Laparoscopic diagnosis and treatment of pelvic benign multicystic mesothelioma associated with high CA19.9 serum concentration

Our plain-English summary of Laparoscopic diagnosis and treatment of pelvic benign multicystic mesothelioma associated with high CA19.9 serum concentration, by V. Pinto, A.C. Rossi, M.G. Fiore, et al (Journal of Minimally Invasive Gynecology, 2010).

The study

• Authors: V. Pinto, A.C. Rossi, M.G. Fiore, V. D'Addario, E. Cicinelli
• Journal: Journal of Minimally Invasive Gynecology
• Published: 2010;17(2):252-4
• Type of article: Case report
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a case of benign multicystic mesothelioma in a 20-year-old woman referred because of amenorrhea. She underwent pelvic transabdominal ultrasound, which disclosed a micropolycystic appearance of the ovaries and a fluid collection in the pouch of Douglas. Tumor serum markers revealed an increase in CA19.9. Abdominal and pelvic computed tomography scans confirmed the presence of ascites. Laparoscopy disclosed small, thin-walled, translucent cysts in the Douglas cavity. The cysts were free-floating in a yellowish, sticky, gelatinous material. Microscopically, cystic lesions showed mesothelium-lined cystic spaces surrounded by a delicate thin fibrovascular wall. With immunohistochemistry, the tumor cells were strongly positive for cytokeratin and calretinin. These aspects were suggestive of benign multicystic mesothelioma. Electron microscopy confirmed the mesothelial nature of this tumor. Serial evaluation of the CA19.9 concentration showed a progressive decrease in the serum marker in the normal range. The patient is now well and symptom-free with no recurrence 24 months after surgery. The association between benign multicystic mesothelioma and increased CA19.9 serum concentration has been described only once, in a man. To our knowledge, this is the second case of benign multicystic mesothelioma associated with increased CA19.9 serum concentration and the first diagnosed in a woman. In the present case, a minimally invasive laparoscopic approach enabled not only histologic diagnosis of benign multicystic mesothelioma but also its surgical treatment. Although benign multicystic mesothelioma is a rare pathologic entity, it is important that sonologists include it in the differential diagnosis of diseases that manifest with ascites. Furthermore, all surgeons should be aware of the macroscopic and laparoscopic appearance of the lesion, and its generally benign course.

Copyright 2010 AAGL. Published by Elsevier Inc. All rights reserved.

In plain English

This case report described a 20-year-old woman in Bari, Italy, referred because of irregular and then absent periods. Ultrasound showed fluid in the pelvis and ovaries with many small cysts. Of several blood tumor markers tested, only CA 19.9 was raised (401.6, against a range of 0 to 30.9). Her absent periods were attributed to polycystic ovary syndrome. Keyhole surgery (laparoscopy) found many thin-walled cysts, about 0.5 cm across, on the pelvic lining (peritoneum), floating in sticky gelatinous material. All the cysts gathered in the pelvis were removed, and the peritoneum and both ovaries were biopsied. Laboratory tests showed features the authors described as suggestive of benign multicystic mesothelioma, and electron microscopy confirmed the tumor's mesothelial nature. Afterwards her CA 19.9 level fell into the normal range. She had no recurrence 24 months after surgery. The authors stated that their report is limited by its short follow-up. They suggested periodic CA 19.9 testing and careful follow-up, citing the risk of local recurrence and of malignant change, which they described as rare and debated. The article did not mention asbestos exposure.

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 (single patient)
• Who was studied: One 20-year-old woman referred to a gynecology unit at the University Medical School of Bari, Italy; the date of treatment is not stated (article submitted 2009)
• Exposure: No asbestos or other exposure history is reported in the article
• Main results:
  • Of the blood tumor markers tested, only CA 19.9 was raised in this patient: 401.6 (range 0 to 30.9); units not given
  • The patient's amenorrhea was due to polycystic ovary syndrome
  • Laparoscopy found numerous thin-walled cysts about 0.5 cm in greatest diameter on the pelvic peritoneum
  • All the cysts gathered in the pelvis were removed, and multiple biopsies were taken from the peritoneum and both ovaries; the peritoneal biopsies were normal
  • The tumor cells were strongly positive for cytokeratin and calretinin; the authors described these features as suggestive of benign multicystic mesothelioma, and electron microscopy confirmed the tumor's mesothelial nature
  • After surgery, the CA 19.9 level fell progressively into the normal range
  • The patient was well and symptom-free, with no recurrence, 24 months after surgery
• The authors' conclusion: The authors concluded that sonologists should consider benign multicystic mesothelioma when ascites is found. They suggested periodic CA 19.9 measurement and careful follow-up, given the risk of local recurrence and malignant transformation, which they described elsewhere in the article as rare and debated.
• Limitations the authors state:
  • The case report is limited by a short follow-up

Topics

Medical terms in this study, explained in our Lexicon: Multicystic Mesothelioma (MCM), Ultrasound, Ascites, Mesothelium, Immunohistochemistry, Calretinin, Differential Diagnosis.

Related studies

• Long-term results of laparoscopic cytoreductive surgery and HIPEC for the curative treatment of low-grade pseudomyxoma peritonei and multicystic mesothelioma — F. Mercier, G. Jeremie, et al. (2020)
• A recurrence of benign multicystic peritoneal mesothelioma treated through laparoscopic excision: a case report and review of the literature — T.D. Witek, J.W. Marchese, et al. (2014)
• Laparoscopic excision of a benign peritoneal cystic mesothelioma — A. Limone, J. Maier, et al. (2010)
• Resection of mesothelial cyst of uterine round ligament by laparoscopic transabdominal preperitoneal procedure alone or combined with open surgery — D. Chen, P. Zhang, et al. (2019)
• Laparoscopic management of peritoneal mesothelioma associated with pelvic endometriosis — F.R. Nezhat, S.M. DeNoble, et al. (2010)
• Remote Recurrence of Benign Multicystic Peritoneal Mesothelioma — C.E. Lee, A. Agrawal (2017)

Browse return to medical research.