Benign multi-cystic peritoneal mesothelioma of the porta hepatis

Our plain-English summary of Benign multi-cystic peritoneal mesothelioma of the porta hepatis, by H. Aziz, M. Hao, A. Merchant, et al (International Journal of Surgery Case Reports, 2020).

The study

• Authors: H. Aziz, M. Hao, A. Merchant, D. Alfson, C. Foran, M. Raashid Sheikh
• Journal: International Journal of Surgery Case Reports
• Published: 2020;74:218-221
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Our case report describes a patient where multiple laparoscopies five years from initial presentation of symptoms were performed prior to laparotomy for benign multi-cystic peritoneal mesothelioma (BMPM), which has not been documented.

Presentation: A 61-year-old woman presented with years of chronic abdominal pain. Computerized tomography (CT) demonstrated a multi-cystic mass near the porta hepatis, and ultrasound was concerning for contained gallbladder perforation. Fine needle aspiration (FNA) demonstrated benign ductal epithelial cells in a background of mucin and bile without the presence of malignant cells. During laparotomy, a cystic mass attached to the porta hepatis seen emanating from the small bowel mesentery, and additional small cystic lesions through the abdomen were removed. The specimen, measuring 26 × 18 × 8 cm, showed multi-loculated cysts filled with serous fluid.

Discussion: BMPM is a rare neoplasm of mesothelioma cells originating from serosa of viscous organs. BMPMs appear as cystic structures with thin walls containing mucinous/gelatinous fluid. Microscopic features include a lack of invasion and no increased cellularity in the stroma, with or without inflammation (Myers & Babiker, 2018). It is postulated to be either a reactive or neoplastic process. There is no gold-standard treatment for BMPM. Our case is unique in the sense that our patient required several surgical biopsies before final diagnosis could be made.

Conclusion: This case highlights the difficulty of diagnosing BMPM and differentiating it from malignant diseases that can present similarly and can be associated with significantly worse prognosis. Defined management strategies have yet to be demonstrated.

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

In plain English

This case report described a 61-year-old Hispanic woman with several years of chronic, dull abdominal pain, treated by the authors' hepatobiliary surgery division in Los Angeles. CT showed a multi-cystic mass near the porta hepatis and multiple peritoneal nodules. A needle sample found no malignant cells. A later CT showed the mass had nearly resolved, but the nodules had grown. Over five years from her first presentation, multiple laparoscopies were performed. The two the article described found only benign cysts on biopsy. As her pain worsened, surgeons performed a laparotomy. They removed a cystic mass measuring 26 × 18 × 8 cm and many small cysts. The final diagnosis was benign multi-cystic peritoneal mesothelioma. The article did not describe the patient's occupation or whether she had any asbestos exposure. In their background discussion, the authors stated there is no association between asbestos exposure and benign mesothelioma. The authors concluded that the case highlights how hard this condition is to diagnose and to tell apart from malignant diseases, and that defined management strategies have yet to be demonstrated. After surgery, the patient chose continued surveillance with symptom checks and CT imaging as needed.

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
• Who was studied: One 61-year-old Hispanic woman with several years of chronic abdominal pain, treated at the University of Southern California Medical Center, Los Angeles
• Exposure: The article did not report the patient's occupation or any asbestos exposure history. In their discussion of the literature, the authors stated that benign mesothelioma is not associated with asbestos exposure.
• Main results:
  • CT showed a multi-cystic abdominal mass near the porta hepatis and multiple peritoneal nodules.
  • Fine needle aspiration of the mass found benign cells and no malignant cells.
  • A follow-up CT showed near complete resolution of the mass near the porta hepatis.
  • At the first laparoscopy, the removed appendix was unremarkable and the biopsied peritoneal nodule was a mesothelial cyst.
  • At the second laparoscopy, the biopsied peritoneal nodule was a peritoneal inclusion cyst without malignant cells.
  • Multiple laparoscopies spanning five years from initial presentation were performed before laparotomy.
  • At laparotomy, the abdominal mass specimen measured 26 × 18 × 8 cm and contained multi-loculated cysts filled with serous fluid.
  • The final diagnosis was benign multi-cystic peritoneal mesothelioma.
  • After discussion with medical oncologists, the patient chose continued surveillance with symptom checks and CT imaging as needed, with outpatient follow-up planned because of the high risk of recurrence.
• The authors' conclusion: The authors concluded that the case highlights the difficulty of diagnosing benign multi-cystic peritoneal mesothelioma and distinguishing it from malignant diseases that can present similarly and carry a significantly worse prognosis, and that defined management strategies have yet to be demonstrated.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Laparotomy, Ultrasound, Small Bowel Mesentery, Serous Fluid, Neoplasm, Mesothelioma, Inflammation.

Related studies

• Acute presentation of multi-cystic peritoneal mesothelioma — M. Redden, A. Riddell (2022)
• Peritoneal benign cystic mesothelioma: a case report and review of the literature — S. van Ruth, M.W. Bronkhorst, et al. (2002)
• Giant benign cystic peritoneal mesothelioma: US, CT, and MRI findings — A. Ozgen, D. Akata, et al. (1998)
• Benign cystic peritoneal mesothelioma — J.A. Schneider, E.J. Zelnick (1985)
• Peritoneal, benign, cystic mesothelioma with free-floating cysts, re-examined by new methods. A case report — O.H. Iversen, T. Hovig, et al. (1988)
• Peritoneal benign cystic mesothelioma — J. Hidvégi, F. Schneider, et al. (1991)

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