Well-differentiated papillary mesothelioma of the peritoneum: a pathological analysis and review of the literature

Our plain-English summary of Well-differentiated papillary mesothelioma of the peritoneum: a pathological analysis and review of the literature, by A.V. Hoekstra, M.W. Riben, M. Frumovitz, et al (Gynecologic Oncology, 2005).

The study

• Authors: A.V. Hoekstra, M.W. Riben, M. Frumovitz, J. Liu, P.T. Ramirez
• Journal: Gynecologic Oncology
• Published: 2005;98(1):161-7
• Type of article: Case report, Review
• Cited by: 45 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Well-differentiated papillary mesothelioma (WDPM) of the peritoneum is a rare subtype of peritoneal epithelioid mesothelioma which typically has low malignant potential. It most commonly occurs in young women lacking a history of asbestos exposure. Only 38 female patients with peritoneal WPDM have been reported in the literature, and no uniform treatment recommendation has been established.

Case Report: A 74-year-old asymptomatic woman without significant past medical history underwent workup and subsequent surgery for an adnexal mass with a normal serum CA-125 level. Exploratory laparotomy identified an ovarian serous cystadenoma and an incidental multifocal peritoneal neoplasm with extensive calcifications. Histology and cytology confirmed WDPM with extensive, intimately associated mesothelial cystic inclusions and zonal calcifications with osseous metaplasia. Our patient did not receive adjuvant therapy and was without clinical or radiologic evidence of disease 12 months after diagnosis.

Conclusion: WDPM of the peritoneum in women is frequently asymptomatic and associated with an indolent course. Patient outcomes are usually favorable after tumor-debulking surgery without adjuvant therapy.

In plain English

This article was a case report combined with a review of published cases of well-differentiated papillary mesothelioma (WDPM) of the peritoneum. The authors described WDPM as a rare subtype of epithelioid mesothelioma with low malignant potential. The patient was a 74-year-old woman, a real estate agent, who had no symptoms. The article does not describe any asbestos exposure for her. Surgery for a mass near the right ovary found a benign ovarian tumor and, incidentally, multiple calcified nodules on the peritoneum. Pathologists diagnosed WDPM with multiple inclusion cysts and calcification, including areas of bone formation (osseous metaplasia). She received no further treatment after surgery and had no clinical or radiologic evidence of disease 12 months after diagnosis. The authors also reviewed 38 previously reported cases in women. Only one of these 38 had reported asbestos exposure. Follow-up was reported for 32 patients and ranged from 6 weeks to 29 years. Of these 32, 25 (78%) were alive, and two died of WDPM or complications of its treatment. The authors proposed that most patients undergo removal of bulky disease followed by close observation, with adjuvant therapy used judiciously.

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 of one patient, plus a review of previously reported cases in the English literature
• Who was studied: One 74-year-old woman, a real estate agent, treated at The University of Texas M.D. Anderson Cancer Center. The review covered 38 previously reported female patients with peritoneal WDPM, aged 2 to 74 years (median 41).
• Exposure: The article does not describe any asbestos exposure for the patient. Among the 38 reviewed cases, only one patient had reported exposure to asbestos.
• Main results:
  • Case patient: before surgery, her serum CA-125 level was less than 7 units/mL.
  • Case patient: the diagnosis was well-differentiated papillary mesothelioma with multilocular inclusion cysts (benign cystic mesothelioma) and calcification.
  • Case patient: bone formation (osseous metaplasia) arose within islands of calcification next to the tumor.
  • Case patient: she received no adjuvant therapy and had no clinical or radiologic evidence of recurrent disease at 12 months after diagnosis.
  • Review: among the 38 previously reported female patients, ages ranged from 2 to 74 years (median 41 years).
  • Review: 12 of the 38 patients received adjuvant therapy.
  • Review: among the 32 patients with reported follow-up (6 weeks to 29 years, median 3 years), the overall survival rate during follow-up was 78% (25 of 32).
  • Review: two patients (6%) died of WDPM or complications of its treatment.
• The authors' conclusion: Based on the literature they gathered, the authors proposed that most patients should have resection of bulky disease (not extensive, radical debulking) followed by close observation. They added that adjuvant therapy has potential significant side effects and should be used judiciously.

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, Peritoneum, Epithelioid, Mesothelioma, Asbestos Exposure, CA-125, Laparotomy, Neoplasm.

Related studies

• 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 female peritoneum: a clinicopathologic study of 26 cases — A. Malpica, S. Sant'Ambrogio, et al. (2012)
• Well-differentiated papillary mesothelioma of the peritoneum: a separate entity — K. Hoekman, G. Tognon, et al. (1996)
• Therapeutic strategies for well-differentiated papillary mesothelioma of the peritoneum — Y.K. Lee, H.J. Jun, et al. (2013)
• Heterozygous loss of NF2 is an early molecular alteration in well-differentiated papillary mesothelioma of the peritoneum — H. Nemoto, G. Tate, et al. (2012)
• Simultaneous occurrence of a rectal carcinoma and a diffuse well differentiated papillary mesothelioma of the peritoneum — G.R. Jatzko, J. Jester (1997)

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