International Journal of Surgery Case Reports

Our medical research library holds 25 studies published in International Journal of Surgery Case Reports (2013–2025). Each entry links to the study's record on PubMed and, where there is one, to the publisher's page and a free full text. 25 have an abstract, the authors' own summary as PubMed records it: open "Abstract" to read it.

About the journal

• Publisher: Wolters Kluwer Health, Inc
• Published: 2010 to the present, United States
• Language: English
• ISSN: 2210-2612 (electronic)
• Its record in the NLM Catalog

2020s

• Benign Multicystic Peritoneal Mesothelioma (BMPM) as a rare cause of abdominal pain: a case report and review of the literature. H.B. Hassine, M. Touati, A. Bouchrika, et al. 2025;131:111448. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: Benign Multicystic Peritoneal Mesothelioma (BMPM) is a rare, benign cystic neoplasm arising from the peritoneum, predominantly affecting women of reproductive age. It is characterized by a slow progression and a high recurrence rate post-surgical resection. Due to its non-specific clinical presentation, BMPM remains a diagnostic challenge.

  Case Presentation: We report a case of a 38-year-old female with a history of left ovarian cystectomy who presented with acute, stinging abdominal pain. Imaging studies, including ultrasound, contrast-enhanced computed tomography, and magnetic resonance imaging, revealed a large multicystic lesion in the left flank. Complete surgical excision was performed. Histopathology confirmed the diagnosis of BMPM.

  Discussion: Benign multicystic peritoneal mesothelioma (BMPM) is a rare, often asymptomatic cystic lesion predominantly affecting women of reproductive age, with unclear etiology possibly linked to hormones or prior inflammation. Imaging shows multiloculated cystic masses, and diagnosis is confirmed histologically and immunohistochemically. Surgical resection is the main treatment due to high recurrence, with close follow-up recommended.

  Conclusion: BMPM is a rare peritoneal neoplasm with a challenging diagnosis due to its non-specific symptoms and imaging characteristics. Complete surgical resection remains the mainstay of treatment, although close follow-up is necessary due to its high recurrence potential.

  Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Primary pleural small cell carcinoma with massive pleural effusion: A rare case report. P. Rabha, J.P. Wisely, A. Jain, et al. 2025;132:111450. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction And Importance: Lung cancer is the leading cause of cancer-related mortality worldwide, with small cell lung carcinoma (SCLC) accounting for significant morbidity and mortality. While SCLC typically arises from neuroendocrine cells in the central lung, primary pleural small cell carcinoma is exceedingly rare. Its atypical presentation poses diagnostic challenges, emphasizing the need for early recognition and accurate diagnosis to optimize outcomes.

  Case Presentation: A 70-year-old male presented with progressive shortness of breath and significant weight loss. Imaging revealed massive pleural effusion. Pleural fluid analysis via pleurocentesis, including cytological evaluation and cell block analysis, revealed features consistent with small cell neuroendocrine carcinoma. Immunohistochemical studies confirmed the diagnosis, with tumor cells positive for pancytokeratin, TTF1, synaptophysin, and INSM1, and negative for Napsin-A, p40, WT1, calretinin, and chromogranin. A Ki-67 proliferation index of >90 % indicated a highly proliferative tumor. Chemotherapy with Carboplatin and Etoposide was initiated, leading to a partial response as evidenced by follow-up PET-CT imaging.

  Clinical Discussion: Primary pleural small cell carcinoma is an exceptionally rare and aggressive variant of SCLC. Accurate diagnosis relies on cytological and immunohistochemical analyses to differentiate it from other pleural malignancies, particularly mesothelioma. The high Ki-67 index indicates its aggressive nature. Management follows conventional SCLC protocols, with systemic chemotherapy as the primary treatment modality. The patient's partial response highlights the potential for disease control with prompt intervention.

  Conclusion: This case highlights the rarity and aggressive nature of primary pleural small cell carcinoma. Advanced diagnostic techniques and timely treatment are critical.

  Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Giant benign mesenteric cysts (mesothelioma and lymphangioma): A report of two cases. J.E. Prior-Rosas, B. Mejía-Ruíz, B.A. Magdaleno-Becerra, et al. 2024;125:110587. PubMed · Publisher · Free full text

  Abstract

  Introduction And Importance: Mesenteric cysts are a rare group of intra-abdominal tumors located in the mesentery or omentum, most of this lesion are asymptomatically but occasionally presents with non-specific symptoms, which makes diagnosis difficult.

  Case Presentation: We present two cases of giant mesenteric cyst in our Institution, the first case is a women of 23 years with previous gynecologic surgery with chronic abdominal pain and large abdominal mass CT showed a giant intraabdominal 30 × 25 × 15 cm, the patient went to laparotomy and a large mesenteric tumor found. The Histopathology reported a Benign cyst mesothelioma (BCM). The second case is a 47 year male with intermittent abdominal pain and abdominal CT shows a 20x21x15 cm tumor. Laparotomy was performed. Histopathology reported a large lymphangioma.

