the name of this entity is also controversial. Some authors prefer the term “peritoneal inclusion cyst (PCM)” instead of “benign cystic mesothelioma” and argue that the term mesothelioma should only be used when there is evidence of atypia. Most cases of BMPM are discovered incidentally. Others reflect sequela of tumor mass effect. It appears intra-operatively as large, multi-focal, cystic lesions in the peritoneal and pelvic cavity. Diagnosis is achieved through surgical sampling with histopathological examination. Immunobiologically, BMPM exhibits multiple small cystic spaces with flattened lining containing calretinin positive cells without atypical features, mitotic figures, or tissue invasion. Treatment includes cytoreductive surgery. Here we present a case of BMPM in a 60-year-old male – a rare disease in an uncommon patient population.
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Affiliation(s)
- Momal Tara Chand
- Ascension St. John Hospital, Anatomical & Clinical Pathology. Detroit, MI, USA
| | - Jacob Edens
- Ascension ST John Hospital, Department of Pathology. Detroit, MI, USA
| | - Tayson Lin
- Ascension Providence Hospital, Department of Internal Medicine. Southfield, MI, USA
| | - Ian Anderson
- Ascension ST John Hospital, Department of Pathology. Detroit, MI, USA
| | - Richard Berri
- Ascension ST John Hospital, Department of Surgery. Detroit, MI, USA
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Rapisarda AMC, Cianci A, Caruso S, Vitale SG, Valenti G, Piombino E, Cianci S. Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management. Arch Gynecol Obstet 2018; 297:1353-1375. [PMID: 29511797 DOI: 10.1007/s00404-018-4728-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/28/2018] [Indexed: 10/25/2022]
Abstract
PURPOSE Peritoneal mesothelial cysts (PMC) are a clinical dilemma because of their true pathogenic nature. Many definitions have been associated with PMC, including "benign multicystic mesothelioma", "cystic mesothelioma", "multilocular peritoneal inclusion cysts", ''inflammatory cysts of the peritoneum" or "postoperative peritoneal cyst". METHODS We herein performed a systematic review of the literature focusing on clinical and histopathological aspects of PMC, diagnosis, and therapies. Moreover, we described our experience with a case of PMC in a young female. RESULTS Since there is often a history of prior surgery or inflammatory disease, most authors consider PMC of reactive origin. However, in some cases they occur without any documentable signs of disease or injury. A variety of clinical findings can complicate the preoperative assessment and a multitude of histological pictures may potentially lead to a misdiagnosis. The absence of a uniform treatment strategy and lack of long-term follow-up often hinder the accurate definition leading to unnecessary or unnecessarily aggressive therapy. CONCLUSIONS PMC are more common than had previously been thought. Most authors consider them non-neoplastic; thus the designation of "peritoneal inclusion cyst" is preferable. The term "mesothelioma" should be used only in cases of histological evidences of atypia. The high rates of recurrence suggest that the goal of treatment should not be necessarily complete eradication, but symptomatic relief through individualized treatment. This is a topic of particular importance, especially in young female where recurrence rates could be lower than those reported in adults and where an improperly aggressive treatment could have repercussions on fertility.
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Affiliation(s)
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Salvatore Caruso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Salvatore Giovanni Vitale
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy.
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Eliana Piombino
- Department of Medical and Surgical Sciences and Advanced Technologies, G.F. Ingrassia, Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", Anatomic Pathology Section, School of Medicine, University of Catania, Catania, Italy
| | - Stefano Cianci
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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D'Antonio A, Baldi C, Addesso M, Napolitano C. The first case of benign multicystic mesothelioma presenting as a splenic mass. Ecancermedicalscience 2016; 10:678. [PMID: 27899951 PMCID: PMC5102685 DOI: 10.3332/ecancer.2016.678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Indexed: 01/31/2023] Open
Abstract
Multicystic mesothelioma (MM) is a relatively rare tumour arising in the pelvic peritoneum of the tuboovarian region of young woman. Exceptionally, MM occurs on the serosal surfaces of various organs including kidney, bladder, lymph nodes, and liver. We report here the first case of MM wherein a 58-year-old woman with a previous history of endometriosis of the right ovary presented with a large multicystic mass of the spleen. The diagnosis of MM was made on a surgical specimen after splenectomy. A histopathologic examination is always necessary for the diagnosis of MM which should be differentiated from other lesions particularly from cystic lymphangioma. At one year follow-up, the patient had no evidence of recurrence. Despite the high frequency of local recurrences, MM is a benign lesion and ‘en bloc’ surgical excision with prolonged follow-ups is the treatment of choice.
