Benign Multicystic Peritoneal Mesothelioma in a Male Teen: Case Report and Review of the Literature

The case of a Peruvian 15-year-old male with a left-flank abdominal mass suspected to be a peritoneal pseudomyxoma is presented. The patient underwent a R0 surgery, and the pathology review showed a benign multicystic peritoneal mesothelioma. Characterized by recurrent mesothelial peritoneal cysts originating in the epithelial and mesenchymal elements of mesothelial tissue, this benign tumor is unusual among young males.

An unusual cause of acute surgical abdomen: benign multicystic peritoneal mesothelioma associated with adenomatous tumor

Benign multicystic peritoneal mesothelioma (BMPM) is a rare disease that primarily affects fertile women with previous abdominal surgery. BMPM associated with adenomatous tumor is a single case report, according to our opinion. The patient had a history of abdominal surgery nine years ago for ovarian cysts. Upon admission, the diagnosis was acute surgical abdomen with acute peritonitis signs. The treatment applied consisted in the removal of peritoneal cysts and partial omentectomy. Only immunohistochemical examination established the diagnosis. The aim is to discuss diagnostic and therapeutic difficulties, underlining that there is no consensus on the use of chemotherapeutics. In conclusion, establishing a preoperative diagnosis is difficult if not impossible. One of the causes of acute surgical abdomen may be BMPM. The malignant transformation of this disease is rare, but the disease recurrence rate is over 50%, and it is often recommended to be monitored through abdominal computed tomography.

Novel TNS3-MAP3K3 and ZFPM2-ELF5 fusion genes identified by RNA sequencing in multicystic mesothelioma with t(7;17)(p12;q23) and t(8;11)(q23;p13)

Multicystic mesothelioma is a rare disease of unknown etiology and pathogenesis. Nothing has been known about the cytogenetic and molecular genetic features of these tumors. Here we present the first cytogenetically analyzed multicystic mesothelioma with the karyotype 46,XX,t(7;17)(p13;q23),t(8;11)(q23;p13). RNA-sequencing showed that the t(7;17)(p13;q23) generated a chimeric TNS3-MAP3K3 gene, which codes for a chimeric protein kinase, as well as the reciprocal MAP3K3-TNS3 in which the region of TNS3 coding for the SH2_Tensin_like region and the tensin phosphotyrosine-binding domain is under the control of the MAP3K3 promoter. The other translocation, t(8;11)(q23;p13), generated a chimeric ZFPM2-ELF5 gene which codes for a chimeric transcription factor in which the first 40 amino acids of ELF5 are replaced by the first 100 amino acids of ZFPM2. RT-PCR together with Sanger sequencing verified the presence of the above-mentioned fusion transcripts. The finding of acquired clonal chromosome abnormalities in cells cultured from the lesion and the presence of the TNS3-MAP3K3 chimeric protein kinase and the ZFPM2-ELF5 chimeric transcription factor confirm the neoplastic nature of multicystic mesothelioma.

Benign multicystic mesothelioma masquerading as a urachal cyst

Benign multicystic mesothelioma (BMM) is a benign intra-abdominal lesion that generally occurs in women in their reproductive years. A urachal cyst occurs when the epithelial-lined urachal canal fails to completely obliterate. We report a case of a 38-year-old female presenting with abdominal pain found to have a lesion highly suspicious for a urachal cyst. On pathologic evaluation the lesion was identified as a BMM. This is the first report of BMM presenting as a lesion suspected to be a urachal cyst.

Diagnosis and treatment of benign multicystic peritoneal mesothelioma

Benign multicystic peritoneal mesothelioma (BMPM) is a rare cystic mesothelial lesion that occurs predominantly in reproductive aged women. A 56-year-old Caucasian male was admitted to our surgical department with a chief complaint of a painful mass in his right lower abdomen for almost 2 years. The physical examination revealed a palpable painful mass. Computed tomography demonstrated an irregular, cystic tumor in his right lower abdomen. There was no obvious capsule or internal septations. No enhancement after intravenous administration of contrast was noted. An exploratory laparotomy was performed, and a multicystic tumor and adherent to the caecum was noted. The walls of the cysts were thin and smooth, filled with clear fluid, and very friable. An en bloc resection of the tumor, including appendix and caecum, was performed. Histological examination revealed multiple cysts lined with flattened simple epithelial cells, and the capsule walls of the cysts were composed of fibrous tissue. Immunohistochemical analysis documented positive expression of mesothelial cells and calretinin. The final diagnosis was BMPM. The patient was well at 6-mo follow-up. BMPM is exceedingly rare lesion. A complete resection of the tumor is required. The diagnosis of BMPM is based on pathological analysis.

