Primary Ovarian Mesothelioma: A Case Series with Electron Microscopy Examination and Review of the Literature

Our plain-English summary of Primary Ovarian Mesothelioma: A Case Series with Electron Microscopy Examination and Review of the Literature, by L. Vimercati, D. Cavone, M.C. Delfino, et al (Cancers, 2021).

The study

• Authors: L. Vimercati, D. Cavone, M.C. Delfino, B. Bruni, L. De Maria, A. Caputi, S. Sponselli, R. Rossi, L. Resta, F. Fortarezza, F. Pezzuto, G. Serio
• Journal: Cancers
• Published: 2021;13(9)
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary ovarian mesothelioma is a rare, aggressive neoplastic disease with a poor prognosis. At onset, the tumor is only rarely limited to the ovaries and usually already widespread in the peritoneum. The rarity of this entity and the difficulties differentiating it from either ovarian carcinoma or peritoneal mesothelioma may lead to frequent misdiagnoses and may raise some concerns about its histogenesis. Thus, reporting such rare cases is fundamental to gain greater awareness of this neoplasm and try to answer unsolved questions. Herein, we described four cases of histological diagnoses of ovarian mesothelioma extrapolated by the regional mesothelioma register of Apulia (southern Italy). In all cases, a detailed medical history was collected according to national mesothelioma register guidelines. A broad panel of antibodies was used for immunohistochemistry to confirm the diagnoses. Moreover, ovarian tissue samples were also examined by transmission and scanning electron microscopy, detecting asbestos fibers and talc crystals in two cases. Because of the few cases described, we reviewed the English literature in the Medline database, focusing on articles about ovarian mesothelioma "misclassification", "misdiagnosis", "diagnostic challenge" or "diagnostic pitfall" and on unsolved questions about its histogenesis and possible risk factors.

In plain English

This case series described four women with primary ovarian mesothelioma from a southern Italian (Apulia) register and reviewed published cases. Of 138 peritoneal mesotheliomas in women registered from 1995 to 2017, four were confined to the ovary at diagnosis; two later spread to the peritoneum. Tissue was re-examined with antibody stains, and two cases with electron microscopy. Mean age was 52.2 years and mean survival 52 months; two women were lost to follow-up, so their times were not times to death. Reported exposures were an asbestos-coated ironing board (case 1), perineal cosmetic talc (cases 2 and 3), and washing a husband's asbestos-exposed work clothes (case 4). Case 1 tissue showed talc, quartz and glass fiber; no asbestos fibers were detected in the sample. Case 2 tissue contained talc and fibers probably attributable to tremolite asbestos. The review listed 21 previously reported cases. The authors stated their findings did not demonstrate a certain causal link, and that few cases and limited material restricted the analysis. They concluded that histology, antibody staining and electron microscopy together are needed to distinguish these tumors.

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 (four cases) with immunohistochemistry and transmission and scanning electron microscopy, plus a review of the English-language literature
• Who was studied: Four women whose tumors were classified as primary ovarian mesothelioma because, at diagnosis, the tumor was confined to the ovary without peritoneal spread. They came from 138 female peritoneal mesothelioma cases in the Apulia (southern Italy) mesothelioma register, 1995 to 2017. They were diagnosed in 1995, 1998, 2001 and 2007, at ages 38, 65, 54 and 52.
• Exposure: Non-work exposures as reported in medical histories. Case 1: an ironing board coated with asbestos-containing material, used about 10 years until 1985. Cases 2 and 3: cosmetic talc used for perineal hygiene from birth (1933 to 1980, and 1947 to 1985). Case 4: washing the work clothes of a husband occupationally exposed to asbestos (1981 to 1990).
• Main results:
  • Across the four patients, the mean age was 52.2 years and the mean survival was 52 months. Two patients (cases 1 and 4, recorded at 120 and 36 months) were lost to follow-up, so their recorded survival times were not observed times to death.
  • According to register information, the four cases had an average exposure duration of about 24 years and an average latency of 40 years.
  • Case 1: scanning electron microscopy of ovarian tissue did not detect asbestos fibers in the examined sample. It found talc and quartz, and artificial glass fibers.
  • Case 2: scanning electron microscopy of ovarian tissue found fibers probably attributable to tremolite asbestos, as well as talc, quartz and glass fibers.
  • Case 2 later developed pleural plaques (2000) and secondary pleural and peritoneal mesothelioma (2002).
  • Case 3 later developed a secondary malignant tumor of the peritoneum (diffuse miliary peritoneal carcinosis) 12 months after diagnosis.
  • Cases 3 and 4 had no tissue available for electron microscopy.
  • The literature review covered 11 articles listing 21 previously reported ovarian mesothelioma cases. Asbestos exposure was recorded as present in 2 of them (both from Attanoos and Gibbs, 2000), and as absent or not investigated in the rest.
• The authors' conclusion: The authors concluded that a combination of histology, immunohistochemistry and electron microscopy is needed to distinguish primary ovarian mesothelioma from other tumors. They also stressed taking a comprehensive exposure history in these patients.
• Limitations the authors state:
  • Insufficient tissue and the small number of cases did not allow comprehensive clinical-pathological correlations or advanced molecular analyses.
  • The finding of talc and tremolite-like material in tissue does not claim to demonstrate a certain causal link between exposure and ovarian mesothelioma. The authors presented it as a starting point for future studies.
  • Because of the long latency, patients may not remember distant exposures (recall bias). The authors stated that their standardized exposure history aimed to address this.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Prognosis, Peritoneum, Carcinoma, Peritoneal Mesothelioma, Neoplasm, Immunohistochemistry, Scanning Electron Microscopy (SEM).

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