Peritoneal Deciduoid Mesothelioma: An Unusual Presentation Complicating an Already Challenging Diagnosis

Our plain-English summary of Peritoneal Deciduoid Mesothelioma: An Unusual Presentation Complicating an Already Challenging Diagnosis, by N. Dominiak, W. Graybill, W. Gunning, et al (International Journal of Surgical Pathology, 2017).

The study

• Authors: N. Dominiak, W. Graybill, W. Gunning, M.S. Richardson, L.S. Spruill
• Journal: International Journal of Surgical Pathology
• Published: 2017;25(4):352-356
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This report highlights a diagnostically challenging case of diffuse deciduoid mesothelioma occurring in the peritoneum of a 25-year-old woman, 8 months postpartum. Optimally debulked tumor consisted of sheets of polygonal cells arranged in solid, trabecular, and pseudopapillary configurations, with vesicular, occasionally grooved nuclei and small nucleoli. A barrage of immunohistochemical stains revealed an unusual staining pattern characterized by diffusely positive keratin, WT-1, and mesothelin staining, but lack of calretinin positivity. Electron microscopy demonstrated only rare thin, long, branching cellular projections. Cytogenetics revealed balanced translocations of 12p and 1q and 16p. Based on compiled ancillary studies, a diagnosis of deciduoid mesolthelioma was made and supported by consultations from experts at 3 outside facilities. Twenty-seven months after diagnosis, the patient is alive and undergoing treatment with progression of disease. This case is presented in detail, and a discussion of the diagnostic criteria and current application of those criteria is provided.

In plain English

This article is a case report about one patient, a 25-year-old woman diagnosed with deciduoid mesothelioma, a rare variant of epithelial mesothelioma, in the peritoneum (the lining of the abdomen). She sought care 8 months after giving birth because of abdominal swelling and pelvic pain. She had a 15.5 × 10 × 11 cm pelvic mass, fluid in the abdomen, and tumors spread over most of the peritoneum, including a 3-cm area invading the diaphragm. The tumor's microscopic appearance was not specific, so many stains were run. The tumor was positive for keratin, WT-1 and mesothelin but negative for calretinin and CK7. The authors wrote that, to their knowledge, this was the first reported calretinin- and CK7-negative deciduoid mesothelioma. Chromosome testing found two balanced translocations. Three outside institutions agreed with the diagnosis. After further surgery and chemotherapy, the cancer recurred. At 27 months after diagnosis she was alive and still being treated, with progressing disease. The article does not report whether she was exposed to asbestos. Based on earlier published cases, the authors suggested that pleural and peritoneal tumors might need to be classified as separate entities.

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 (single patient)
• Who was studied: One 25-year-old woman with no previous significant medical history, seen 8 months postpartum for abdominal distention and pelvic pain
• Exposure: No exposure was studied. The article does not report this patient's asbestos exposure history.
• Main results:
  • At presentation the patient had a 15.5 × 10 × 11 cm pelvic mass with ascites and omental caking
  • Tumor studded the diaphragm, with a 3-cm area of diaphragmatic invasion
  • The tumor stained diffusely positive for keratin, WT-1 and mesothelin but was negative for calretinin
  • The authors stated that, to their knowledge, this was the first report of a calretinin- and CK7-negative deciduoid mesothelioma
  • Electron microscopy showed scattered cell projections consistent with rudimentary branching microvilli
  • Cytogenetic studies found two balanced reciprocal translocations, t(1;12)(p32;q13) and t(16;16)(p11.2;p13); DNA microarray analysis was normal
  • Three outside institutions agreed with the diagnosis of deciduoid mesothelioma
  • Despite further debulking and intraperitoneal chemotherapy, the mesothelioma recurred
  • Twenty-seven months after diagnosis the patient was alive and still undergoing treatment, with progression of disease
• The authors' conclusion: After reviewing the literature, the authors suggested that the view that pleural and peritoneal deciduoid mesotheliomas are one entity may be premature, and that pleural and peritoneal tumors perhaps should be classified as separate entities.

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: Mesothelioma, Peritoneum, Trabecular, Wilms Tumor 1 (WT-1), Mesothelin, Calretinin, Translocation.

Related studies

• Primary Malignant Deciduoid Mesothelioma: A Challenging Diagnosis — M. Regragui, N.B. Guebessi (2019)
• "Signet-ring" cells--a caveat in the diagnosis of a diffuse peritoneal mesothelioma occurring in a lady presenting with recurrent ascites: an unusual case report — B. Rekhi, S. Pathuthara, et al. (2010)
• An unusual case of ascites: pitfalls in diagnosis of malignant peritoneal mesothelioma — J.R. Clark, W.B. Ross (2000)
• Lymphangitis carcinomatosa complicating primary malignant peritoneal mesothelioma — P.S. Craft, M.S. Reading, et al. (1996)
• An unusual presentation of malignant mesothelioma: the incidental finding of tumor in the hernia sac during herniorrhaphy — J. Brenner, P.P. Sordillo, et al. (1981)
• Spontaneous urinary bladder perforation: An unusual presentation of well-differentiated papillary peritoneum mesothelioma — A. Serao, F. Ambrosini, et al. (2022)

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