Papillary tumors of the peritoneum in women: mesothelioma or papillary carcinoma

Our plain-English summary of Papillary tumors of the peritoneum in women: mesothelioma or papillary carcinoma, by M. Kannerstein, J. Churg, W.T. McCaughey, et al (American Journal of Obstetrics and Gynecology, 1977).

The study

• Authors: M. Kannerstein, J. Churg, W.T. McCaughey, D.P. Hill
• Journal: American Journal of Obstetrics and Gynecology
• Published: 1977;127(3):306-14
• Cited by: 126 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 002238).

Abstract

It has been urged recently that the surface tumors of the ovary be classified as mesotheliomas because both of these neoplasms have a common ancestry. It was suggested also that the rare extragonadal peritoneal tumor of a microscopic morphology similar to that of the ovarian tumor be considered as a mesothelioma. In the present report, objections to this classification are offered. Fifteen cases of diffuse and/or localized peritoneal tumors interpreted as papillary carcinoma arising from extraovarian tissue of Müllerian potentiality are described, and distinctions from mesothelioma are pointed out. Reasons for opposing the grouping of ovarian carcinoma or extragonadal papillary carcinoma of the peritoneum with mesothelioma include the need for categorizing the latter separately in order to monitor its association with asbestos exposure and the possibility that biological differences between these tumors may lead to the development of different modes of therapy.

In plain English

This pathology case series described 15 female patients whose tumors had been sent to the authors as possible peritoneal mesothelioma. The authors rejected that diagnosis. The tumors were papillary and looked like ovarian carcinoma, and the authors interpreted them as papillary carcinoma arising outside the ovary. None of the 15 was known or suspected to have had significant asbestos exposure. Apart from a 4-year-old child and a 27-year-old woman, ages ranged from 53 to 83. Nine had diffuse peritoneal involvement. Seven tumors resembled serous papillary carcinoma of the ovary rather convincingly, and psammoma bodies (small calcified deposits) were seen in 10. A stain for epithelial mucin was definitely positive in four of the 13 cases tested. In at least seven cases, examination by eye could not separate the tumor from diffuse mesothelioma. The authors argued against calling these tumors, or ovarian surface tumors, mesothelioma. One reason was that mesothelioma needs its own category so its link with asbestos exposure can be monitored. They stated that their case selection did not allow conclusions about how common these tumors are.

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 series of 15 tumors reviewed by pathologists, with a discussion of how such tumors should be classified
• Who was studied: 15 female patients (ages 4, 27, and 53 to 83) with papillary peritoneal tumors. Their cases had been submitted from many sources over about six years for consideration as possible peritoneal mesothelioma, and that diagnosis was rejected. Over the same period the authors received 113 cases categorized as diffuse peritoneal mesothelioma, 13 (11.5 per cent) of them in women.
• Exposure: None of the 15 patients was known or suspected to have had significant asbestos exposure. The study examined how the tumors should be classified, not an exposure.
• Main results:
  • Apart from a 4-year-old child and a 27-year-old woman, ages ranged from 53 to 83 years, averaging 67
  • Nine of the 15 cases showed diffuse peritoneal involvement
  • Seven of the 15 tumors resembled serous papillary carcinoma of the ovary rather convincingly; the rest were less characteristic
  • Psammoma bodies were present in 10 of the 15 tumors (the count is confirmed by Table I)
  • The periodic acid-Schiff stain after diastase, a test for epithelial-type mucin, was available in 13 cases. It was definitely positive in four, entirely negative in three, and equivocal in six.
  • In at least seven cases, gross examination (by eye) could not distinguish the tumor from diffuse mesothelioma. In the remaining seven, the descriptions of the masses were unlike typical mesothelioma.
  • Metastases were known in four cases to lymph nodes, and in one case each to the lung (and pleura) and the adrenal
• The authors' conclusion: The authors concluded that these tumors more convincingly resemble papillary carcinomas than mesothelioma. They opposed grouping ovarian carcinoma or similar tumors outside the ovary with mesothelioma. Their reasoning was that putting the common ovarian tumors under that name could confuse statistics on mesothelioma, which serves to monitor the epidemiology of asbestos exposure.
• Limitations the authors state:
  • The varied way cases were selected rules out statistical conclusions about how common these tumors are
  • Some cases were included despite uncertainty about the state of the ovaries or minimal tumor involvement of the ovaries
  • With light microscopy, telling these carcinomas apart from mesothelioma is very difficult in many instances

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: Peritoneum, Mesothelioma, Carcinoma, Neoplasm, Asbestos Exposure.

Related studies

• Primary papillary serous neoplasia of the peritoneum: a clinicopathologic and ultrastructural study of eight cases — U. Raju, G. Fine, et al. (1989)
• Peritoneal papillary carcinoma — S.B. Lele, M.S. Piver, et al. (1988)
• Well-differentiated papillary mesothelioma of the peritoneum: a pathological analysis and review of the literature — A.V. Hoekstra, M.W. Riben, et al. (2005)
• Benign papillary mesothelioma of the peritoneum: a consideration in the differential diagnosis of peritoneal implants — G. Tzanakakis, K.S. McCully, et al. (1989)
• Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum — R.L. Attanoos, R. Webb, et al. (2002)
• Papillary peritoneal tumors in women — A. Foyle, M. Al-Jabi, et al. (1981)

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