  Clinical Discussion: BCM tumors are rare intrabdominal lesions often diagnosed in premenopausal women. Its etiopathogenesis is still unclear, associated risk factors are endometriosis, pelvic inflammatory disease and previous pelvic surgery. Lymphangiomas are an infrequent cyst tumors. It results from a failure in the evolutionary development of the lymphatic system, often localized in the head and neck and its localization in the abdomen is even rare. The definitive diagnosis is made by histopathology.

  Conclusion: Mesenteric cysts diagnosis if often challenge due to nonspecific symptoms and significant overlap in imaging appearance between the different entities, its diagnosis should be in mind when encounter a cystic abdominal tumor, surgical complete removal of this tumors is the optimal treatment to prevent recurrence and complications.

  Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Long-term survival from multidisciplinary treatment of primary malignant pericardial mesothelioma: A case report. V.A. Hai, N.T.M. Chau, H.V. Hoanh, et al. 2024;125:110615. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction And Importance: Primary malignant pericardial mesothelioma is an extremely rare disease with a poor prognosis. Currently, there are no specific guidelines for diagnosis and treatment in Vietnam and international countries for this disease, so treatment experiences from previous clinical cases are very important in the management of this disease.

  Case Presentation: The research team reports a clinical case diagnosed and treated with a combination of surgery and chemotherapy using the Pemetrexed + Carboplatin regimen at the Oncology Center. The patient has survived for an additional 17 months up to the current time.

  Clinical Discussion: This is an exceptionally rare incident. He survived for a duration of 17 months, which is almost three times longer than the average survival time observed in other documented cases. Additional reports on cases with pericardial mesothelioma are necessary to have a comprehensive understanding of its nature, enabling early identification and appropriate treatment.

  Conclusion: The patient underwent surgical intervention and received chemotherapy as part of their treatment. The research team emphasizes the importance of a multidisciplinary approach in diagnosing and treating primary malignant pericardial mesothelioma.

  Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Case report and analysis of the literature on sarcomatous mesothelioma of the left atrium. W. Rouabeh, T. Cherif, I. Mgarrech, et al. 2023;109:108537. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction And Importance: Primary intracardiac malignant mesothelioma is an extremely uncommon condition with a terrible prognosis. Because of its rarity, there have been extremely few examples described in the literature.

  Case Presentation: We are reporting the instance of a 44-year-old lady who was referred to the department of cardiology for worsening dyspnea, palpitations, and a recent syncopal episode. On examination, the patient had signs of global heart failure. Cardiac imaging showed a tissue mass infiltrating the atrioventricular sulcus at the mitral valve level, responsible for severe mitral stenosis. Pleural effusion without an intrapleural mass was also noted. Urgent surgery was performed, including excision of the tumor mass, mechanical replacement of the mitral valve, and tricuspid plasty. The anatomo-pathological study concluded in cardiac mesothelioma. The patient was transferred back to the cardiology department 9 months after surgery due to severe left heart failure. TTE and TOE were performed and revealed tumor recurrence responsible for severe mitral stenosis. The course was marked by the onset of cardiogenic shock refractory to treatment, followed by the death of the patient. The case we are reporting seems to be the initial instance documented as exclusively primary intracardiac mesothelioma especially its lack of association with any other pleural sarcomatoid mesothelioma or asbestos exposure.

  Clinical Discussion: In cases where a large atrial tumor is present, prompt surgical intervention is recommended to mitigate the risk of catastrophic embolization or valve orifice obstruction. The objective of surgical intervention is to excise the entire neoplasm with sufficient surrounding tissue, a feat that is infrequently achievable. Palliative debulking may be a beneficial intervention for patients who do not necessitate complete resection, particularly those experiencing relevant or rapidly escalating symptoms. Cardiac transplantation remains a viable option in the event of an unresectable malignant tumor.

  Conclusion: The short-term prognosis is poor. Surgical treatment remains the best treatment for this type of tumor. Total excision should be considered, but may not be feasible in all cases. Adjuvant chemotherapy may be considered.

  Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Response to Nivolumab followed by complete cytoreductive surgery with HIPEC resulted in long-term survival in a patient with sarcomatoid-predominant biphasic peritoneal mesothelioma. A case report. P.H. Sugarbaker. 2023;107:108359. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction And Importance: Sarcomatoid-predominant biphasic peritoneal metastases is a rapidly progressing and deeply invasive variant of this disease with survival measured in months. Although cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is a standard of care for epithelioid peritoneal mesothelioma, the sarcomatoid variant is so aggressive, the standard treatment is not recommended. Immunotherapy has recently been utilized for pleural mesothelioma. Partial responses to immunotherapy may be combined with CRS to achieve a favorable outcome in sarcomatoid-predominant peritoneal mesothelioma.