[Unexpected diagnosis of a cystic pelvic mass: benign mesothelioma of the uterus: case report]

BACKGROUND

Benign mesothelioma is a rare tumour mostly found in the genital tract.

CASE

We report the case of 30-years old woman presenting pelvic pain. The ultrasound scan revealed a cystic pelvic mass. Laparoscopic exploration showed a uterine posterior formation. The resection of the dome was performed. Histologic exam and immnunochemistry concluded to a benign cystic mesothelioma.

CONCLUSION

The benign mesothelioma of the uterus is usually discovered in histology, differential diagnosis for solid forms can be made with leiomyoma or adenomyoma, whereas the cystic forms can be discussed essentially with the ovarian cysts. The presence of mesothelial immunophenotype in immunochemistry improves diagnosis. Clinical outcome is always favourable without recurrence or malignant transformation.

Benign multicystic peritoneal mesothelioma

Benign multicystic peritoneal mesothelioma is a rare tumor that occurs mainly in women in their reproductive age. It is characterized by the formation of multiple, thin-walled, multilocular cysts that frequently produce large, intra-abdominal masses. The short follow-ups and possible etiologies based on the published reports make it difficult to draw any firm conclusions.

[Recurrent benign cystic peritoneal mesothelioma]

The benign cystic peritoneal mesothelioma (BCPM) is a rare neoplasm affecting mainly females at reproductive age. The natural history and physiopathology of the BCPM are not entirely known. It is mainly characterized by the lack of malignant elements, no tendency to metastasis and by a pervasive tendency to generate local recurrences after surgical removal. The clinical manifestations are insidious, uncharacteristic; the benign cystic peritoneal mesothelioma is often discovered during a surgical procedure addressing another condition. Imaging tests can raise the suspicion of BCPM but the diagnostic can only be confirmed by histopathological examination corroborated with an immunohistochemical analysis. There are no long term studies dictating a single therapeutic attitude but a high risk of local recurrences and the possibility of transformation into malignant mesothelioma have lead to the current tendency towards an aggressive treatment of the tumor. We present the case of a recurrent benign cystic peritoneal mesothelioma in a 40 years old female patient, emphasizing the therapeutic approach and the role of radical surgery in the treatment of BPCM.

Multicystic peritoneal mesothelioma: report of three cases

Multicystic peritoneal mesothelioma is a rare lesion occurring mainly in women in a reproductive age. Its pathogenesis is unclear. We report three cases of multicystic peritoneal mesothelioma in patients that were 28, 38 and 47 years of age (one male, two females). A history of abdominal surgery was reported in two cases. Explorative laparotomy was presumptive of a pseudomyxoma peritoni in two cases, and hyperthermic intraperitoneal chemotherapy was performed. Histological examination demonstrated multicystic lesions with mesothelial cells lining confirmed by immunohistochemical analysis. Unusual findings such as hyperplasia, hobnail features, cytoplasmic vacuolisation and papillary pattern were occasionally noted. The clinical presentation, pathogenesis and pathologic features including differential diagnosis of multicystic peritoneal mesothelioma are discussed.

Mesothelial cyst of the liver in a neonate

Mesothelial cysts are very rare congenital cystic lesions that are derived from coelomic remnants. We report a neonate with a mesothelial cyst of hepatic origin. On routine antenatal ultrasound study, an intra-abdominal mass was seen. After birth, the cystic lesion's size increased to 8 cm and became symptomatic. Surgical resection was performed. Preoperative diagnostic imaging studies, including CT and MRI, did not identify the etiology, but the cyst appeared to be of hepatic origin. Intra-operatively, the cystic lesion was confirmed to have originated from the liver. Based on immunohistological analysis, the final diagnosis was mesothelial cyst of the liver.

Benign Peritoneal Multicystic Mesothelioma Diagnosed and Treated by Laparoscopic Surgery

Benign cystic mesothelioma is a rare pathology predominantly encountered in females. The increased use of laparoscopy for abdominal pain, particularly in female patients, implies that surgeons are aware of the macro- and laparoscopic presentation of this tumor for adequate diagnosis and therapy. In this paper, we present the case of a young woman with benign multicystic mesothelioma in which only laparoscopy led to the appropriate diagnosis. Subsequently, the tumor was removed by laparoscopic surgery.

