Case report: Papillary mesothelioma of the peritoneum with foamy cell lining

Our plain-English summary of Case report: Papillary mesothelioma of the peritoneum with foamy cell lining, by S. Stolnicu, E. Quiñonez, M. Boros, et al (Diagnostic Pathology, 2013).

The study

• Authors: S. Stolnicu, E. Quiñonez, M. Boros, C. Molnar, I. Dulcey, F.F. Nogales
• Journal: Diagnostic Pathology
• Published: 2013;8:162
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Unlabelled: A 34-year-old female, with a history of continued asbestos exposure, presented with a papillary peritoneal mesothelioma with a diffuse, prominent clear foamy cell change, with microvacuolation in its papillary lining, that expressed cytokeratins 7, 5/6 and calretinin as well as nuclear WT-1 and apical membrane staining for thrombomodulin, podoplanin D2-40 and HBME-1. In contrast, lining cells were CD68 negative. Foamy cell change has been reported in isolated cases as solid cords but not as a diffuse change in the mesothelial papillary lining. This phenomenon prompts differential diagnoses with abdominal and renal papillary clear cell tumours, which were discarded after a characteristic mesothelial immunophenotype was demonstrated.

Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4679576081031834.

In plain English

This article is a case report describing one patient. A 34-year-old non-smoking woman with 30 years of continued exposure to asbestos fibrocement roofing and wall plates came to a gynaecology department in Oradea, Romania, with abdominal swelling and pain. A scan showed abdominal fluid and multiple nodules, and the blood marker CA125 was raised. Surgeons removed the omentum, which held a 10 cm growth, and part of the left ovary, and debulked (reduced) the largest peritoneal nodule. Under the microscope, the tumour had a branching (papillary) structure lined by cells with foamy, bubbly cytoplasm. Staining tests showed a pattern typical of mesothelial cells, and the final diagnosis was malignant mesothelioma of the peritoneum, foamy cell subtype. The patient declined further cancer treatment and was alive with tumour 3 months after diagnosis. The authors wrote that, in earlier published cases, foamy cells appeared only in solid sheets. They concluded that this change can be confused with other tumours, such as ovarian and kidney clear cell cancers, and that the staining pattern helps tell them apart. The article did not name the asbestos fiber type.

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)
• Who was studied: One 34-year-old non-smoking woman seen at the Gynaecology Department, Oradea District Hospital, Romania; date of presentation not given
• Exposure: 30 years of continued exposure to asbestos fibrocement roofing and wall plates (described in the discussion as asbestos in the roof plates of the house); fiber type not stated
• Main results:
  • The patient's CT scan showed abundant ascites and multiple intra-abdominal nodules of 2-10 cm
  • The patient's serum CA125 was elevated
  • Surgery on the patient found a 10 cm omental growth
  • Surgeons performed an omentectomy and partial left ovary resection, and debulked the largest peritoneal nodule (not stated to be removed completely)
  • The patient's tumour cells had foamy cytoplasm filled with many small vacuoles
  • All of the patient's tumour cells expressed cytokeratin 7, cytokeratins 5/6 and calretinin
  • CD68 was negative in all of the patient's tumour cells
  • The patient's final diagnosis was malignant mesothelioma of the peritoneum, foamy cell subtype, involving the omentum and left ovarian surface
  • The patient declined further cancer treatment and was alive with tumour 3 months after diagnosis
  • The authors reported that in previously published cases foamy cells were seen only in solid sheets, unlike this case
• The authors' conclusion: The authors concluded that diffuse foamy change in the papillary lining can prompt confusion with tumours such as ovarian clear cell carcinoma and renal papillary clear cell tumours, and that the characteristic mesothelial immunophenotype helps make the distinction

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: Well-Differentiated Papillary Mesothelioma, Peritoneum, Asbestos Exposure, Peritoneal Mesothelioma, Calretinin, Wilms Tumor 1 (WT-1), Podoplanin (D2-40), HBME-1.

Related studies

• Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum — R.L. Attanoos, R. Webb, et al. (2002)
• Therapeutic strategies for well-differentiated papillary mesothelioma of the peritoneum — Y.K. Lee, H.J. Jun, et al. (2013)
• Well-differentiated papillary mesothelioma of the female peritoneum: a clinicopathologic study of 26 cases — A. Malpica, S. Sant'Ambrogio, et al. (2012)
• Papillary mesothelioma of the peritoneum in the absence of asbestos exposure — T. Meister, T. Birkfellner, et al. (2003)
• Well-differentiated papillary mesothelioma with invasive foci — A. Churg, T. Allen, et al. (2014)
• Well-differentiated papillary mesothelioma of the peritoneum: a diagnostic dilemma on fine-needle aspiration cytology — J.G. Nasit, G. Dhruva (2014)

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