  Case Presentation: A 39-year-old woman developed an expanding abdomen. A 10 cm pelvic mass was removed by hysterectomy. With an initial diagnosis of advanced ovarian cancer, she was treated with cisplatin plus paclitaxel. Disease progression led to a review of her original pathology and a repeat biopsy which showed biphasic peritoneal mesothelioma with sarcomatoid predominance. Treatment with Nivolumab was transiently beneficial. Repeat CT 8 months later showed partial bowel obstruction and necrotic expanding tumor masses that were partially calcified. CRS with HIPEC and normothermic long-term intraperitoneal pemetrexed (NIPEC) plus intravenous cisplatin resulted in a 5-year disease-free survival.

  Clinical Discussion: The specimens removed at CRS showed marked progression within large masses. Smaller masses resected with CRS showed fibrosis and calcification. The response to Nivolumab was heterogeneous with smaller masses with good blood supply adequately treated but larger masses markedly progressed.

  Conclusions: A combination of partial response to immunotherapy with a complete CRS plus HIPEC and NIPEC can result in a long-term favorable outcome.

  Copyright © 2023 The Author. Published by Elsevier Ltd.. All rights reserved.

• Surgical management of a benign multicystic peritoneal mesothelioma: A case report. S. Amine, O. Yacine, A. Souhaib, et al. 2023;107:108308. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction And Importance: Benign multicystic peritoneal mesothelioma is rare, with around 200 cases reported in the literature. We report the case of a patient operated on for the diagnosis of cystic lymphangioma but the pathology examination retained the diagnosis of benign cystic peritoneal mesothelioma.

  Case Presentation: A 47-year-old patient, who consulted for abdominal distension evolving for a year. Examination revealed a 30-centimeter abdominal mass. The CT scan showed an intraperitoneal cystic mass measuring 24 × 13 × 32 cm. The diagnosis of cystic lymphangioma was suspected and we decided to surgically remove the mass. We performed a laparotomy. There was a large multi-cystic formation that seemed to develop at the expense of the parietal peritoneum and the greater omentum. A monobloc resection was performed. The postoperative was eventless. Pathology concluded to a benign cystic peritoneal mesothelioma.

  Discussion: The BMPM is a rare peritoneal neoplasm that develops mainly in women, during sexual activity. Its etiopathogenesis is unknown. It is often mesenteric or omental. Generally, resection is considered the sole treatment for benign mesotheliomas. However, this surgery needs to be R0 or it will expose to a certain recurrence. Some authors recommend a more aggressive approach associating cytoreductive surgery with heated intraperitoneal chemotherapy.

  Conclusion: Benign multicystic peritoneal mesothelioma is a rare pathology of the peritoneum which develops mainly in women during periods of reproductive activity. Despite its benignity, it presents a high risk of recurrence, up to 50 % of cases.

  Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Benign multicystic mesothelioma of appendiceal origin treated by hyperthermic intraperitoneal chemotherapy: A case report. S.J. Lee, J.H. Nahm, J. Kang, et al. 2022;99:107665. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction And Importance: Peritoneal benign cystic mesothelioma is a rare benign tumor that originates from a mesothelial proliferative lesion of the peritoneum. However, proper surgical management remains unclear due to its low incidence. We report a clinical case of peritoneal benign cystic mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).

  Case Presentation: A 60-year-old female who underwent laparoscopic appendectomy in 2015 presented with abdominal pain in right lower quadrant area. Computed tomography of the abdomen and pelvis revealed a ruptured appendiceal mucocele or mucinous neoplasm, and several seeding-like small nodules in the greater omentum and right peritoneum. Cytoreductive surgery followed by HIPEC was performed; right hemicolectomy and lymph node dissection, omentectomy, and right abdominal partial peritonectomy. HIPEC with mitomycin was conducted for 90 min and an anastomosis between the ileum and colon was made after HIPEC. The pathologic results revealed the colonic mass was a multi-loculated cyst lined by mesothelial cells containing amorphous eosinophilic fibrinoid material, which are common features of benign cystic mesothelioma.

  Clinical Discussion: Peritoneal benign cystic mesothelioma is known as a borderline disease of mesothelial tumors. Because its etiology is unknown, treatment strategies are not determined.

  Conclusion: Cytoreductive surgery followed by HIPEC can be considered to treat peritoneal benign cystic mesothelioma and prevent its malignant transformation.

  Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Benign cystic mesothelioma: A case report on the presentation of an unusual tumor. Y. Salem, A. Farhan, H.S. Aljawder, et al. 2021;82:105918. PubMed · Publisher · Free full text

  Abstract

  Introduction: Benign cystic mesothelioma of the peritoneum is a rare, benign abdominal tumor. It can present with vague signs and symptoms and is often found on imaging or incidentally during surgery.