Multicystic and well-differentiated papillary peritoneal mesothelioma treated by surgical cytoreduction and hyperthermic intra-peritoneal chemotherapy (HIPEC)

BACKGROUND

Multicystic peritoneal mesothelioma (MPM) and well-differentiated papillary peritoneal mesothelioma (WDPPM) are exceedingly uncommon lesions with uncertain malignant potential and no uniform treatment strategy. The aim of the current study was to review our experience with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in these clinical settings.

METHODS

Four women with MPM and eight with WDPPM underwent 13 procedures of cytoreduction and close-abdomen HIPEC with cis-platin and doxorubicin. Seven patients had recurrent disease after previous debulking (one operation in five patients, two in one, four in one). Potential clinicopathological prognostic factors were assessed.

RESULTS

Optimal cytoreduction (residual tumor nodules <or=2.5 mm) was performed in 12 of 13 procedures. Median follow-up was 27 months (range 6-94). One grade 4 postoperative complication (NCI/CTCAE v.3.0) and no operative mortalities occurred. One patient underwent the procedure twice due to locoregional MPM recurrence. Transition of typical WDPPM to malignant biphasic mesothelioma was documented in one patient who died of disease progression following incomplete cytoreduction and HIPEC. Following multimodality treatment, 5-year overall and progression-free survival were 90.0% (standard error = 9.0) and 79.7% (11.9), respectively. Progression-free survival following previous debulking surgery (median 24 months; range 2-87) was statistically worse (P = .0156). Incomplete cytoreduction and poor performance status correlated to both reduced overall and progression-free survival after cytoreduction and HIPEC.

CONCLUSIONS

MPM and WDPPM are borderline tumors capable of transformation into potentially lethal processes. Definitive tumor eradication by means of cytoreduction and HIPEC seems more effective than debulking surgery in preventing disease recurrence or transition to aggressive malignancies.

[Benign peritoneal cystic mesothelioma as differential diagnose of an ovarian dependant tumor. Case report and review of the literature]

Benign cystic mesothelioma is an uncommon lesion of the peritoneum, occurring predominantly in women of reproductive age. The present case is a multitreated perimenopausal woman with lower urinary tract symptoms without clinical improvement despite the treatment, and pelvic pain with physical findings and radiology studies of a probable ovarian mass dependant tumoration, requiring protocolized exploratory laparotomy, finding a benign cystic mesothelioma. Despite the low incidence of this tumoration the gynecologist must be familiar with this disease, because of the high recurrence. Nowadays, steroid hormone receptors typification seems to play an important role to control the recurrence of this tumoration.

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.

Acute urinary retention caused by a large peritoneal inclusion cyst: a case report

BACKGROUND

Pelvic masses have been known to cause bladder symptoms and compression. This is the first documented case of a large peritoneal inclusion cyst causing acute urinary retention from bladder outlet obstruction.

CASE

A 36-year-old woman, gravida 2, para 2, presented to the gynecology clinic with an indwelling Foley catheter that was placed at an outside hospital secondary to acute urinary retention. Computed tomography, performed several days earlier for complaints of progressively worsening lower abdominal and pelvic pain, revealed a 10-cm, complex, cystic mass within the pelvis between the rectum and sigmoid colon, with anterior displacement of the bladder. The patient's past surgical history included a total abdominal hysterectomy as well as separate exploratory laparotomy for resection of a 20-cm peritoneal inclusion cyst and a prophylactic bilateral salpingo-oophorectomy. Due to the acute urinary retention and worsening pain, the decision was made to proceed with laparoscopic removal and drainage of the mass, which turned out to be consistent with a recurrent peritoneal inclusion cyst. Symptom relief was immediate.

CONCLUSION

A large, recurrent, peritoneal inclusion cyst obstructed the bladder neck and presented as acute urinary retention. Laparoscopy relieved the symptoms.

Benign cystic mesothelioma presenting as a huge pelvic mass--a case report

Benign cystic mesothelioma is an extremely rare peritoneal tumor. It is reported in women of childbearing [corrected] age but also in males and needs a careful [corrected] differential diagnosis between benign and malign neoplasia to choose the most [corrected] adeguate therapy. A 25-year-old female [corrected] was treated in our clinic for a gigantic cystic mass (25 x 22 x 3 cm in diameter) containing [corrected] many to [corrected] cysts of different sizes. All tumoral markers were within normal range. Surgical [corrected] treatment consisted of radical excision of the mass and the prognosis was good [corrected].

