Primary papillary serous neoplasia of the peritoneum: a clinicopathologic and ultrastructural study of eight cases

Our plain-English summary of Primary papillary serous neoplasia of the peritoneum: a clinicopathologic and ultrastructural study of eight cases, by U. Raju, G. Fine, K.A. Greenawald, et al (Human Pathology, 1989).

The study

• Authors: U. Raju, G. Fine, K.A. Greenawald, J.M. Ohorodnik
• Journal: Human Pathology
• Published: 1989;20(5):426-36
• Cited by: 85 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The well-documented but rare primary papillary serous peritoneal tumors are difficult problems for the pathologist and the clinician. Because of their unusual location, these tumors are often classified as mesothelioma or advanced ovarian carcinoma. In this study, we report the clinicopathologic features of eight primary peritoneal serous papillary tumors and compare their histologic and ultrastructural features to 12 serous ovarian tumors and 16 epithelial mesotheliomas (two peritoneal and 14 pleural). The eight peritoneal serous papillary tumors occurred in women aged 19 to 75 years; two were serous tumors of low malignant potential (borderline) and six were serous carcinomas. The tumors were located in the mesosalpinx, left pelvis, omentum, and/or surface of the ovary. The two patients with borderline neoplasms had long disease-free survival (11 years and 20 years), while three of the four patients with carcinoma with more than 1 year of follow-up died of disease. The peritoneal serous papillary tumors were morphologically identical to serous ovarian tumors of equivalent grade. Well-differentiated papillary structures with distinct fibrovascular cores and one or several layers of columnar, crowded cells, dense overlapping nuclei with a long axis perpendicular to the surface of the papillary cores, and numerous psammoma bodies were features of the peritoneal and ovarian serous tumors. In contrast, the tubulo-alveolar, solid, or poorly defined papillary structures lined by well-spaced polygonal to cuboidal cells with abundant cytoplasm, absence of nuclear polarity, and infrequent psammoma bodies characterized the mesotheliomas. Epithelial mucin and carcinoembryonic antigen (CEA) immunoreactivity, when present, supported a diagnosis of serous tumor in these generally mucin-poor and CEA-negative neoplasms. Ultrastructurally, the cells of serous tumors had slender, straight microvilli of variable length interspersed with or without cilia, while the nonciliated cells of mesothelioma had long, exuberant, wavy microvilli. The morphologic and clinical features of the peritoneal papillary serous tumors are distinctive enough to warrant their separation from mesotheliomas.

In plain English

This pathology study described eight women with papillary serous tumors arising in the abdominal lining (peritoneum), not the ovary. Under the light microscope the authors compared them with 12 serous ovarian tumors and 16 epithelial mesotheliomas (14 pleural, two peritoneal). Electron microscopy covered seven peritoneal tumors, seven ovarian serous tumors and ten mesotheliomas. The women were aged 19 to 75; two tumors were borderline (low malignant potential) and six were serous carcinomas. Mesothelioma was first considered or diagnosed in most of the eight cases. The peritoneal tumors looked like ovarian serous tumors of comparable grade. Under the electron microscope, serous tumor cells had slender, generally straight microvilli (tiny surface projections); mesothelioma cells had long, bushy, wavy ones. The two women with borderline tumors were free of clinical disease 11 and 20 years after surgery. Three women with carcinoma died of metastatic or recurrent disease. The mesothelioma patients were 15 men and one woman, most with a history of asbestos exposure; no exposure details were given. The authors concluded these tumors are distinctive enough to be separated from mesotheliomas.

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: Clinicopathologic and ultrastructural case series of eight primary peritoneal serous tumors, compared with serous ovarian tumors and epithelial mesotheliomas
• Who was studied: Eight women (two black, six white) aged 19 to 75 years with primary peritoneal serous tumors, studied by pathologists in Michigan (Henry Ford Hospital, Detroit; St Joseph's Hospital, Mt Clemens; some material from other Michigan hospitals). The comparison groups were 12 serous ovarian tumors and 16 epithelial mesotheliomas, all reviewed by light microscopy. Electron microscopy covered seven of the peritoneal tumors, seven serous ovarian tumors and ten mesotheliomas. Study dates are not given.
• Exposure: Not an exposure study. Asbestos is mentioned only for the mesothelioma comparison group, most of whom had a history of asbestos exposure. No fiber types, jobs or doses are given.
• Main results:
  • Of the eight peritoneal tumors, two were serous tumors of low malignant potential (borderline) and six were serous carcinomas.
  • Electron microscopy was done on seven of the peritoneal serous tumors, ten mesotheliomas and seven serous tumors.
  • In most of the eight peritoneal cases, a diagnosis of mesothelioma was initially considered or made.
  • Under the microscope, the serous ovarian tumors were similar to the peritoneal serous tumors of comparable grade.
  • Under the electron microscope, the microvilli of the peritoneal serous carcinomas were slender, generally straight, of variable length and fewer than in mesotheliomas.
  • Under the electron microscope, the microvilli of the mesotheliomas were exuberant, long, bushy and wavy.
  • Peritoneal serous tumors: only one of the seven tested showed weak CEA immunoreactivity.
  • Serous ovarian tumors: five of ten had positive, but usually weak and focal, CEA reactions.
  • Mesotheliomas: the cells were negative for epithelial mucin and CEA.
  • The two women with borderline peritoneal tumors were alive and free of clinical disease 11 and 20 years after hysterectomy, salpingo-oophorectomy and local adjuvant therapy.
  • Three of the six women with peritoneal serous carcinoma died of metastatic or recurrent disease despite adjuvant therapy. The text gives the times as 4 months, 3 years and 4 months after initial surgery; the table gives different times.
  • The 16 epithelial mesotheliomas (14 pleural, two peritoneal) occurred in 15 men and one woman aged 43 to 86 years.
• The authors' conclusion: The authors concluded that the morphologic and clinical features of the peritoneal papillary serous tumors are distinctive enough to warrant separating them from mesotheliomas.
• Limitations the authors state:
  • The authors describe their series as small.
  • Because serous tumors are usually CEA negative, the authors state that the CEA stain is of limited use in telling these tumors apart from mesothelioma.
  • The authors state that electron microscopy does not replace careful light microscopic examination.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneum, Mesothelioma, Carcinoma, Omentum, Neoplasm, Disease-Free Survival, Well-Differentiated, Carcinoembryonic Antigen (CEA).

Related studies

• Papillary tumors of the peritoneum in women: mesothelioma or papillary carcinoma — M. Kannerstein, J. Churg, et al. (1977)
• 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)
• Cytopathology of serous neoplasia of the ovary and the peritoneum: differential diagnosis from mesothelial proliferations — L.R. Pisharodi, C.W. Bedrossian (1996)
• Peritoneal papillary carcinoma — S.B. Lele, M.S. Piver, et al. (1988)
• Benign papillary mesothelioma of peritoneum: a histological, histochemical and ultrastructural study of six cases — J.R. Goepel (1981)

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