  Presentation Of Case: We report the case of a 30-year-old man presenting with acute abdominal pain that radiated to the right iliac fossa. No masses were found on superficial or deep palpation or on conducting a sonography. The patient underwent a diagnostic laparoscopy with an appendectomy, which revealed a perforated appendix and two cysts in the pelvis and iliac fossa.

  Discussion: A benign cystic mesothelioma is an inclusion cyst found in the peritoneal cavity and has no specific clinical presentation. It can be symptomatic or found incidentally during surgery. Benign cystic mesotheliomas have a high recurrence rate and may undergo malignant transformation.

  Conclusion: Complete surgical excision of benign cystic mesothelioma must always be the first step of the treatment plan for this condition. It is difficult to treat with no evidence-based treatment modality available; thus, treatment should only be undertaken in a specialized center.

  Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

• Extra-gastrointestinal stromal tumor presenting as a huge peritoneal mass and mimicking as mesothelioma - A case report. D. Ghartimagar, A. Ghosh, M.K. Shrestha, et al. 2021;78:351-355. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction And Importance: Extra-gastrointestinal stromal tumors are group of soft tissue neoplasm, which originates outside the gastrointestinal tract comprising of less than 5% of the total gastrointestinal stromal tumors.

  Case Presentation: A 67 years old male came with a history of vague abdominal pain, discomfort and loss of appetite. Per abdominal examination showed a palpable firm mass which was filling both the flanks. Radiological imaging revealed a large abdomino-pelvic mass with central necrotic areas. Exploratory laparotomy was done and the mass was excised intact from the sigmoid mesocolon. Histopathological diagnosis was given as extra-gastrointestinal stromal tumors.

  Clinical Discussion: Extra-gastrointestinal stromal tumor was first described by Miettinen et al. in 1999. The tumor can arise from the pleura, omentum, mesentery, retroperitoneum and prostate. The clinical presentation of the tumor depends on its location and the size of tumor. Patients with these tumors present with abdominal pain, followed by abdominal mass and distention. These tumors show pathological, immunohistochemical and molecular biological characters similar as that of gastrointestinal stromal tumor.

  Conclusion: Extra-gastrointestinal stromal tumor is a rare tumor and can reach to a considerable large size before presenting with clinical symptoms especially if the tumor arises from the mesocolon. IHC study plays an important role to reach to the final diagnosis as the tumor can mimic mesothelioma in routine staining.

  Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Giant retroperitoneal myxoma: A case report and literature review. Z. Zhang, L. Song, X. Zhu, et al. 2021;84:106055. PubMed · Publisher · Free full text

  Abstract

  Introduction And Importance: Myxoma is a benign tumor and is mesenchymal in origin. Myxomas of the retroperitoneum are extremely rare entities.

  Case Presentation: We here report a case of a 67-year-old male who presented with progressive abdominal distention for 3 years. Laboratory investigations revealed a reduction in erythrocytes, lymphocytes, hemoglobin, and an elevation in carbohydrate antigen 19-9. Imaging findings showed a multilocular cystic mass in the right abdomen with thin septa and internal calcifications. Laparotomy revealed that the mass had arisen from the retroperitoneum and the histological study suggested the diagnosis of myxoma.

  Discussion: Myxoma features as a "cystic mass" in imaging studies. Therefore, the possibility of a cystic lymphangioma, cystic mesothelioma and myxoma should be considered when a multicystic lesion in the retroperitoneal space is observed. Due to the rarity of retroperitoneal myxomas and lack of specific manifestations and diagnostic methods, preoperative diagnosis is often delayed or incorrect. And until now, only a few cases of retroperitoneal myxoma have been reported.

  Conclusion: The report will increase the understanding of the diagnosis and treatment of retroperitoneal myxomas. A brief review of the related literature was also carried out.

  Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Malignant pleural mesothelioma showing rare morphology indistinguishable from myxofibrosarcoma concomitant with EGFR-mutated lung adenocarcinoma: A case report. H. Onagi, T. Hayashi, T. Saito, et al. 2021;85:106237. PubMed · Publisher · Free full text

  Abstract

  Introduction And Importance: Primary tumors of the pleura are rare, with malignant mesothelioma being the most common of these neoplasms. Pathological diagnosis of sarcomatoid mesothelioma can be more challenging than that of epithelioid malignant mesothelioma because of its similarities with true sarcomas and restricted or inconsistent expression of mesothelial markers in immunohistochemistry analysis.

