Fine-needle aspiration cytology of multicystic mesothelioma

Our plain-English summary of Fine-needle aspiration cytology of multicystic mesothelioma, by K. Devaney, P.J. Kragel, E.J. Devaney (Diagnostic Cytopathology, 1992).

The study

• Authors: K. Devaney, P.J. Kragel, E.J. Devaney
• Journal: Diagnostic Cytopathology
• Published: 1992;8(1):68-72
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This report details the cytologic findings from a case of peritoneal multicystic mesothelioma (MCM). Fine-needle aspiration of a 20 cm abdominal mass in a 31-year-old man yielded a specimen which consisted of a monomorphous population of mesothelial cells lacking cytologic atypia which were arranged in three patterns: monolayered sheets, single cells, and two-cell-thick strands of mesothelial cells with little or no intervening stroma. The background was clean, without necrotic debris or abundant inflammatory cells. The mesothelial cells were not arranged in prominent papillary formations; mitotic figures were not found. The mesothelial cells were cytokeratin positive and vimentin positive, and negative for carcinoembryonic antigen (CEA) and factor VIII. The FNA findings from MCM should be distinguished from those of a variety of other abdominal lesions, including cystic lymphangioma, ovarian and primary peritoneal epithelial tumors, necrotic tumors with cystic degeneration, developmental cysts, and infectious cysts.

In plain English

This was a case report describing a fine-needle aspiration (FNA) sample from one 31-year-old man with peritoneal multicystic mesothelioma, a cystic growth of the lining of the abdomen. He had noticed gradually increasing abdominal discomfort and girth for almost 10 years. A CT scan showed a mainly cystic mass about 20 cm across in the lower abdomen and pelvis. The needle sample contained a uniform population of mesothelial cells, arranged mostly as flat sheets and two-cell-thick strands, with a few single cells and a clean background. No dividing cells (mitotic figures) or significant atypia (abnormal-looking cells) were found. The cells stained positive for cytokeratin and vimentin and negative for CEA and factor VIII. The surgically removed mass measured 22 x 15 x 13 cm and weighed 1,245 g. Two years later the patient was alive and well, without evidence of recurrent disease. The authors concluded that these features, especially the two-cell-thick strands, can help identify this lesion on FNA. They cautioned that the staining and electron-microscope findings are not unique to it and may also occur in malignant mesothelial tumors. The article does not discuss asbestos.

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 (cytology of a single patient's fine-needle aspiration, with surgical pathology and a discussion of other diagnoses to consider)
• Who was studied: one 31-year-old man with a large abdominal mass diagnosed as peritoneal multicystic mesothelioma
• Main results:
  • On CT scan, the patient's mass was about 20 cm in diameter, located in the midline of the lower abdomen and pelvis, and primarily cystic.
  • The FNA sample from the patient consisted of a monotonous population of cells, arranged mainly as monolayered sheets and two-cell-thick strands, with a few single cells.
  • Mitotic figures, significant atypia or pleomorphism, three-dimensional papillary structures, mucin and psammoma bodies were looked for but not found in the patient's FNA preparations.
  • The cells in the patient's FNA sample were strongly positive for cytokeratin and positive for vimentin, and negative for Factor VIII and CEA.
  • The surgical specimen removed from the patient measured 22 x 15 x 13 cm, weighed 1,245 g, and was primarily cystic.
  • Under the electron microscope, the cells lining the patient's cysts had long microvillous processes characteristic of mesothelial cells.
  • Two years after diagnosis and treatment, the patient was alive and well, without evidence of recurrent disease.
• The authors' conclusion: The authors stated that they consider multicystic mesothelioma when an FNA from a multicystic abdominal lesion is relatively cellular and uniform, with mesothelial cells in sheets, short strands and single cells. They found two-cell-thick strands with little or no intervening stroma helpful, and said the background should be free of necrotic debris and large numbers of inflammatory cells.
• Limitations the authors state:
  • The authors noted that the staining pattern and the electron-microscope finding of microvilli are not unique to multicystic mesothelioma and may also be seen in malignant mesothelial tumors.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Fine-Needle Aspiration, Cytology, Multicystic Mesothelioma (MCM), Mesothelial Cells, Carcinoembryonic Antigen (CEA).

Related studies

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• Rounded atelectasis: diagnosis by fine-needle aspiration cytology — W.T. Miller, P.K. Gupta, et al. (1992)
• Fine-needle aspiration cytology of localized fibrous tumor of pleura — D. Dusenbery, M.M. Grimes, et al. (1992)
• Fine needle aspiration cytology of well-differentiated papillary mesothelioma: a case report — Y. Gong, R. Ren, et al. (2005)
• 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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