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Affiliation(s)
- Antonio D'Antonio
- Department of Pathologic Anatomy, AOU S Giovanni di Dio e Ruggi D'Aragona, via S Leonardo, Salerno 84100, Italy
| | - Carlo Baldi
- Department of Pathologic Anatomy, AOU S Giovanni di Dio e Ruggi D'Aragona, via S Leonardo, Salerno 84100, Italy
| | - Maria Addesso
- Unit of Pathologic Anatomy, Hospital Scarlato ASL SA, Pagani (SA) 84013, Italy
| | - Carmine Napolitano
- Unit of Surgery, AOU S Giovanni di Dio e Ruggi D'Aragona, via S Leonardo, Salerno 84100, Italy
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Yagmur Y, Akbulut S, Gumus S, Babur M, Can MA. Case Report of Four Different Primary Mesenteric Neoplasms and Review of Literature. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e28920. [PMID: 28180018 PMCID: PMC5286558 DOI: 10.5812/ircmj.28920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/29/2015] [Accepted: 06/18/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION It is rare for primary tumors to arise from the mesentery. Lymphangiomas appear as congenital malformations of the lymphatic system or benign neoplasms as a large, thin-walled, often multilocular cyst. Mesenteric infiltration is common and during surgical treatment, adjustment of structures such as the bowel and resection of the spleen may be required. Cystic mesotheliomas are rare, benign tumors that originate from the peritoneal mesothelium and are more common in women. Mesenteric cysts are mostly benign and rare intra-abdominal tumors, and can be seen as occupying a large cyst. Malignant fibrous histiocytoma is a rare pleomorphic sarcoma that is more commonly encountered in men. After the extremities, the second most common areas to be affected are the retroperitoneum and peritoneal cavity. CASE PRESENTATION We encountered four cases of different primary mesenteric neoplasms that were operated at the Gazi Yasargil teaching and research hospital, department of general surgery, Diyarbakir, Turkey, between 2013 and 2014. We reviewed these primary mesenteric neoplasms and compared them with previous literature. CONCLUSIONS Primary mesenteric tumors are rare and mostly benign tumors. Complete surgical excision is necessary for all tumors and follow-up is necessary after surgery for malignant fibrous histiocytoma due to recurrence.
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Affiliation(s)
- Yusuf Yagmur
- Gazi Yasargil Teaching and Research Hospital, Department of General Surgery, Diyarbakir, Turkey
- Corresponding Author: Yusuf Yagmur, Department of General Surgery, Gazi Yasargil Teaching and Research Hospital, Diyarbakir, Turkey. Tel: +90-5327180042, E-mail:
| | - Sami Akbulut
- Department of General Surgery, Inonu University, Malatya, Turkey
| | - Serdar Gumus
- Gazi Yasargil Teaching and Research Hospital, Department of General Surgery, Diyarbakir, Turkey
| | - Mehmet Babur
- Gazi Yasargil Teaching and Research Hospital, Department of General Surgery, Diyarbakir, Turkey
| | - Mehmet Ali Can
- Gazi Yasargil Teaching and Research Hospital, Department of General Surgery, Diyarbakir, Turkey
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Occhionorelli S, Tartarini D, Pascale G, Maccatrozzo S, Stano R, Vasquez G. Benign multicystic mesothelioma of peritoneum complicating acute appendicitis in a man: a case report. J Med Case Rep 2016; 10:44. [PMID: 26922647 PMCID: PMC4769818 DOI: 10.1186/s13256-016-0826-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 01/30/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Benign multicystic mesothelioma is a rare pathology. Few cases are reported in the medical literature and acute presentation is extremely uncommon. CASE PRESENTATION We describe an acute clinical presentation of the neoplasm that revealed itself with signs and symptoms attributable to acute appendicitis in a 41-year-old white man. Abdominal echography and computed tomography scans demonstrated the presence of a mass in direct contiguity with cecal fundus, but diagnosis remained unclear. Our patient underwent surgery and complete removal of the neoplasm. Only a definitive histological examination defined the nature of the lesion. No signs of relapse were demonstrated 1 year after the operation. CONCLUSIONS We showed that an acute presentation of a benign neoplasm represents a diagnostic and therapeutic challenge for the surgeon, because of the difficult differential diagnosis that acute presentation can sometimes pose and the trouble that an emergence treatment can imply.