  Presentation Of Case: Here, we present an unusual case of malignant pleural mesothelioma concomitant with lung adenocarcinoma in a 72-year-old Japanese man, a smoker with no family history of cancer and asbestos exposure. Malignant pleural mesothelioma is composed of epithelial and spindle-shaped cells. Spindle-shaped cells with scant eosinophilic cytoplasm and hyperchromatic nuclei proliferated in abundant myxoid stroma containing thin-walled blood vessels, mimicking myxofibrosarcoma. The loss of BAP1 (BRCA1-associated protein 1) expression, as assessed by immunohistochemistry, and homozygous deletions of CDKN2A, detected using fluorescence in situ hybridization (FISH), were observed in both components. Targeted sequencing revealed that lung adenocarcinoma harbored EGFR mutations, whereas no mutations were detected in either component of biphasic mesothelioma.

  Discussion: Although alcian blue-stained mucins were detected in biphasic mesothelioma subsets, the clinicopathological significance of myxoid stroma in biphasic and sarcomatoid mesothelioma remains largely unknown.

  Conclusion: Our case presented a unique morphology mimicking myxofibrosarcoma in a sarcomatoid component of biphasic mesothelioma; therefore, it raises a question on the clinicopathological significance of myxoid stroma in sarcomatous areas of biphasic and sarcomatoid mesothelioma.

  Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Peritonectomy of the colonic mesentery. Case report of a new surgical technology. P.H. Sugarbaker. 2021;86:106369. PubMed · Publisher · Free full text

  Abstract

  Introduction And Importance: Malignant peritoneal mesothelioma is a local-regional disease process that requires a comprehensive treatment plan including complete cytoreductive surgery and regional chemotherapy.

  Case Presentation: Treatments used in our patient began with a complete cytoreductive surgery. This required visceral resections, parietal peritonectomy, peritonectomy of the small bowel and its mesentery, and a peritoneal resection of the colonic mesentery with sparing of the major vasculature of the large bowel.

  Clinical Discussion: Peritoneal resection of the colonic mesentery and other treatments were performed in the absence of major complications. A 20-day hospitalization was required. The patient shows no internal hernias and no evidence of disease by CT follow-up at 4 years postoperatively. Her quality of life is excellent.

  Conclusions: Malignant peritoneal mesothelioma was in the past a disease of limited survival without effective treatment options. Peritoneal resection of the colonic mesentery may be required for complete cytoreduction. A sequence of cytoreductive surgical procedures and regional chemotherapy treatments has made long-term survival possible.

  Copyright © 2021 The Author. Published by Elsevier Ltd.. All rights reserved.

• Benign multi-cystic peritoneal mesothelioma of the porta hepatis. H. Aziz, M. Hao, A. Merchant, et al. 2020;74:218-221. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: Our case report describes a patient where multiple laparoscopies five years from initial presentation of symptoms were performed prior to laparotomy for benign multi-cystic peritoneal mesothelioma (BMPM), which has not been documented.

  Presentation: A 61-year-old woman presented with years of chronic abdominal pain. Computerized tomography (CT) demonstrated a multi-cystic mass near the porta hepatis, and ultrasound was concerning for contained gallbladder perforation. Fine needle aspiration (FNA) demonstrated benign ductal epithelial cells in a background of mucin and bile without the presence of malignant cells. During laparotomy, a cystic mass attached to the porta hepatis seen emanating from the small bowel mesentery, and additional small cystic lesions through the abdomen were removed. The specimen, measuring 26 × 18 × 8 cm, showed multi-loculated cysts filled with serous fluid.

  Discussion: BMPM is a rare neoplasm of mesothelioma cells originating from serosa of viscous organs. BMPMs appear as cystic structures with thin walls containing mucinous/gelatinous fluid. Microscopic features include a lack of invasion and no increased cellularity in the stroma, with or without inflammation (Myers & Babiker, 2018). It is postulated to be either a reactive or neoplastic process. There is no gold-standard treatment for BMPM. Our case is unique in the sense that our patient required several surgical biopsies before final diagnosis could be made.

  Conclusion: This case highlights the difficulty of diagnosing BMPM and differentiating it from malignant diseases that can present similarly and can be associated with significantly worse prognosis. Defined management strategies have yet to be demonstrated.

  Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Malignant peritoneal mesothelioma presenting as a mass in a Spigelian hernia. Report of a case. P.H. Sugarbaker. 2020;68:239-241. Case report PubMed · Publisher · Free full text

  Abstract

  Background: Gastrointestinal cancer, gynecologic cancer and malignant peritoneal mesothelioma may disseminate widely to the surfaces of the abdomen and pelvis. In some patients this spread of the disease may find its way into a hernia sac.

  Methods: The Spigelian hernia is caused by a protrusion of the peritoneum of the anterior abdominal wall into the abdominal wall muscle. This peritoneal defect occurs through the semilunar line of Spiegel in or closely associated with the semicircular line of Douglas.

  Results: A patient presented with a large (11 cm greatest diameter) mass in the left lower quadrant. The mass was composed of malignant peritoneal mesothelioma and was anatomically located within the Spigelian hernia belt. At the time of cytoreductive surgery numerous other sites of malignant peritoneal mesothelioma were present within the abdomen and pelvis.

