Multicystic peritoneal mesothelioma in an octogenarian: diagnosis, natural history, and treatment

Our plain-English summary of Multicystic peritoneal mesothelioma in an octogenarian: diagnosis, natural history, and treatment, by C.M. Psoinos, D. Kandil, B. Piperdi, et al (International Journal of Surgical Pathology, 2012).

The study

• Authors: C.M. Psoinos, D. Kandil, B. Piperdi, L.A. Lambert
• Journal: International Journal of Surgical Pathology
• Published: 2012;20(1):92-6
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Multicystic peritoneal mesothelioma (MCPM) is a rare cystic proliferation most often seen in women of reproductive age with a history of prior abdominal surgery. This is a case report of an 83-year-old woman diagnosed with MCPM during an exploratory laparotomy for presumed peritoneal carcinomatosis from colon cancer. After complete removal of all visible MCPM, the patient remains free of both colon cancer and MCPM. This article reviews the literature with regards to the pathology, natural history, risk of malignant transformation, and current options for management of MCPM, including cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

In plain English

This article was a case report of one patient plus a review of earlier published literature on multicystic peritoneal mesothelioma (MCPM), a rare condition in which cysts lined by mesothelial cells form inside the abdomen. The patient, an 83-year-old woman, had had surgery for stage II colon cancer. Fifteen months later, CT scans showed multiple lesions in the peritoneal cavity, and some grew over the next 3 months. At surgery, more than 20 fluid-filled cysts, 1 to 6 cm across, were found, and all were removed. Pathology showed cysts lined by bland mesothelial cells, consistent with MCPM. The authors reported that she remained free of both colon cancer and MCPM. They did not state how long she was followed. The article did not describe any asbestos exposure in this patient. Citing earlier reports, the authors stated that, unlike malignant peritoneal mesothelioma, MCPM has no known association with asbestos exposure. They suggested that early referral to a peritoneal surface malignancy program should be considered for patients with MCPM.

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 a single patient combined with a review of the published literature
• Who was studied: One 83-year-old woman with no prior surgical history, previously treated for stage II colon cancer. The authors are at University of Massachusetts–Memorial Medical Center, Worcester, MA. Dates of care are not given.
• Exposure: No asbestos or other exposure was reported for the patient. Citing earlier reports, the article states only that MCPM, unlike malignant peritoneal mesothelioma (MPM), has no known association with asbestos exposure.
• Main results:
  • Fifteen months after colon surgery, surveillance CT in this patient showed multiple low attenuation lesions in the peritoneal cavity.
  • A repeat CT 3 months later showed that some of the lesions had grown.
  • Needle biopsy of 2 of the lesions found acellular serous fluid.
  • At surgery, more than 20 thin-walled, fluid-filled cysts measuring 1 to 6 cm were found throughout the peritoneal cavity. All were removed.
  • Pathology showed cysts lined by bland mesothelial cells, without hemorrhage, necrosis or mitosis. Cytokeratin 5/6 and calretinin stains were diffusely positive, consistent with MCPM.
  • After removal of all visible MCPM, the patient was reported to remain free of both colon cancer and MCPM. No length of follow-up is given.
  • From the literature review (other authors' studies): across 4 published case series totaling 12 patients treated with cytoreductive surgery and HIPEC, the overall recurrence rate was 16.7% (n = 2).
• The authors' conclusion: The authors concluded that early referral to a peritoneal surface malignancy program should be considered for patients with MCPM. They based this on the published reports of cytoreductive surgery with HIPEC and on recent improvements in that treatment.
• Limitations the authors state:
  • The authors note that because MCPM is rare, there are few data to guide clinical management.
  • The authors note that the published surgery-plus-HIPEC series each had small numbers of patients.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Laparotomy, Colorectal Cancer, Pathology, Malignant Transformation, Cytoreductive Surgery, HIPEC.

Related studies

• Benign multicystic mesothelioma with concurrent colonic adenocarcinoma: a report of two cases — A. Husain, M. Ozdemirli (2012)
• Laparoscopic diagnosis and treatment of pelvic benign multicystic mesothelioma associated with high CA19.9 serum concentration — V. Pinto, A.C. Rossi, et al. (2010)
• Benign multicystic peritoneal mesothelioma presenting as a ghost abdominal mass — H. Jerraya, W. Ghariani, et al. (2016)
• 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)
• Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma — T.C. Chua, T.D. Yan, et al. (2011)
• Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management — A.M.C. Rapisarda, A. Cianci, et al. (2018)

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