Malignant biphasic peritoneal mesothelioma in a child: fine-needle aspiration cytology, histopathology, and immunohistochemical features along with review of literature

Our plain-English summary of Malignant biphasic peritoneal mesothelioma in a child: fine-needle aspiration cytology, histopathology, and immunohistochemical features along with review of literature, by S.K. Arora, R. Srinivasan, R. Nijhawan, et al (Diagnostic Cytopathology, 2012).

The study

• Authors: S.K. Arora, R. Srinivasan, R. Nijhawan, D. Bansal, P. Menon
• Journal: Diagnostic Cytopathology
• Published: 2012;40(12):1112-5
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Peritoneal mesotheliomas in children are of rare occurrance. We herein report the clinical, radiological, and pathological findings of a rare case of malignant peritoneal mesothelioma occurring in nine-year-old female child. The child presented with abdominal distension and awareness of a painless mass in the abdomen which on radiology appeared as a large heterogeneous pelvic mass with peritoneal deposits at multiple sites. To the best of our knowledge, this is the first case of a peritoneal malignant mesothelioma on which fine needle aspiration (FNA) was performed as first line investigation of the primary tumor. The cytological features, major differential diagnoses, and the pitfalls therein are discussed. Histopathology revealed biphasic pattern of mesothelioma which is again a rare pattern. Immunochemistry was carried out on the cell block made from the FNA as well as the biopsy specimen essentially showed the same features. There was positivity for vimentin, EMA, and cytokeratin 5/6 while WT1, calretinin, and CEA were negative; however, D2-40 showed diffuse membranous positivity in the epithelial areas and cytoplasmic positivity in the spindle areas confirming a mesothelioma. We emphasize the use of immunochemistry on cell block material for a confident diagnosis of mesothelioma in such cases.

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In plain English

This article was a case report about one nine-year-old girl from a remote village in Himachal Pradesh, India, who had malignant peritoneal mesothelioma, a cancer of the lining of the abdomen. She came with a swollen abdomen and a painless mass. The report recorded no history of direct or indirect asbestos exposure. Scans showed a large pelvic mass with deposits on the abdominal lining, and doctors first suspected a germ cell tumor. Cells taken with a fine needle showed a cancer that was hard to classify. Rhabdomyosarcoma and malignant teratoma were considered. Tissue removed at surgery showed a biphasic mesothelioma, meaning it had both epithelial and spindle-cell parts. Staining tests on the needle sample and the surgical tissue gave the same results and confirmed mesothelioma. To the best of their knowledge, the authors said, this was the first peritoneal mesothelioma in which fine-needle aspiration was used as the first-line investigation of the main tumor. They concluded that staining tests on needle-sample cell blocks can support a confident diagnosis in such cases.

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), with a discussion of the diagnostic difficulties
• Who was studied: One nine-year-old girl from a remote village in Himachal Pradesh, India, whose father was a farmer; seen at the Postgraduate Institute of Medical Education and Research, Chandigarh
• Exposure: No asbestos exposure was reported for this child
• Main results:
  • The first clinical diagnosis was a malignant germ cell tumor, but the child's blood tumor markers (alpha fetoprotein and beta-hCG) were normal
  • Fine-needle aspiration showed a malignant tumor that could not be classified further. Rhabdomyosarcoma with florid mesothelial hyperplasia, or malignant teratoma, were considered
  • Tissue from the laparotomy biopsies showed a biphasic mesothelioma
  • Staining on the FNA cell block and on the biopsy tissue gave the same results. The tumor was positive for markers including cytokeratin 5/6 and D2-40, and negative for WT1, calretinin and CEA
  • D2-40 staining appeared on the cell membranes in the epithelioid areas and in the cell cytoplasm in the spindle areas
  • Desmin was weakly positive, but myogenin was negative, which the authors took as excluding rhabdomyosarcoma
  • Looking back at the cytology slides, the authors found the features quite suggestive of malignant mesothelioma
• The authors' conclusion: The authors believed, to the best of their knowledge, that this was the first peritoneal malignant mesothelioma in which FNA was performed as the first-line investigation of the primary tumor. They emphasized staining (immunochemistry) on cell block material for a confident diagnosis of mesothelioma in such cases.
• Limitations the authors state:
  • The child had no ascites, so peritoneal fluid could not be examined

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: Biphasic Mesothelioma, Peritoneal Mesothelioma, Fine-Needle Aspiration, Cytology, Histopathology, Malignant Mesothelioma, Mesothelioma, Cell Block.

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