  Conclusions: The left lower quadrant mass was a malignant peritoneal mesothelioma presenting within a Spigelian hernia defect. This phenomenon has not been previously reported.

  Copyright © 2020 The Author. Published by Elsevier Ltd.. All rights reserved.

• Multicystic peritoneal mesothelioma treated with complete cytoreductive surgery, peritonectomy and hyperthermic intra-peritoneal chemotherapy-A case report. N. Padmanabhan, H. Ishibashi, K. Nishihara, et al. 2020;74:152-157. Case report PubMed · Publisher · Free full text

  Abstract

  Background: Multicystic Peritoneal mesothelioma is a rare and distinct variety of peritoneal mesothelioma with borderline malignant potential. Conventional Tumor bulking has been associated with recurrence of 45-50 %. Hence a comprehensive treatment with Complete cytoreductive surgery with involved field peritonectomy (CRS) and Hyperthermic Intra-peritoneal chemotherapy (HIPEC) is being increasingly adopted for MCPM.

  Case Presentation: A 47 year old lady evaluated for peri-menopausal disturbance was diagnosed to have a multicystic lesion in the pelvis. With a preoperative suspicion of diagnosis of pseudomyxoma peritonei, CRS with HIPEC was planned. On exploration a diffuse multicystic mass was found in omentum and pouch of douglas with typical morphological features of MCPM. Complete cytoreduction was achieved with anterolateral and sub-diaphragmatic peritonectomy, omentectomy and panhystrectomy. HIPEC was performed with cisplatin 50 mg/m2 for 40 min. Pathological examination revealed MCPM of omentum and uterine surface with focal clusters of mesothelial proliferation. However there was low proliferative activity 1-2 %.

  Discussion: MCPM presents with wide spread peritoneal spread but with relative sparing of visceral invasion. Literature review suggests the disease spread is similar to PMP and treatment with CCRS and HIPEC has yielded long term survivals in MCPM.

  Conclusions: This patient with voluminous disease burden in abdomen required surgical management and HIPEC for her condition. Whether CCRS alone without HIPEC can be an alternative for limited disease will be interesting research for future clinical reports.

  Copyright © 2020. Published by Elsevier Ltd.

• Primary malignant pericardial mesothelioma presenting with cardiac tamponade. S. Matsuyama, T. Imazuru, M. Uchiyama, et al. 2020;73:253-256. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: Primary malignant pericardial mesothelioma is a rare tumor that is very difficult to diagnose. Furthermore, it is a lethal disease, because patients usually have progressed at the time of referral.

  Presentation Of The Case: We report a 44-year-old man with primary malignant pericardial mesothelioma. He was referred to our hospital for the diagnosis and treatment of a massive pericardial effusion and huge tumor. Pericardiocentesis was performed, but we could not obtain definitive diagnosis, and the cardiac tamponade continued along with the signs/symptoms. He required surgical intervention for the diagnosis and treatment. After surgery, his signs/symptoms improved. He received adjuvant therapy, although he died 7 months after surgery.

  Discussion: Primary malignant pericardial mesothelioma is a rare tumor. The most common signs and symptoms are related to constriction of the heart by the tumor and/or effusion. Even if the pericardial fluid specimen obtained by pericardiocentesis is negative for malignant cells, primary malignant pericardial mesothelioma should be included in the differential diagnosis. Because the malignancy is usually advanced at the time of diagnosis, it has been difficult to cure. Radiation and chemotherapy have been used in addition to surgery, but have been minimally effective.

  Conclusion: The outcome of our patient with pericardial malignant mesothelioma was dismal. The indications for surgical intervention should be carefully considered except for critical cases requiring alleviation of immediate life-threating conditions.

  Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Spontaneous diaphragmatic rupture following neoadjuvant chemotherapy and cytoreductive surgery in malignant pleural mesothelioma: A case report and review of the literature. M. Cattaneo, P. Mendogni, F. Damarco, et al. 2020;77S(Suppl):S85-S87. Case report PubMed · Publisher · Free full text

  Abstract

  Introduction: Diaphragmatic rupture (DR) is an acquired diaphragmatic defect that can cause herniation of abdominal organs into the chest. It is usually a trauma-related lesion, but rarely it can occur spontaneously. Every DR with abdominal herniation should be considered a surgical emergency.

  Presentation Of Case: A 61-year-old male patient, with previous exposure to asbestos, was diagnosed of Stage Ib malignant pleural mesothelioma (MPM). He underwent neo-adjuvant chemotherapy (three cycle of cisplatin-pemetrexed combination) and a cytoreductive surgery with pleurectomy/decortication. Post-operative course was characterized by prolonged air-leakage (PAL). After three months, during a follow-up CT-scan, a spontaneous diaphragmatic rupture (SDR) with gastric herniation was detected and treated by a laparascopic diaphragmatic repair and suture.

