Clear cell mesothelioma presenting as an incarcerated abdominal hernia

Our plain-English summary of Clear cell mesothelioma presenting as an incarcerated abdominal hernia, by N.G. Ordóñez (Virchows Archiv, 2005).

The study

• Author: N.G. Ordóñez
• Journal: Virchows Archiv
• Published: 2005;447(5):823-7
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A clear cell mesothelioma presenting as an incarcerated ventral abdominal hernia in a 67-year-old man who had no history of asbestos exposure is described. The cause of the cytoplasmic clearing was the presence of large amounts of glycogen. Although uncommon, this variant of mesothelioma is important to recognize because it can be easily confused with other clear cell tumors involving the serosal membranes. Significant recent advances in the immunohistochemistry of epithelioid mesothelioma are briefly reviewed because immunohistochemical studies can be helpful in establishing the correct diagnosis.

In plain English

This article was a case report describing one patient. A 67-year-old black man sought care for an incarcerated ventral abdominal hernia that had developed a year earlier. He had a history of smoking, diverticulitis and prostate cancer, but not of asbestos exposure. Tissue removed during the hernia repair contained a malignant tumor. A CT scan showed extensive omental "caking" and fluid in the abdomen (ascites). The tumor, which originated in the peritoneum, was made of cells with strikingly clear cytoplasm caused by large amounts of glycogen. It stained strongly for calretinin, keratin 5/6, WT1 protein, D2-40 and podoplanin, and the other markers tested were negative. Electron microscopy showed long branching microvilli. The author took these findings as confirming mesothelioma, while noting that the electron microscopy sample was poorly preserved. The author concluded that pathologists need to be aware that mesotheliomas can show this clear cell appearance. The discussion briefly reviewed other studies of markers that help tell mesothelioma apart from similar-looking cancers.

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 (one patient), with a brief discussion of other published work on immunohistochemical markers
• Who was studied: One 67-year-old black man with an incarcerated ventral abdominal hernia that had developed a year earlier, seen at the M.D. Anderson Cancer Center, Houston (author's institution)
• Exposure: No history of asbestos exposure; the patient had a history of smoking
• Main results:
  • The tumor originated in the peritoneum and presented as an incarcerated ventral abdominal hernia
  • A CT scan showed extensive omental caking and ascites
  • The tumor was made of uniform polygonal cells with strikingly clear cytoplasm
  • The clearing of the cells was caused by large amounts of glycogen inside them
  • Stain for mucin was negative
  • Strong staining for calretinin, keratin 5/6 and WT1 protein, and negative staining for CEA, MOC-31 and B72.3
  • Strong staining for D2-40 and podoplanin; all other markers tested were negative
  • Electron microscopy showed numerous long branching microvilli on the cell surface
• The authors' conclusion: The author concluded that pathologists need to be aware that mesotheliomas can show this uncommon clear cell appearance and should consider mesothelioma when diagnosing tumors with similar features. The author considered the case unusual both because the hernia was the presenting symptom and because of the clear cell appearance.
• Limitations the authors state:
  • The tissue used for electron microscopy was poorly preserved

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, Asbestos Exposure, Immunohistochemistry, Epithelioid.

Related studies

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• Benign multicystic peritoneal mesothelioma presenting as a ghost abdominal mass — H. Jerraya, W. Ghariani, et al. (2016)
• Primary peritoneal clear cell carcinoma versus ovarian carcinoma versus malignant transformation of endometriosis: a vexing issue — L. Insabato, V. Natella, et al. (2015)
• Malignant peritoneal mesothelioma, clear cell variant, in a female and its differentiation from clear cell carcinoma — H. Hayashi, T. Kawata, et al. (2017)
• Are oestrogens and genetic predisposition etiologic factors in the development of clear cell carcinoma of the peritoneum? — R. Wuntakal, A. Lawrence (2013)
• Mesothelioma with clear cell features: an ultrastructural and immunohistochemical study of 20 cases — N.G. Ordóñez (2005)

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