An 8-Year-Old Child with Malignant Deciduoid Mesothelioma of the Abdomen: Report of a Case and Review of the Literature

Our plain-English summary of An 8-Year-Old Child with Malignant Deciduoid Mesothelioma of the Abdomen: Report of a Case and Review of the Literature, by M. Wolff-Bar, T. Dujovny, E. Vlodavsky, et al (Pediatric and Developmental Pathology, 2015).

The study

• Authors: M. Wolff-Bar, T. Dujovny, E. Vlodavsky, S. Postovsky, S. Morgenstern, D. Braslavsky, A. Nissan, R. Steinberg, M. Feinmesser
• Journal: Pediatric and Developmental Pathology
• Published: 2015;18(4):327-30
• Type of article: Case report, Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma is an uncommon tumor that usually arises in the pleural cavity of adults with a history of asbestos exposure. Less frequently, it appears in the peritoneum or other mesothelial surfaces. Deciduoid mesothelioma is a rare subtype that has been found at both sites. Of the 3 reported cases in children, 2 originated in the mesenterium and 1 in the pleura. We describe a 4th case of pediatric, malignant, deciduoid mesothelioma and a third case in the mesenteric cavity. The patient was an 8-year-old girl who presented with abdominal pain and fullness. Workup revealed extensive involvement of the abdomen by a serosa-based tumor. The clinical and pathologic findings are described, and the pertinent literature is reviewed.

In plain English

This article described one patient and reviewed earlier published reports. The patient, an 8-year-old girl, had weakness, loss of appetite, weight loss, intermittent diarrhea and abdominal pain. Computed tomography showed a large pelvic mass and tumor spread along the abdominal lining. Microscope and staining findings were consistent with deciduoid malignant mesothelioma, a rare subtype of epithelioid mesothelioma, here in the peritoneum. No primary or secondary asbestos exposure was recorded for her. She had surgery to remove all visible tumor with heated cisplatinum chemotherapy inside the abdomen, four more days of abdominal chemotherapy, then six courses of pemetrexed and cisplatin. About 24 months after surgery she was disease-free. Their review of the medical literature of the last 20 years found 34 reported childhood mesotheliomas. Earlier reports documented asbestos exposure in 33 of 61 adult deciduoid cases and in none of the childhood deciduoid cases. The authors suggested the good outcome so far may relate to the extensive surgery, the chemotherapy, and the tumor's non-invasive nature and relatively low proliferative rate.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of one patient with a review of the published literature
• Who was studied: One 8-year-old girl treated at the authors' tertiary pediatric medical center. The authors' institutions are in Israel. No dates are given.
• Exposure: No primary or secondary (household) asbestos exposure was recorded for this patient
• Main results:
  • Computed tomography showed a large pelvic mass, mostly in the Douglas pouch. It also showed an omental cake, thick nodular peritoneum and calcifications throughout the abdomen.
  • On immunohistochemistry, the tumor was diffusely positive for keratin 7, vimentin and calretinin, and focally positive for CA-125. It was negative for WT1, and Ki 67 was positive in about 15% of tumor cells.
  • The microscopic and immunohistochemical findings were consistent with deciduoid malignant mesothelioma
  • Treatment had several steps: cytoreductive surgery with intraoperative hyperthermic intraperitoneal cisplatinum (41 degrees C for 90 minutes), then four days of continuous intraperitoneal chemotherapy, then 6 courses of pemetrexed and cisplatin. About 24 months after surgery and 18 months after completing treatment, she was disease-free.
  • The authors' review of the last 20 years of medical literature found 34 cases of pediatric mesothelioma of any type at any site. Only 3 of these children had a possible history of asbestos exposure (fathers who worked in the industry).
  • From the earlier reports reviewed, previous asbestos exposure was documented in 33 of 61 adult deciduoid mesothelioma cases and in none of the pediatric cases
• The authors' conclusion: The authors suggested that the favorable course so far may be due to several factors: the extensive debulking surgery, the intraoperative and later chemotherapy, the tumor's non-invasive nature (it seemed to coat rather than invade organs) and its relatively low proliferative rate. They reported this as, to their knowledge, the third malignant peritoneal deciduoid mesothelioma in a child, and called for awareness to avoid underdiagnosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Cavity, Asbestos Exposure, Peritoneum, Pleura.

Related studies

• Clinical, histologic, and genetic features of mesothelioma in a 7-year-old child — A. Sugalski, M. Davis, et al. (2013)
• Malignant biphasic peritoneal mesothelioma in a child: fine-needle aspiration cytology, histopathology, and immunohistochemical features along with review of literature — S.K. Arora, R. Srinivasan, et al. (2012)
• Deciduoid mesothelioma: report of 21 cases with review of the literature — N.G. Ordóñez (2012)
• Solitary benign fibrous mesothelioma of the peritoneum: A rare entity in a 2-year-old child — S. Singh, M. Sangwan, et al. (2016)
• Benign cystic mesothelioma of the peritoneum in a child-case report and review of the literature — V.C. Shakya, C.S. Agrawal, et al. (2011)
• Peripheral lymphadenopathy as the initial manifestation of malignant mesothelioma in a child — Y.S. Gong, Y.T. Rong, et al. (2013)

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