[Benign cystic mesothelioma, a rare tumor of the peritoneum]

We report the case of a 28-year-old woman, who presented with acute abdominal and pelvic pain, the appearance of appendicitis. Because of her symptoms urgent operation was performed. Appendicetomy was performed, during the operation multiple cystic lesions were discovered on the right ovary and the peritoneal surface of the mesentery. Laparatomy was performed with removal of the visible cystic lesions, which contained mucous fluid. Final histology revealed benign cystic mesothelioma, which is a rare lesion of the peritoneum, occurring mainly in women in reproductive age. The etiology of cystic mesothelioma is still unclear. The short-term prognosis is favourable, but high recurrence rate. Some authors reported effective intraperitoneal chemotherapy, but no clinical study is available about long term outcome. We hope that surgical eradication was effective to prevent recurrence. One year after the operation the patient is complaint and symptom free.

Malignant peritoneal mesothelioma

BACKGROUND AND OBJECTIVES

The incidence of malignant peritoneal mesothelioma (MPM) is rising. Our aim was to present our experience with this entity in order to increase the awareness about this disease to avoid misdiagnosis.

METHODS

Records of seven patients with histologically confirmed MPM were retrospectively reviewed. Demographic and clinicopathological findings were studied in detail.

RESULTS

There were two females and 5 males; mean age was 50.3 years (range 16-73). Asbestos exposure was recorded in two patients, familial Mediterranean fever in one and previous radiation in one. Main presentations were abdominal pain and distension. None of the patients was diagnosed preoperatively. The average delay in diagnosis was 10 months. Calretinin expression was identified in all tumors. Three patients were treated with cytoreductive surgery combined with systemic chemotherapy. Two patients who remain alive were young female patients who were diagnosed by laparoscopic incidental findings and were treated with cytoreductive surgery combined with hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). Median survival was 19.7 months. The average survival time of the five patients who died of their diseases was 10.2 months.

CONCLUSIONS

An awareness of MPM is important to prevent misdiagnosis. Immunohistochemistry has an important role in confirming the diagnosis. MPM remains a difficult therapeutic challenge. Thorough cytoreductive surgery is the cornerstone of current treatment while HIIC is a promising strategy in suitable patients.

A mesothelial cyst of the round ligament presenting as an inguinal hernia after gonadotropin stimulation for in vitro fertilization

OBJECTIVE

To report the case of a round ligament cyst which, as the result of gonadotropin stimulation for IVF, simulated an incarcerated inguinal hernia.

DESIGN

Case report.

SETTING

A private infertility center and a university hospital.

PATIENT(S)

A 31-year-old woman who developed left lower quadrant pain after gonadotropin stimulation for IUI and a tender left inguinal mass after increasing ovarian stimulation for IVF/intracytoplasmic sperm injection.

INTERVENTION(S)

Surgical excision of a mesothelial cyst of the left round ligament and exploration of the left inguinal canal.

MAIN OUTCOME MEASURE(S)

Successful surgical excision of left inguinal mass.

RESULT(S)

Resolution of symptoms.

CONCLUSION(S)

Mesothelial cysts of the round ligament should be included in the differential diagnosis of inguinal masses in women. Gonadotropin stimulation might cause previously unrecognized cysts to simulate an incarcerated inguinal hernia, necessitating surgical repair.

Multicystic malignant mesothelioma of the tunica vaginalis with an unusually indolent clinical course

We report an extremely rare case of a multicystic malignant mesothelioma in the tunica vaginalis with an unusually indolent clinical course. A 48-year-old man presented with a one-month history of painless swelling of right scrotal contents. Ultrasonography and computed tomography (CT) revealed a multicystic mass in the right scrotal sac with evidence of neither distant nor lymph node metastases. The testicular tumor markers were within the normal limits. Inguinal orchiectomy was performed under the suspicion of a malignant tumor. The cystic tumor consisted of fibrocellular, microcystic and adenomatoid elements microscopically was diagnosed biphasic malignant mesothelioma of tunica vaginalis but no invasion into the testis, epididymis and also scrotum. The patient has been disease-free for 72 months and is being followed on an outpatient basis with no further adjuvant therapy.

[Benign cystic mesothelioma with multiple recurrences: a clinical case]

Benign multicystic mesothelioma is a rare disease with a high tendency to local recurrence, but with no tendency to malignancy. The correct diagnosis can be made by histopathological examination in conjunction with immunohistochemical and ultrastructural evaluations. A case of benign cystic mesothelioma recurring three times in a 48-year-old woman is reported, and the management of this disease and the importance of radical surgery are discussed.

