Cytomorphologic characteristics of fine needle core biopsy of multicystic peritoneal mesothelioma: a case report and review of the literature

Our plain-English summary of Cytomorphologic characteristics of fine needle core biopsy of multicystic peritoneal mesothelioma: a case report and review of the literature, by A.M. Kemp, R. Nayar, D. De Frias, et al (Diagnostic Cytopathology, 2010).

The study

• Authors: A.M. Kemp, R. Nayar, D. De Frias, X. Lin
• Journal: Diagnostic Cytopathology
• Published: 2010;38(3):192-7
• Type of article: Case report
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Multicystic peritoneal mesothelioma (MPM) is an uncommon cystic mesothelial proliferative lesion. It occurs predominantly in women of reproductive age and most commonly arises in the pelvis. The preoperative diagnosis of MPM is difficult to establish based on clinical and radiographic findings, and has therefore traditionally been diagnosed following surgical resection. Due to differing management of MPM and its differential diagnoses including both benign and malignant lesions, it would be beneficial to diagnose MPM preoperatively. We report a case of MPM in a middle aged female that was diagnosed by fine needle core biopsy and touch preparations, allowing for appropriate clinical management. The cytomorphologic features of needle core biopsy, immunocytochemical studies and differential diagnosis are discussed. Furthermore, despite its infrequency, the current case emphasizes the importance of the inclusion of this entity in the differential diagnosis of cystic lesions of the abdomen and pelvis at the time of on-site evaluation and final diagnosis, in order to avoid misinterpretation of strips of benign mesothelial cells as inadequate for diagnosis.

In plain English

This article was a case report with a review of the literature on multicystic peritoneal mesothelioma (MPM), an uncommon cystic growth of the abdominal lining. The patient was a 61-year-old woman with abdominal swelling, discomfort and urinary symptoms. An MRI showed a 22 cm complex cystic mass filling the pelvis and extending into the abdomen. Fluid was drawn from the mass and four needle core biopsies were taken. The cores showed cystic spaces lined by a single layer of benign-appearing cells resembling mesothelial cells, which stained positive for calretinin, cytokeratin 5/6 and cytokeratin 7. Based on the cells, the tissue structure and the staining, MPM was diagnosed before surgery. The mass was removed one year later, and examination of it confirmed the diagnosis. The authors concluded that the findings allowed a reliable diagnosis of MPM and that long-term follow-up is needed because recurrence is common and there is a minimal risk of becoming malignant. Asbestos was not studied. The authors wrote that, unlike malignant mesothelioma, no link between MPM and asbestos exposure has been cited in the literature.

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 literature
• Who was studied: One 61-year-old woman with a 2-month history of abdominal swelling and discomfort, shortness of breath and urinary symptoms. The authors are from the Department of Pathology, Northwestern Memorial Hospital, Chicago. No study dates are given.
• Exposure: No asbestos or other fiber exposure was studied or reported for the patient. The authors' discussion states that no association between MPM and asbestos exposure has been cited in the literature. The patient had earlier abdominopelvic surgery, which the authors list among apparent risk factors.
• Main results:
  • MRI showed a 22 cm complex cystic mass occupying the pelvis and extending into the abdomen.
  • Fluid drawn from the mass showed benign-appearing mesothelial cells.
  • Four needle core biopsies with touch preparations were taken from different sites within the mass.
  • The stained cores showed cystic spaces lined by a single layer of benign-appearing cells compatible with mesothelial cells.
  • In the patient's core biopsies, the lining cells were weakly and focally positive for BerEP4, and negative for cytokeratin 20, B72.3, monoclonal CEA and p63. They were also positive for calretinin, cytokeratin 5/6 and cytokeratin 7.
  • Based on the cell findings, the structure seen in the cores and the staining profile, MPM was diagnosed before surgery.
  • One year later the mass was surgically removed. Examination of the removed mass confirmed the biopsy diagnosis of MPM.
• The authors' conclusion: The authors concluded that the case highlights cell findings that allow a reliable diagnosis of MPM and the exclusion of other conditions. They also concluded that long-term follow-up is needed because of the high rate of recurrence and the minimal risk of malignant transformation.

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: Biopsy, Peritoneal Mesothelioma, Surgical Resection, Differential Diagnosis, Mesothelial Cells.

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