Mesothelial neoplasms presenting as, and mimicking, ovarian cancer

Our plain-English summary of Mesothelial neoplasms presenting as, and mimicking, ovarian cancer, by H. Mani, M.J. Merino (International Journal of Gynecological Pathology, 2010).

The study

• Authors: H. Mani, M.J. Merino
• Journal: International Journal of Gynecological Pathology
• Published: 2010;29(6):523-8
• Type of article: Case report
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesotheliomas of the abdominal cavity are rare tumors that primarily involve the peritoneum, mesentery, and omentum. The involvement of the viscera is usually secondary to bulky and extensive serosal disease. We describe 7 cases of mesothelioma in which the initial manifestation was that of an ovarian mass. All patients underwent surgery with a primary diagnosis of ovarian cancer. Clinical histories, gross features, and histology slides were reviewed. Immunostains were performed on all cases and electron microscopy was performed in 2 cases. The patients ranged in age from 22 to 52 years and the lesions ranged in size from 3.8 to 9 cm. Of the 7 cases, 4 were predominantly cystic and 3 were solid. Histologically, all cystic tumors were multicystic mesothelioma, whereas the 3 solid tumors were diffuse malignant mesotheliomas. One patient had a borderline mucinous tumor with the mesothelioma occurring as a mural nodule, an association not described earlier. The oldest patient in this series had a diffuse malignant mesothelioma of the peritoneum with predominant ovarian surface involvement. Mesothelial neoplasms can present as ovarian masses in young women. Awareness of this presentation is important to establish appropriate management.

In plain English

This case series came from the National Cancer Institute's Laboratory of Pathology. The authors searched their files for patients who had surgery for suspected ovarian cancer but whose tumors were reclassified as mesothelioma after pathology review. They found seven cases between 1999 and 2007. The women were 22 to 52 years old (mean 32.7 years). Their ovarian masses measured 3.8 to 9 cm: four were mainly cystic and three mainly solid. The four cystic tumors were multicystic mesothelioma, all in women in their thirties. The solid tumors were malignant mesothelioma. Six women had disease on the peritoneum and/or omentum; for one consultation case this was unknown. In one 22-year-old, mesothelioma occurred alongside a borderline mucinous ovarian tumor, which the authors believed was the first such combination reported. The oldest woman had more extensive peritoneal disease, with secondary involvement of the ovarian surface and superficial tissue. The article did not report asbestos or other exposures. The authors concluded that mesothelial tumors can present as ovarian masses in both young and older women, and that a high index of suspicion and ancillary studies are needed for correct diagnosis.

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 (pathology review of 7 cases)
• Who was studied: 7 women, aged 22 to 52 years (mean 32.7, median 33), who had surgery for presumed ovarian cancer and whose tumors were reclassified as mesothelial neoplasms; Laboratory of Pathology, National Cancer Institute, Bethesda, MD; 1999 to 2007
• Exposure: Not reported. The article does not describe asbestos or any other exposure history for these patients.
• Main results:
  • On gross examination, the ovarian masses were predominantly solid in 3 cases and predominantly cystic in 4. Sizes ranged from 3.8 to 9 cm (mean 5.76 cm).
  • Four cases (case numbers 3 to 6) were multicystic mesothelioma, and all 4 of these patients were in the fourth decade of life (their thirties).
  • Six of the 7 patients had peritoneal and/or omental involvement. For case 4, a consultation case, information on disease outside the ovary was not available.
  • In case 2 (age 22), a borderline mucinous tumor of intestinal type was accompanied by a malignant spindle and epithelioid neoplasm. Its immunostaining profile and electron microscopy supported a diagnosis of mesothelioma. The authors described this as, to their knowledge, the first case combining mesothelioma and a mucinous tumor.
  • Only case 7 (the oldest patient, age 52) had more extensive peritoneal disease. In her case the ovaries were involved secondarily, at the ovarian surface and superficial ovarian tissue.
• The authors' conclusion: The authors concluded that mesothelial tumors can present as ovarian masses in both young and older women, and that a high index of suspicion and ancillary studies are necessary for correct diagnosis.
• Limitations the authors state:
  • For one consultation case (case 4), detailed information on disease outside the ovary was not available, and only a single representative section was available for review.

Topics

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

Medical terms in this study, explained in our Lexicon: Neoplasm, Ovarian Cancer, Mesothelioma, Peritoneum, Mesentery, Omentum, Histology, Multicystic Mesothelioma (MCM).

Related studies

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• p16/CDKN2A FISH in Differentiation of Diffuse Malignant Peritoneal Mesothelioma From Mesothelial Hyperplasia and Epithelial Ovarian Cancer — T. Ito, M. Hamasaki, et al. (2015)
• Asbestosis and abdominal neoplasms — E.E. Keal (1960)
• Utility of glucose transporter 1 in the distinction of benign and malignant thoracic and abdominal mesothelial lesions — S.M. Lagana, R.N. Taub, et al. (2012)
• Malignant mesothelioma presenting as a giant chest, abdominal and pelvic wall mass — Z.H. Shao, X.L. Gao, et al. (2011)

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