[Benign peritoneal multicystic mesothelioma]

MMPB is a rare disease, very often is a casual finding because has not a specific sintomatology; the isthological examen permits the diagnosis; the prognosis is good but follow-up is necessary because the recurrences are possible.

Benign cystic mesothelioma: a rare cause of ascites in a case with familial Mediterranean fever

Benign cystic mesothelioma (BCM) is a rare neoplasm of the peritoneum, consisting of solitary or multiple cysts arising from mesothelial cells. Here we report a patient with a previous diagnosis of familial Mediterranean fever (FMF) presenting with abdominal distension and ascites which were found to be due to BCM. The co-existence of these two entities has not been reported previously. Ascites as the presenting feature of BMC is also a rare observation.

Benign cystic mesothelioma of the peritoneum: a clinicopathologic study of 17 cases and immunohistochemical analysis of estrogen and progesterone receptor status

Benign cystic mesothelioma (BCM) is an uncommon lesion of the peritoneum occurring predominantly in women of reproductive age. Although most patients are managed by surgical resection, a reported high incidence of cyst recurrence has led to the use of hormonal therapy in isolated cases in an attempt to control cyst size and relieve local symptoms. To date, the estrogen receptor (ER) and progesterone receptor (PR) status of BCM has not been evaluated. Here we present our experience with 17 cases (13 women, 4 men) of BCM seen over a 19-year period, including an immunohistochemical analysis of ER and PR status in 14 cases. All lesions showed typical morphological features of BCM, and calretinin immunostaining was positive in 14 of 14 cases. Five patients experienced either 1 or 2 tumor recurrences, and no patients died of disease. One case was diffusely positive for ER only, 1 case was focally positive for PR only, and 1 case was focally positive for both ER and PR. Although immunohistochemical detection of female sex hormone receptors in BCM is uncommon, the focal presence of ER and/or PR in some lesions does provide weak biologic support for the use of hormonal manipulation as a therapeutic option. Hum Pathol 34:369-374.

Malignant transformation of "benign" cystic mesothelioma of the peritoneum

BACKGROUND AND OBJECTIVES

Peritoneal mesothelioma is being diagnosed with greater accuracy as a result of immunocytochemical analysis. The histological type of peritoneal mesothelioma has a great influence on the natural history of the disease. Benign cystic mesothelioma is a definite clinical entity; however, the absence of a uniform approach to treatment and a lack of long-term follow-up of patients seriously hinders an accurate assessment of the disease process.

METHODS

The medical history of a patient with a diagnosis of benign peritoneal cystic mesothelioma followed for 10 years is presented. The medical literature of this disease is reviewed.

RESULTS

The patient was a 36-year-old woman initially diagnosed with benign cystic peritoneal mesothelioma; however, after six surgical procedures with the aim of reducing the volume of intraperitoneal fluid and cysts, the disease developed into an aggressive, diffuse malignant mesothelioma. Involvement of abdominal incisions, invasion of lymph nodes, and invasion of the viscera occurred.

CONCLUSIONS

Peritoneal cystic mesothelioma is a disease in need of careful longitudinal studies in order to better define the clinical course of these patients. This case report along with a literature review suggests caution in the assessment of cystic mesothelioma as a benign process. This patient had a clear malignant transformation of benign cystic mesothelioma to an invasive and potentially lethal process.

Peritoneal benign cystic mesothelioma: a case report and review of the literature

Peritoneal benign cystic mesothelioma is a rare tumour of unknown aetiology. It usually presents with mild abdominal pain and a solid tumour on physical examination. The differential diagnosis with solid abdominal tumours is difficult. Computed tomography, magnetic resonance imaging as well as aspiration cytology are useful in suggesting the pre-operative diagnosis. We present one case report and discuss this entity.

Benign multicystic mesothelioma: a case report

Benign multicystic mesothelioma (also known as multilocular peritoneal inclusion cyst) is a rare lesion found on any abdominal peritoneal surface that occurs most frequently in premenopausal women. We report the case of a 36-year- old woman, who presented with a history of generalized abdominal pain, intermittent abdominal bloating, and episodes of loose stools. A pelvic ultrasound revealed a complex cystic mass with fine internal septations. The patient was managed by laparotomy with removal of mass, total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and multiple peritoneal biopsies. Final pathology revealed benign multicystic mesothelioma. Although mesothelioma is a rare tumour, it is important for all gynaecologists to recognize its existence, the appearance of this lesion, and its generally benign course. This is especially important as it occurs in young women where fertility considerations must be part of the discussion of any pelvic surgery.

