Well differentiated papillary mesothelioma of abdomen- a rare case with diagnostic dilemma

Our plain-English summary of Well differentiated papillary mesothelioma of abdomen- a rare case with diagnostic dilemma, by A. Saha, P.K. Mandal, A. Manna, et al (Journal of Laboratory Physicians, 2018).

The study

• Authors: A. Saha, P.K. Mandal, A. Manna, K. Khan, S. Pal
• Journal: Journal of Laboratory Physicians
• Published: 2018;10(2):248-250
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Well-differentiated papillary mesothelioma is a rare tumor occurring predominantly in the peritoneum of young women, a few with history of asbestos exposure. A 28-year-old woman presented with ascites and pain abdomen. Ultrasonography and computed tomography scan of the abdomen revealed a mass in the retroperitoneum measuring 15 cm × 12 cm. Histopathological examination along with immunohistochemistry (IHC) confirmed it to be a papillary mesothelioma in the peritoneum. It is difficult to differentiate from more common malignant mesothelioma and papillary adenocarcinoma, which also have poorer prognosis. The difficulty can be resolved by clinico-radiological correlation along with histopathological examination and IHC.

In plain English

This is a case report from West Bengal, India, about one woman with well-differentiated papillary mesothelioma, a rare tumor of the peritoneum (the abdominal lining). The case report gives her age as 27; the abstract says 28. She had abdominal pain and swelling, and the authors reported no history of asbestos exposure or construction work. Ultrasound showed a mass with fluid in the abdomen. A CT scan measured it at 14 cm × 11 cm and suggested a possible left adnexal mass (in the area of the ovary and fallopian tube). The authors noted that testing of the fluid falsely pointed to a reactive cause. Surgery removed a 15 cm × 12 cm mass. Under the microscope it showed no atypia, mitosis or necrosis. Tissue staining was positive for vimentin, calretinin, WT 1 and, focally, cytokeratin, and supported the diagnosis. A chest CT showed no lesions. She was followed without chemotherapy, and follow-up to 9 months was uneventful. The authors concluded that this tumor must be told apart from more aggressive look-alikes by using staining together with clinical history, imaging and microscopy.

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 woman, aged 27 according to the case report (28 in the abstract), with abdominal pain and distension. The authors are at hospitals in West Bengal, India; the article gives no dates for the case.
• Exposure: No asbestos exposure: the patient had no history of exposure to asbestos or of work in the construction industry.
• Main results:
  • Ultrasound showed an abdomino-pelvic mass with ascites. A CT scan showed a mass measuring 14 cm × 11 cm whose site of origin could not be identified, and a left adnexal mass was suggested.
  • Examination of the ascitic fluid showed a few fragments of mesothelial cells mixed with lymphocytes. The authors state this fluid cytology falsely suggested a reactive cause in this case.
  • The surgically removed mass was irregular, gray-white and measured 15 cm × 12 cm.
  • Under the microscope there was no atypia, mitosis or necrosis. Areas of vascular invasion and psammoma bodies were noted.
  • Immunohistochemistry was positive for vimentin, calretinin, WT 1 and cytokeratin (focal). The Ki-67 proliferation index was about 1%. Desmin, Ber-EP4 and chromogranin A were negative.
  • A chest CT showed no lesions in the thoracic cavity. The patient was followed without chemotherapy, and follow-up to 9 months after surgery was uneventful.
• The authors' conclusion: The authors concluded that well-differentiated papillary mesothelioma has uncertain malignant potential and needs to be distinguished from aggressive mimics with much poorer prognosis. They said no single staining marker does this, and that results of a panel of stains should be read together with clinical history, imaging and standard microscopy.

Topics

Medical terms in this study, explained in our Lexicon: Well-Differentiated Papillary Mesothelioma, Peritoneum, Asbestos Exposure, Ascites, Retroperitoneum, Immunohistochemistry, Malignant Mesothelioma, Adenocarcinoma.

Related studies

• Well-differentiated papillary mesothelioma of the peritoneum: a diagnostic dilemma on fine-needle aspiration cytology — J.G. Nasit, G. Dhruva (2014)
• A Case Report of Peritoneal Mesothelioma as an Acute Abdomen Mimic: A Rare Presentation and Diagnostic Challenges — L. Fadl, M. Fadl, et al. (2024)
• Well-differentiated papillary mesothelioma — K.J. Butnor, T.A. Sporn, et al. (2001)
• Well-differentiated papillary mesothelioma of the peritoneum is genetically defined by mutually exclusive mutations in TRAF7 and CDC42 — M. Stevers, J.T. Rabban, et al. (2019)
• Well-differentiated papillary mesothelioma of the pleura: a series of 24 cases — F. Galateau-Sallé, J.M. Vignaud, et al. (2004)
• Well-differentiated papillary mesothelioma of the female peritoneum: a clinicopathologic study of 26 cases — A. Malpica, S. Sant'Ambrogio, et al. (2012)

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