Peritoneal well-differentiated papillary mesothelioma coexisting with endometrial adenocarcinoma mimicking peritoneal carcinomatosis: A case report

Our plain-English summary of Peritoneal well-differentiated papillary mesothelioma coexisting with endometrial adenocarcinoma mimicking peritoneal carcinomatosis: A case report, by Y.Y. Chen, P.C. Li, Y.H. Hsu, et al (Taiwanese Journal of Obstetrics & Gynecology, 2020).

The study

• Authors: Y.Y. Chen, P.C. Li, Y.H. Hsu, D.C. Ding
• Journal: Taiwanese Journal of Obstetrics & Gynecology
• Published: 2020;59(6):968-971
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: We present a rare case of well-differentiated papillary mesothelioma (WDPM) found incidentally in a 59-year-old woman with endometrial cancer.

Case Report: A 59-year-old nulliparous obese woman with a past history of hypertension and diabetes mellitus presented with postmenopausal bleeding for 11 months. Two months prior to this admission, an episode of massive vaginal bleeding lasting for a day was noticed by the patient. Hysteroscopy was performed after her visit to our outpatient department. Papillary tumors with active bleeding were found in the uterine cavity. Endometrial biopsy showed adenocarcinoma, endometrioid type characterized by papillary architecture lined by columnar cells with mild nuclear pleomorphism. The patient proceeded to magnetic resonance imaging (MRI), which demonstrated a 6.4 × 5.5 × 4.9 cm intrauterine mass. Her tumor marker levels were elevated (CA 125 87.8 IU/ml, CA19-9160.54 IU/ml). The patient then underwent a staging surgery and final pathology revealed stage IA endometrial cancer. During surgery, multiple nodules were found in the peritoneum, initially considered as tumor metastasis and eventually proved to be WDPM.

Conclusion: In conclusion, the simultaneous occurrence of WDPM with endometrial cancer is a rare entity. Although no standardized treatment has been established, WDPMs have a relatively favorable prognosis compared to malignant mesotheliomas.

Copyright © 2020. Published by Elsevier B.V.

In plain English

This case report described one 59-year-old woman, seen at the authors' hospital department, who had postmenopausal bleeding for 11 months. She had never been exposed to talc or asbestos. Hysteroscopy found bleeding papillary tumors in the uterus, and a biopsy showed endometrioid adenocarcinoma, a cancer of the uterine lining. Her tumor markers were raised (CA 125 87.8 IU/ml, CA19-9 160.54 IU/ml). During staging surgery, many small white nodules were found on the omentum, bladder, pouch of Douglas, pelvic wall and mesentery, and the surgeons at first suspected the cancer had spread. Pathology showed grade 1 endometrioid adenocarcinoma of the uterus, recorded as pT1bN0, plus peritoneal well-differentiated papillary mesothelioma (WDPM). The peritoneal tumor cells stained positive for WT-1 and calretinin. No lymph node involvement was seen, and no cancer cells were found in the ascites. She recovered uneventfully and received radiotherapy. The authors wrote that, unlike malignant mesothelioma, the cause of WDPM remains unclear. They concluded that WDPM occurring together with endometrial cancer is rare, that the nodules can be mistaken for metastasis, and that pathology with immunohistochemistry is important for accurate 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: case report (single patient)
• Who was studied: One 59-year-old nulliparous, obese woman with hypertension and diabetes mellitus, seen at the authors' outpatient department (authors affiliated with Hualien Tzu-Chi Hospital and Tzu Chi University, Hualien, Taiwan); dates of care not given
• Exposure: No asbestos exposure: the article states the patient was never exposed to talc or asbestos. No family history of cancer; BRCA status unknown.
• Main results:
  • Hysteroscopy found papillary tumors with active bleeding in the uterine cavity; endometrial biopsy showed endometrioid-type adenocarcinoma
  • The patient's tumor markers were elevated: CA 125 87.8 IU/ml and CA19-9 160.54 IU/ml (printed as 'CA19-9160.54')
  • At staging surgery, multiple white miliary nodules were found on the omentum, bladder, pouch of Douglas, lateral pelvic wall and mesentery, and peritoneal carcinomatosis (spread of cancer) was suspected at first
  • Pathology showed grade 1 endometrioid adenocarcinoma of the uterus, pT1bN0, and WDPM of the omentum, both ovaries, bladder peritoneum, pouch of Douglas, lateral pelvic wall and mesentery
  • The peritoneal tumor cells were positive for WT-1 and calretinin on immunohistochemistry
  • No lymph node involvement was seen and no cancer cells were found in the ascites
  • Postoperative recovery was uneventful, and the patient received adjuvant radiotherapy; the authors planned CT monitoring every 6 months or annually (no follow-up outcome reported)
  • In their discussion, the authors stated that, unlike malignant mesothelioma, which is known to be related to asbestos exposure, the cause of WDPM remains unclear
• The authors' conclusion: The authors concluded that WDPM occurring at the same time as endometrial cancer is rare, that the peritoneal implants may be misinterpreted as tumor metastasis, and that pathologic examination with immunohistochemical analysis is important for an accurate diagnosis.

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: Well-Differentiated Papillary Mesothelioma, Adenocarcinoma, Biopsy, Columnar Cell, Nuclear Pleomorphism, Tumor Marker, Staging, Pathology.

Related studies

• Well-differentiated papillary mesothelioma: peritoneal implants are not always metastases in the presence of cancer — G.W. Irwin, A. Ervine, et al. (2014)
• Expression of the retinoblastoma-related gene Rb2/p130 is downregulated in atypical endometrial hyperplasia and adenocarcinoma — T. Susini, D. Massi, et al. (2001)
• Collagenous Spherulosis in Well-Differentiated Papillary Mesothelioma in a Female With Multilocular Peritoneal Inclusion Cysts — B. AbdullGaffar, L.G. Raman (2019)
• Primary Peritoneal Low-grade Serous Carcinoma in a Patient With Lynch Syndrome: A Case Report — S. Makiuchi, H. Yoshida, et al. (2020)
• Simultaneous occurrence of a rectal carcinoma and a diffuse well differentiated papillary mesothelioma of the peritoneum — G.R. Jatzko, J. Jester (1997)
• Incidental finding of multiple well-differentiated papillary mesotheliomas in peritoneum — M. Jakobsen, B. Engvad, et al. (2016)

Browse return to medical research.