Giant benign cystic mesothelioma: a case report and review of literature

A 28-year-old man was admitted because of weight loss and a huge abdominal mass. The abdominal cavity was filled by a large number of cysts with a maximum diameter of 10 cm as diagnosed by ultrasound and computed tomography. Laparotomy was performed and a 33 kg cystic tumour originating from the peritoneum was resected en bloc. Histopathological work-up showed multiple cysts covered by cubic or flat mesothelial cells with uniform nuclei. The final diagnosis was benign cystic mesothelioma. Twenty-three months after surgical debulking, a follow-up computed tomography scan showed recurrence of the disease. In this report, we describe the characteristics, aetiology and differential diagnosis of this rare lesion.

Peritoneal cystic mesothelioma

A 43-year-old man complained that during the previous 2 years he had experienced a number of episodes of hepatic colic. After examination, we diagnosed a symptomatic cholelithiasis with a sclerosed and atrophic gallbladder. He underwent laparoscopic surgery. During the operation, we observed multiple peritoneal tumors that appeared to be metastases of a gallbladder cancer. The histological study demonstrated a benign chronic cholecystitis accompanied by multiple peritoneal cystic mesotheliomas, an extremely rare tumor in men. The etiology of cystic mesothelioma is still unclear. It has been suggested that they are really multiple inclusion cysts that result from a proliferative reaction within the peritoneal tissue; their continued proliferation might be caused by the continued persistence of an inciting factor. However, in our patient, the proliferation appeared to be related to an extensive peritoneal tissue reaction to the chronic gallbladder inflammatory process. We did not use sclerosing therapy because we had resected the gallbladder and most of the visible lesions laparoscopically; therefore, we had most likely eliminated the potential source of the inciting factor. Because it is very difficult during laparascopy to differentiate these benign quistic mesotheliomas from peritoneal metastases or tuberculous lesions, it is debatable whether the surgeon should continue or terminate the laparoscopic procedure in these ambivalent and potentially risky circumstances.

[Mesothelial cysts in urology: a diagnostic and therapeutic problem]

OBJECTIVE

To present our experience with mesothelial cysts with excretory system involvement.

METHODS

3 cases of mesothelial cyst are presented; two of them caused obstructive uropathy.

RESULTS

Cases 1 and 2 were treated by surgery, while case 3 was managed conservatively. All cases are currently asymptomatic.

CONCLUSIONS

Mesothelial cysts are an uncommon cause of obstructive uropathy. Treatment is by surgery for the symptomatic cases and conservative management is a valid alternative for the asymptomatic cases.

[Polycystic mesothelioma of the peritoneum. Description of 4 cases]

Cystic mesothelioma is a rare tumor of the peritoneal cavity arising from mesothelial cells. About 130 cases have been reported in the literature. The tumor is more frequent (85%) in adult women and rarely occurs in children. It is benign but recurrences are often described. The differential diagnosis with adenomatoid tumors, lymphangiomas, cystic malignant mesotheliomas and metastatic serous cystic tumors of the ovary is supported by immunohistochemistry. We describe four cases of cystic mesothelioma of the peritoneum; two of the cases occurred in pregnant women, one in a 45-year-old man and one in a 5-year-old boy. Asbestos exposure was not documented. The mesothelial origin of the neoplasms was supported by immunohistochemical analysis. Furthermore, tests for simian virus 40 (SV40 T antigen), to determine whether this virus was also present in the lesions, were negative.

[Cystic mesothelioma of the peritoneum in a male]

We report a case of cystic mesothelioma of the peritoneum in a young male with local recurrences and whose diagnosis was confirmed by standard histological studies and immunohistochemistry. This rare tumor appears generally in young females through abdominal pain and mass. Local recurrences without distant metastases are a feature of this pathology. The adequate treatment requires complete resection.

[Peritoneal cystic mesothelioma. A clinical case and review of the literature]

Multicystic peritoneal mesothelioma is an extremely rare benign neoplastic disease with high tendency to recur locally, but no tendency to malignancy. Correct diagnosis can be made with histopathologic examination and always with immunohistochemical and ultrastructural evaluation. A case in a twenty-eight-year-old woman is reported and the anatomo-clinical characteristics of multicystic peritoneal mesothelioma from sixty-nine cases described in the literature are specified, discussing the management of this disease and emphasizing the importance of a nondemolitive approach.