Differentiating a large abdominal cystic lymphangioma from multicystic mesothelioma: report of a case

Our plain-English summary of Differentiating a large abdominal cystic lymphangioma from multicystic mesothelioma: report of a case, by H. Nagata, Y. Yonemura, E. Canbay, et al (Surgery Today, 2014).

The study

• Authors: H. Nagata, Y. Yonemura, E. Canbay, H. Ishibashi, M. Narita, M. Mike, N. Kano
• Journal: Surgery Today
• Published: 2014;44(7):1367-70
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a case of retroperitoneal cystic lymphangioma in a 30-year-old woman who presented with abdominal distention and pain. Imaging studies revealed a large, thin-walled multicystic mass occupying the whole abdomen. Based on a preoperative diagnosis of multicystic mesothelioma, we performed laparotomy, which revealed a tumor arising from the gastropancreatic ligament in the posterior wall of the omental bursa. We resected the tumor completely, without the adjacent viscera. The final pathological diagnosis was cystic lymphangioma, based on the immunohistochemical findings of positive CD31 and CD34 expression, the presence of smooth muscle confirmed by smooth muscle antigen and desmin, and negative calretinin, WT-1 and cytokeratins 5/6 expression. Multicystic mesotheliomas and cystic lymphangiomas are so similar in morphology that immunohistochemical staining should be fully utilized to differentiate them.

In plain English

This article was a case report of one patient, together with a review of published literature. A 30-year-old woman came to the emergency room at Kameda Medical Center in Japan with one week of dull abdominal pain. Her abdomen had been swelling for about a year. Scans showed a mass made of many cysts, 32 cm by 18 cm, filling her abdomen. A blood marker, cancer antigen 125, was slightly raised at 69 U/ml. The doctors first thought the mass was a multicystic mesothelioma and operated. The tumor arose from the gastropancreatic ligament and was removed completely without removing nearby organs. Laboratory staining of the tissue led to a final diagnosis of cystic lymphangioma instead. The cyst lining was positive for CD31 and CD34 and negative for calretinin, WT-1 and cytokeratins 5/6, and the cyst walls contained smooth muscle. The authors stated that multicystic mesothelioma, unlike pleural mesothelioma, is not asbestos-related. They concluded that the two tumors look so alike that immunohistochemical staining should be fully used to tell them apart.

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 with a review of the literature
• Who was studied: one 30-year-old woman with no remarkable medical history, seen at Kameda Medical Center, Japan, with abdominal pain and about a year of abdominal swelling
• Exposure: No asbestos or other exposure was studied or reported for this patient. In the discussion, the authors stated that multicystic mesothelioma, unlike pleural mesothelioma, is not asbestos-related.
• Main results:
  • CT showed a multilocular, ovoid mass measuring 32 cm by 18 cm that reached the pelvis.
  • Cancer antigen 125 was slightly raised, at 69 U/ml (reference range 0 to 35 U/ml).
  • Before surgery the patient was thought to have multicystic mesothelioma, and she underwent laparotomy.
  • The tumor arose from the gastropancreatic ligament and was removed completely without removing adjacent organs.
  • The cyst-lining cells were negative for calretinin, WT-1 and cytokeratins 5/6. They were positive for mesothelin and thrombomodulin, and faintly positive for HBME-1.
  • Staining for smooth muscle antigen and desmin showed a layer of smooth muscle in the cyst wall.
  • The final diagnosis was cystic lymphangioma.
• The authors' conclusion: The authors concluded that multicystic mesotheliomas and cystic lymphangiomas are so similar in appearance that immunohistochemical staining should be fully used to tell them apart.
• Limitations the authors state:
  • The authors noted that the sensitivity and specificity of immunohistochemical markers have not yet been established for cystic mesothelioma. The marker values they cite come from peritoneal epithelioid mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Multicystic Mesothelioma (MCM), Laparotomy, CD34, Desmin, Calretinin, Wilms Tumor 1 (WT-1), Immunohistochemistry.

Related studies

• Imaging features, complications and differential diagnoses of abdominal cystic lymphangiomas — M. Raufaste Tistet, O. Ernst, et al. (2020)
• Cystic lymphangioma: an uncommon type of scrotal swelling — G. Ferguson (1954)
• An Unpleasant Surprise: Abdominal Presentation of Malignant Mesothelioma — D.J. Uhlenhopp, A. Saliares, et al. (2020)
• Benign multicystic peritoneal mesothelioma: a rare cause of intra-abdominal cystic disease — B. Campbell, D. Mehanna, et al. (2017)
• Benign cystic mesothelioma in a boy: An uncommon case mimicking a lymphangioma — P. Fernandez Eire, M.X. Lemos Bouzas, et al. (2015)
• Cystic renal cell carcinoma: arose as a simple cyst, recurred repeatedly as a multicystic mass and finally presented as a solid mass — Y. Shishikura, M. Furusato, et al. (1998)

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