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Affiliation(s)
- Savino Occhionorelli
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, via Luigi Borsari 46, 44121, Ferrara, Italy.
| | - Daniela Tartarini
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, via Luigi Borsari 46, 44121, Ferrara, Italy.
| | - Giovanni Pascale
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, via Luigi Borsari 46, 44121, Ferrara, Italy.
| | - Stefano Maccatrozzo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, via Luigi Borsari 46, 44121, Ferrara, Italy.
| | - Rocco Stano
- Department of Surgery, Emergency Surgery Service, Arcispedale Sant'Anna, via Aldo Moro 8, Cona, 44124, Ferrara, Italy.
| | - Giorgio Vasquez
- Department of Surgery, Emergency Surgery Service, Arcispedale Sant'Anna, via Aldo Moro 8, Cona, 44124, Ferrara, Italy.
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Diffuse mesothelioma of the peritoneum: correlation between histological and clinical parameters and survival in 73 patients. Pathology 2015; 46:604-9. [PMID: 25393250 DOI: 10.1097/pat.0000000000000181] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are few studies addressing survival of diffuse peritoneal mesotheliomas (DPM).In this study, survival data were obtained retrospectively from 73 patients treated with intended cytoreductive surgery for DPM, with a mean follow-up of 42 months. Mesotheliomas were classified as well differentiated papillary (WDPM, n = 2), multicystic (MCM, n = 4), and epithelioid mesotheliomas were subclassified as tubulopapillary (TPM, n = 27), solid/deciduoid (S/DM, n = 34), and or biphasic mesothelioma (BPM, n = 6). Invasion was characterised as absent (grade 0), into stroma (grade 1), into fat (grade 2), and into adjacent structures (grade 3). Peritoneal cancer index (PCI) and completeness of cytoreduction (CCR) were assessed surgically.There were no deaths in the WDPM, MCM, and epithelioid DPM with ≤ grade 1 invasion. There was a stepwise decrease in overall survival from invasive TPM, S/DM, and BPM (p < 0.0001). By univariate analysis, advanced age (p = 0.01), incomplete CCR (p < 0.001), PCI (p = 0.004), mitotic count (p < 0.001), nuclear grade (p < 0.0001), stromal inflammation (p = 0.013), depth of invasion (p < 0.0001), necrosis (p = 0.002), and sarcomatoid growth (p < 0.0001) were associated with decreased overall survival. By multivariate analysis, only sarcomatoid growth (p = 0.0006), depth of invasion (p = 0.02), elevated CCR (CCR 2-3) (p = 0.02), and presence of inflammatory stroma (p = 0.04) were significant variables associated with decreased overall survival.DPM form a spectrum of indolent to highly aggressive tumours. Solid epithelioid/deciduoid tumours have a prognosis intermediate between biphasic mesotheliomas and invasive TPM. The presence and degree of invasion, sarcomatoid features, and inflammatory stroma are poor prognostic indicators.
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Vicens RA, Patnana M, Le O, Bhosale PR, Sagebiel TL, Menias CO, Balachandran A. Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists. ACTA ACUST UNITED AC 2014; 40:436-56. [DOI: 10.1007/s00261-014-0224-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Galateau-Sallé F. [Digestive tumors and pseudotumors that rarely get discussed. Case 4: malignant mesothelioma of the peritoneum]. Ann Pathol 2013; 33:263-9. [PMID: 23954121 DOI: 10.1016/j.annpat.2013.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 06/15/2013] [Indexed: 10/26/2022]
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