Benign Multicystic Peritoneal Mesothelioma: AIRP Best Cases in Radiologic-Pathologic Correlation

Our plain-English summary of Benign Multicystic Peritoneal Mesothelioma: AIRP Best Cases in Radiologic-Pathologic Correlation, by R. Lee, A. Tong, B. Kurtis, et al (Radiographics, 2016).

The study

• Authors: R. Lee, A. Tong, B. Kurtis, A.G. Gilet
• Journal: Radiographics
• Published: 2016;36(2):407-11
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

RadioGraphics continues to publish radiologic-pathologic case material selected from the American Institute for Radiologic Pathology (AIRP) "best case" presentations. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year. On the penultimate day of the course, the best case presentation is held at the American Film Institute Silver Theater and Cultural Center in Silver Spring, Md. The AIRP faculty identifies the best cases, from each organ system, brought by the resident attendees. One or more of the best cases from each of the five courses are then solicited for publication in RadioGraphics. These cases emphasize the importance of radiologic-pathologic correlation in the imaging evaluation and diagnosis of diseases encountered at the institute and its predecessor, the Armed Forces Institute of Pathology (AFIP).

In plain English

This article was a case report of one patient, a 47-year-old African American woman and former smoker. The patient was referred for a pelvic mass after six months of right lower abdominal pain, a 15-pound weight loss, and intermittent nausea and vomiting. Blood tumor markers (CA-125, CEA and CA-19-9) were within normal limits. CT scans showed multiple fluid-filled cysts in the abdomen and pelvis with no enhancing solid tissue. MR imaging showed cysts up to about 3.4 cm, some pressing on the liver, which raised concern for cancer. The masses were removed by surgery. The largest removed cluster measured 11.3 × 6.0 × 2.2 cm. Microscope and staining studies confirmed benign multicystic peritoneal mesothelioma: stains were positive for calretinin, WT1, AE1/3, vimentin and PAX8, and negative for CEA. The article did not report the patient's asbestos exposure history or the patient's outcome after surgery. Discussing other sources, the authors stated that, unlike malignant peritoneal mesothelioma, this condition has no association with asbestos exposure. The authors concluded that it is a benign process with an excellent prognosis, though local recurrence rates range from 25% to 50%.

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 (single patient), published in the AIRP Best Cases in Radiologic-Pathologic Correlation series
• Who was studied: One 47-year-old African American female ex-smoker with a pelvic mass, evaluated by the authors' departments at Westchester Medical Center, Valhalla, NY. Prior history included a benign right ovarian cystectomy 11 years earlier and asthma. Dates of care were not given.
• Exposure: No asbestos or occupational exposure history was reported for the patient. In their discussion, citing other sources, the authors stated that, unlike malignant peritoneal mesothelioma, multicystic mesothelioma has no association with asbestos exposure.
• Main results:
  • The patient's blood tumor markers were within normal limits: CA-125 of 20.1 U/mL, CEA of 2.6 ng/mL, and CA-19-9 of 29 U/mL.
  • CT showed multiple cystic structures (10 to 15 HU) in the abdomen and pelvis with no abnormally enhancing soft tissue. These were new since a negative CT 8 years earlier.
  • MR imaging showed numerous cystic lesions up to about 3.4 cm. Some pressed on the liver and nearby structures, which raised concern for metastatic disease or carcinomatosis.
  • In the surgically removed masses, the largest conglomerate specimen measured 11.3 × 6.0 × 2.2 cm and the largest single cyst measured 4.5 × 4.0 × 1.0 cm.
  • Immunohistochemical staining was positive for calretinin, WT1, AE1/3, vimentin and PAX8, confirming mesothelial origin. The tissue was negative for CEA.
  • Because the cysts pressed on the liver, imaging alone could not exclude malignancy. Pathologic analysis was needed to make the diagnosis.
• The authors' conclusion: The authors concluded that multicystic mesothelioma is a benign process with an excellent prognosis because malignant transformation is very rare. They noted that, although it does not spread, local recurrence rates range from 25% to 50%, and that treatment should aim at pathologic confirmation and symptom relief on an individual basis.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Pathology.

Related studies

• Remote Recurrence of Benign Multicystic Peritoneal Mesothelioma — C.E. Lee, A. Agrawal (2017)
• Imaging appearance of benign multicystic peritoneal mesothelioma: a case report and review of the literature — V. Mehta, V. Chowdhary, et al. (2017)
• Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management — A.M.C. Rapisarda, A. Cianci, et al. (2018)
• A recurrence of benign multicystic peritoneal mesothelioma treated through laparoscopic excision: a case report and review of the literature — T.D. Witek, J.W. Marchese, et al. (2014)
• Benign multicystic peritoneal mesothelioma presenting as a ghost abdominal mass — H. Jerraya, W. Ghariani, et al. (2016)
• A Case of Abdominal Discomfort Caused by Benign Multicystic Peritoneal Mesothelioma — T.G. Cotter, J.S. Van Arnam, et al. (2016)

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