Malignant peritoneal mesothelioma in patients with endometriosis

Our plain-English summary of Malignant peritoneal mesothelioma in patients with endometriosis, by K.J. Butnor, J. Rueckert, E.N. Pavlisko, et al (Journal of Clinical Pathology, 2018).

The study

• Authors: K.J. Butnor, J. Rueckert, E.N. Pavlisko, T.A. Sporn, V.L. Roggli
• Journal: Journal of Clinical Pathology
• Published: 2018;71(11):971-974
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: Florid mesothelial hyperplasia is known to result from endometriosis. Well-differentiated papillary mesothelioma and multiloculated peritoneal inclusion cysts have also been described in women with endometriosis. To our knowledge, peritoneal diffuse malignant mesothelioma (MM) arising in the setting of endometriosis has not been reported. The purpose of this study is to report the clinicopathological characteristics of women with MM and endometriosis.

Methods: The surgical pathology files of a tertiary academic medical centre and the consultation files of one of the study authors were reviewed for cases of MM in females with and without endometriosis.

Results: Six women with MM and endometriosis ranging in age from 29 to 55 years (median=45 years) were identified. All had peritoneal MM and endometriosis involving the peritoneum and/or adnexa. Five had epithelioid MM and one had biphasic MM. Two had paraoccupational exposure to asbestos. The median age of women with MM and endometriosis (44.5 years) was significantly less than the median age of cases without endometriosis (58.0 years) (p value=0.01).

Conclusions: To our knowledge, this is the first report of MM in women with endometriosis. Interestingly, MM in the setting of endometriosis has only been observed in the peritoneum and not in other serosal cavities. The findings in the present study suggest that chronic serosal inflammation secondary to endometriosis may be an inducing factor in rare cases of MM of the peritoneum.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

In plain English

This retrospective case series searched Duke University Health System pathology files and a database of mesothelioma cases sent to one author for professional and medicolegal consultation. The authors identified six women, aged 29 to 55, who had diffuse malignant mesothelioma of the peritoneum together with endometriosis of the peritoneum and/or adnexa. Five tumours were epithelioid and one was biphasic. Two women had reported paraoccupational asbestos exposure: one through a father who was a plumber, one through an uncle who was an ironworker. Lung tissue from the one woman tested showed no asbestosis and no asbestos content above background. The authors wrote that none of the cases could be conclusively attributed to asbestos. The five consultation cases made up 5.8% of the 86 women with peritoneal mesothelioma in that database. Women with endometriosis were diagnosed at a median age of 44.5 years. Women in the database without known endometriosis were diagnosed at a median age of 58.0 years (p value 0.01). The authors found no pleural or pericardial mesothelioma with endometriosis. They concluded that inflammation from endometriosis may be a possible inducing factor in rare cases of peritoneal mesothelioma. They noted that the study was not designed to measure risk.

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: Retrospective case series (review of pathology and consultation files)
• Who was studied: Six women with diffuse malignant peritoneal mesothelioma and peritoneal and/or adnexal endometriosis. One case came from Duke University Health System (Durham, North Carolina, USA) surgical pathology files. Five came from one author's consultation database, which over the last 7 years included 231 women with mesothelioma (86 peritoneal, 145 pleural).
• Exposure: The main condition studied was endometriosis of the peritoneum and/or adnexa. Asbestos exposure was paraoccupational in two cases: a father who was a plumber (10 years) and an uncle who was an ironworker (8 years). Fiber types were not reported.
• Main results:
  • Five of the six mesotheliomas were epithelioid and one was biphasic.
  • Among women with peritoneal mesothelioma, median age at diagnosis was 44.5 years (range 29 to 55) for those with endometriosis. It was 58.0 years (range 20 to 85) for those in the database without endometriosis (p value 0.01).
  • The five consultation cases with endometriosis were 5.8% of all women with peritoneal mesothelioma in the consultation database during the 7-year period.
  • In three cases, endometriosis had been diagnosed at least 5 years before the mesothelioma. In the other three, it was found during the same surgery.
  • In the one case with lung tissue (case 4), there was no asbestosis and asbestos content was not above the laboratory's background range. That case also had no pleural plaques.
  • The authors stated that none of the cases could be conclusively attributed to asbestos.
  • No pleural or pericardial mesothelioma occurring with endometriosis was found.
  • The woman with biphasic mesothelioma died of the disease 1 year after diagnosis.
  • For the other five women, no death records were found in the Social Security Death Index at 4 months to 12 years after diagnosis.
• The authors' conclusion: The authors concluded that their observations prompt consideration of chronic serosal inflammation from endometriosis as a possible inducing factor in rare cases of peritoneal mesothelioma.
• Limitations the authors state:
  • The study was not designed as a formal epidemiology study, so it cannot support conclusions about the risk of mesothelioma for women with endometriosis in the general population.
  • The cases came from a medicolegal consultation database.
  • Some women in the comparison group may have had undiagnosed (subclinical) endometriosis, which could bias the comparison.
  • Where endometriosis and mesothelioma were diagnosed together, it is unknown how long the endometriosis had been present.
  • No lung tissue was available in five cases, so asbestos bodies and asbestosis could not be assessed in them.
  • Clinical records on treatment and outcome were limited.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Reactive Mesothelial Hyperplasia, Well-Differentiated Papillary Mesothelioma, Malignant Mesothelioma, Pathology, Peritoneum, Epithelioid, Biphasic Mesothelioma.

Related studies

• Peritoneal mesothelial hyperplasia associated with gynaecological disease: a potential diagnostic pitfall that is commonly associated with endometriosis — R. Oparka, W.G. McCluggage, et al. (2011)
• Selected topics in peritoneal pathology — P.M. Baker, P.B. Clement, et al. (2014)
• Laparoscopic management of peritoneal mesothelioma associated with pelvic endometriosis — F.R. Nezhat, S.M. DeNoble, et al. (2010)
• Multicystic mesothelioma with endometriosis — G.M. Groisman, H. Kerner (1992)
• Multicystic mesothelioma caused by endometriosis: 2 case reports and review of the literature — Y. Kurisu, M. Tsuji, et al. (2011)
• The value of BRCA-1-associated protein 1 expression and cyclin-dependent kinase inhibitor 2A deletion to distinguish peritoneal malignant mesothelioma from peritoneal location of carcinoma in effusion cytology specimens — W. Althakfi, S. Gazzo, et al. (2020)

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