Multicystic mesothelioma caused by endometriosis: 2 case reports and review of the literature

Our plain-English summary of Multicystic mesothelioma caused by endometriosis: 2 case reports and review of the literature, by Y. Kurisu, M. Tsuji, Y. Shibayama, et al (International Journal of Gynecological Pathology, 2011).

The study

• Authors: Y. Kurisu, M. Tsuji, Y. Shibayama, T. Yamada, M. Ohmichi
• Journal: International Journal of Gynecological Pathology
• Published: 2011;30(2):163-6
• Type of article: Case report, Review
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Multicystic mesothelioma was described as a benign neoplasm in most reports. But, whether it is neoplastic or reactive is still controversial. Although multicystic mesothelioma is often accompanied by endometriosis, histologic findings of the lesion with endometriosis have not been well documented. In this report, 2 cases of multicystic mesothelioma with endometriosis were studied histologically. The first lesion consisted of multiple cysts having thin walls lined with single-layered cuboidal mesothelia, and in the cystic walls, small foci of endometriosis were found. The second lesion was next to the endometriotic cysts in the pelvic space. These histologic findings suggest that endometriosis greatly contributes to the origin of the lesions. In addition, from the review of the literature, cystic mesothelioma was divided into 2 categories, that is, neoplastic or non-neoplastic lesions. Differentiation of both disorders might be possible by the following: size of the lesion, macroscopic and microscopic solid proliferation, features of adenomatoid tumor, and common mesothelioma-like histology. In conclusion, multicystic mesothelioma accompanied by endometriosis is thought to be a secondary non-neoplastic lesion induced by adhesion or inflammation rather than a neoplasm.

In plain English

This article reported two cases of multicystic mesothelioma, a cyst-forming lesion of the peritoneum (the lining of the abdomen), in Japanese women with endometriosis. It also reviewed earlier published reports. The article did not report whether either woman had been exposed to asbestos. In their discussion the authors stated that asbestos is not related to multicystic mesothelioma, but this article presented no data on asbestos. The first woman, in her fourth decade, had a 10 cm cystic lesion removed after an earlier operation for endometriosis. The lesion recurred, and a 9 cm lesion was removed in a third operation. Its cysts were lined by mesothelial cells, and small endometriosis cysts were found in their walls. In the second woman, in her third decade, mesothelial cysts lay next to endometriosis cysts in the pelvis, with no cell atypia. From the literature, the authors divided cystic mesothelioma into neoplastic (true tumor) and non-neoplastic lesions. The authors concluded that multicystic mesothelioma accompanied by endometriosis is thought to be a secondary non-neoplastic lesion caused by adhesion or inflammation rather than a neoplasm.

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 of 2 patients with tissue (histologic and immunostaining) examination, plus a narrative review of the literature
• Who was studied: Two Japanese women with endometriosis treated at Osaka Medical College, Japan: one in her fourth decade and one in her third decade
• Exposure: Endometriosis and prior pelvic operations, which the authors proposed as causes through peritoneal adhesion and inflammation. The article did not report the women's asbestos exposure history.
• Main results:
  • Case 1: a cystic lesion 10 cm in diameter was excised a year after a first operation for endometriosis.
  • Case 1: the lesion recurred after the second operation, and a third operation was performed. The recurrent lesion had a diameter of 9 cm.
  • Case 1: the cells lining the cysts were mesothelial cells, positive for calretinin and D2-40 and negative for EMA and CD10. The cysts were diagnosed as multicystic mesothelioma.
  • Case 1: small cysts scattered within the walls of the mesothelial cysts were diagnosed as endometriotic cysts.
  • Case 2: in the pelvic cavity, cysts lined with single-layered mesothelial cells were found next to endometriotic cysts. The cysts in the excised specimen measured 0.5 to 1.0 cm.
  • Case 2: no cytologic atypia was seen.
  • From the literature review, the authors divided cystic mesothelioma into neoplastic and non-neoplastic lesions. They considered that some multicystic mesotheliomas would be true neoplasms.
  • The authors argued that recurrence after removal does not show that a lesion is a neoplasm, because remaining endometriosis and continuing inflammation can cause recurrence.
  • The authors stated, without presenting data in this article, that asbestos is not related to multicystic mesothelioma.
• The authors' conclusion: The authors concluded that multicystic mesothelioma accompanied by endometriosis is thought to be a secondary non-neoplastic lesion induced by adhesion or inflammation rather than a neoplasm.
• Limitations the authors state:
  • In case 2, the true size of the cysts in the body was unclear; only the excised specimen was measured.

Topics

Medical terms in this study, explained in our Lexicon: Multicystic Mesothelioma (MCM), Neoplasm, Mesothelioma, Adenomatoid Tumor, Histology, Inflammation.

Related studies

• Multicystic mesothelioma with endometriosis — G.M. Groisman, H. Kerner (1992)
• A Case of Abdominal Discomfort Caused by Benign Multicystic Peritoneal Mesothelioma — T.G. Cotter, J.S. Van Arnam, et al. (2016)
• Imaging appearance of benign multicystic peritoneal mesothelioma: a case report and review of the literature — V. Mehta, V. Chowdhary, et al. (2017)
• 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)
• Selected topics in peritoneal pathology — P.M. Baker, P.B. Clement, et al. (2014)
• Malignant peritoneal mesothelioma in patients with endometriosis — K.J. Butnor, J. Rueckert, et al. (2018)

Browse more research in International Journal of Gynecological Pathology, or return to medical research.