  Discussion: Spontaneous diaphragmatic rupture (SDR) is an extremely rare injury of the diaphragm (less than 1% of all DR). In this case, potential predisposing factors for SDR could be: presence of diaphragmatic "locus minoris resistentiae" due to thinning of the diaphragm and increase tissue fragility after neo-adjuvant chemotherapy and diaphragmatic pleural stripping; increased thoraco-abdominal pressure gradient due to PAL and residual pleural space. Thus, we confirmed the feasibility and safety of the laparoscopic approach.

  Conclusion: We highlight the multifactor etiopathology, the challenging diagnosis and the importance of a prompt treatment of SDR.

  Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

2010s

• Hyperthermic intraperitoneal chemotherapy in management of malignant intraductal papillary mucinous neoplasm with peritoneal dissemination: Case report. C. Sirisai, Y. Yonemura, H. Ishibashi, et al. 2019;63:85-88. PubMed · Publisher · Free full text

  Abstract

  Introduction: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are treatment to deal with peritoneal dissemination that has excellent result for various cancer especially pseudomyxoma peritonei (PMP), mesothelioma. For now, this combination of treatment is still running for pancreatic adenocarcinoma but no description for pancreatic cystic tumor like malignant Intraductal papillary mucinous neoplasm (IPMN).

  Presentation Of Cases: We report 3 cases of malignant IPMN with peritoneal dissemination that treated with CRS and HIPEC. Two cases have atypical presentation of malignant IPMN with PMP. HIPEC was performed using cisplatin-based regimen. The longest survival in this study is 93 months, compared to the median survival of 44.3 months without HIPEC.

  Discussion: CRS and HIPEC have not proven to treat in patient with pancreatic cystic tumor with peritoneal dissemination. But these treatments can be improved survival outcome in selected patient.

  Conclusion: CRS and HIPEC trend to improve survival. More studies need, not only to evaluate the role of HIPEC on malignant IPMN, but also prognosis and outcome.

  Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Primary intrahepatic mesotheliomas: A case presentation and literature review. H. Ismael, S. Cox. 2018;47:1-6. PubMed · Publisher · Free full text

  Abstract

  Introduction: Primary Intrahepatic mesotheliomas are malignant tumors arising from the mesothelial cell layer covering Glisson's capsule of the liver. They are exceedingly rare with only fourteen cases reported in the literature. They have nonspecific signs and symptoms and need a high index of suspicion and an extensive workup prior to surgery. Surgery remains the mainstay of treatment.

  Presentation Of Case: 48 year old male presented with a 3 months history of abdominal pain, productive cough, anemia and weight loss. He had no history of asbestos exposure. A computed tomography scan and magnetic resonance study demonstrated a heterogeneous subscapular mass within the dome of the right hepatic lobe measuring 11.3 × 6.1 cm involving the diaphragm. Combined resection of the liver and diaphragm was performed to achieve negative margins. Pathology demonstrated an epithelioid necrotic intrahepatic mesothelioma that stained positive for calretinin, CK AE1/AE3, WT-1, D2-40 and CK7.

  Discussion: Primary intrahepatic mesotheliomas originate from the mesothelial cells lining Glisson's capsule of the liver. They predominantly invade the liver but may also abut or involve the diaphragm. Surgery should include a diagnostic laparoscopy to rule out occult disease or diffuse peritoneal mesothelioma. Complete resection with negative margins should be attempted while maintaining an adequate future liver remnant. Attempts at dissecting the tumor off the involved diaphragm will result in excessive bleeding and may leave residual disease behind.

  Conclusion: Intrahepatic mesotheliomas are rare peripherally-located malignant tumors of the liver. They require a high index of suspicion and a comprehensive workup prior to operative intervention.

  Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Triple primary malignancies in a patient with colorectal adenocarcinoma: A case report. Q. Huang, X. He, H. Qin, et al. 2018;42:34-37. PubMed · Publisher · Free full text

  Abstract

  Introduction: While colorectal carcinoma is one of the most commonly diagnosed malignancies, its synchronous occurrence with other primary malignancies is rare.

  Presentation Of Case: In this case, we describe the diagnosis and surgical intervention of a 55-year-old male patient who was found to have colonic adenocarcinoma at the hepatic flexure, right renal urothelial carcinoma, and malignant mesothelioma.

  Discussion: None of the previous studies reported these three distinct types of cancer, even in those patients with Lynch Syndrome. To the best of our knowledge, this is the first report of such case. The etiology and pathogenesis of multiple primary malignancies are complex. Common genetic and environmental risk factors that were found in different cancers might increase the risk of multiple primary malignancies.

  Conclusion: The use of genetic testing and preoperative imaging studies should be considered to be invaluable tools for detecting synchronous malignancies. Practicing physicians should pay more attention to the risk of simultaneous separate primary malignancies.

  Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Giant primary malignant mesothelioma of the liver: A case report. R. Haji Ali, M. Khalife, G. El Nounou, et al. 2017;30:58-61. PubMed · Publisher · Free full text

  Abstract

  Introduction: Malignant mesothelioma is a rare neoplasm of mesothelial cells arising most frequently in the pleura or peritoneum and less frequently in the liver.

  Case Presentation: We present a case of primary hepatic mesothelioma of 41year old woman. She had no history of asbestos exposure or cancer. Abdominal computed tomography (CT) showed 21cm intrahepatic mass in the right lobe with many cystic lesions and few small calcifications. Pathology showed a biphasic cellular pattern. In addition, the tumor cells were positive for Calretinin, Creatine Kinase (CK)5/6, CK7, CKAEI 1/3, Wilms Tumor protein (WT-1), and Vimentin, but were negative for Alpha Feto protein (AFP), Thrombotic Thrombocytopenic Purpura (TTP-1), Anti-Hepatocyte Specific Antigen (HSA), Synaptophysin, CK20, and Homeobox protein (CDx-2).

  Discussion: Primary intrahepatic mesothelioma (PIHMM) is not included in the classification of the World Health Organization classification of hepatic tumors. Mesothelial cells are not normally found in the liver, but some reported cases suggest it may grow from the mesothelial cells of the Glisson's capsule.

  Conclusion: The probability of hepatic mesothelioma should not be ruled out, even in a young woman without a clear history of asbestos exposure.

  Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

• Laparoscopic treatment of retroperitoneal cystic mesothelioma. Two cases reported. S. Morales Artero, C.J. Castellón Pavón, E. Larraz Mora, et al. 2016;29:230-233. PubMed · Publisher · Free full text

  Abstract

  Retroperitoneal cystic mesothelioma is a very rare lesion. The pathogeny is unclear and establishing a preoperative diagnosis versus others retroperitoneal cystic lesions is difficult. Thus, with increasing experience in laparoscopic retroperitoneal surgery, the use of this approach for exploration of a retroperitoneal mass of unknown origin may provide an alternative to classic open surgery and all the benefits of laparoscopy. We present two cases treated laparoscopycally and review the literature.

  Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

• Primary intrahepatic malignant epithelioid mesothelioma. I. Perysinakis, A.M. Nixon, I. Spyridakis, et al. 2014;5(12):1098-101. PubMed · Publisher · Free full text

  Abstract

  Introduction: Primary malignant hepatic mesotheliomas are extremely rare. We report the case of a patient with primary intrahepatic malignant mesothelioma who was treated in our department.

  Presentation Of Case: A 66-year old male patient was admitted to our department for the evaluation of anemia. An abdominal computed tomography scan revealed a large space occupying lesion in the right liver lobe.

  Discussion: The tumor was subsequently resected and a diagnosis of primary intrahepatic malignant mesothelioma was made after pathologic examination. The patient did not receive adjuvant therapy and is currently alive and free of disease, 36 months after the resection.

  Conclusion: To our knowledge this is the eighth adult case of primary intrahepatic malignant mesothelioma reported in the literature. These tumors are rarely diagnosed preoperatively. Absence of previous asbestos exposure does not exclude malignant mesothelioma from the differential diagnosis. Proper surgical treatment may offer prolonged survival to the patient, without adjuvant therapy.

  Copyright © 2014. Published by Elsevier Ltd.

• Pulmonary mucinous cystadenocarcinoma presenting as a pleural mesothelioma. R. Kassir, F. Forest, D. Kaczmarek. 2013;4(11):942-4. PubMed · Publisher · Free full text

  Abstract

  Introduction: Primary Pulmonary Mucinous Cystadenocarcinoma PPMC is an extremely rare subtype of pulmonary adenocarcinoma, with only a few dozen cases reported in the literature to date.

  Presentation Of Case: We report a extremely rare case of pulmonary mucinous cystadenocarcinoma presenting as a pleural mesothelioma. 53-year-old man exposed to asbestos, he is admitted in hospital with a 5cm mass in right pleura. He was treated by wedge resection. Sparse groups of malignant cells were microscopically observed in pools of mucin. The postoperative histopathological findings were in accordance with the diagnosis of pulmonary mucinous cystadenocarcinoma on cystic adenoid malformation of lung. 5 years later, the patient has no recurrence.

  Discussion: PPMC is usually asymptomatic; hemoptysis is seen occasionally. Preoperative diagnosis is very difficult to establish. Both FNA cytology and transbronchial lung biopsy seem inadequate. Our patient went on to undergo open lung biopsy and histopathological testing that confirmed the diagnosis of PMC.

  Conclusion: It is important to differentiate this rare pathological feature of the lung from other lung tumors as the treatment is surgical rather than medical. Thoracic surgeons should bear in mind this rare tumor for the differential diagnosis of a pleural mesothelioma because this tumor has a favorable prognosis.

  Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

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