Well-Differentiated Papillary Mesothelioma With Two Synchronous Serous Gynaecologic Carcinomas in a 62-Year-Old Woman: Lessons Learned for the Gynaecologic Surgeon

Our plain-English summary of Well-Differentiated Papillary Mesothelioma With Two Synchronous Serous Gynaecologic Carcinomas in a 62-Year-Old Woman: Lessons Learned for the Gynaecologic Surgeon, by J.M. McGinnis, V. Bloomfield, H. Kazerouni, et al (Journal of Obstetrics and Gynaecology Canada, 2020).

The study

• Authors: J.M. McGinnis, V. Bloomfield, H. Kazerouni, L. Helpman
• Journal: Journal of Obstetrics and Gynaecology Canada
• Published: 2020;42(10):1262-1266
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Well-differentiated papillary mesothelioma (WDPM) is a rare tumor of unknown malignant potential. It is typically diagnosed incidentally during benign gynaecologic surgery. We report the first published case of WDPM in a woman with synchronous serous carcinomas of the gynaecologic tract and highlight lessons learned for general gynaecologists and gynaecologic oncologists alike.

Case: A 62-year-old woman was referred for assessment and management of a pelvic mass. Intraoperatively, metastatic high-grade carcinoma was identified and the patient underwent a successful debulking procedure that identified 3 synchronous tumors: ovarian high-grade serous carcinoma, endometrial serous carcinoma, and 2 foci of pelvic WDPM.

Conclusion: This case of WDPM with 2 synchronous serous gynaecologic tumors is a novel addition to the reported literature and offers many learning points about the disease. Gynaecologic surgeons should be familiar with WDPM, as it is predominantly found in reproductive-aged women undergoing benign gynaecologic surgery, may be linked with endometriosis, and has an unclear malignant potential. Multidisciplinary care is essential for accurate diagnosis. Further research is needed to clarify the optimal management and surveillance of WDPM.

Copyright © 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

In plain English

This case report described one 62-year-old woman who was referred to gynaecologic oncology with a pelvic mass after 3 months of abdominal pain. Before surgery, her CA 125 blood marker was 153 kU/L (reference below 35). After surgery, pathology confirmed three separate tumours present at the same time. The first was a stage IIb high-grade serous carcinoma of the ovary. The second was a stage Ia serous carcinoma of the endometrium. The third was well-differentiated papillary mesothelioma (WDPM), found on the sigmoid epiploica and in a nodule from the left pelvic side wall. Carboplatin and paclitaxel chemotherapy was recommended for the carcinomas, and she was referred for pelvic radiotherapy. No further immediate treatment was recommended for the WDPM because of its indolent growth pattern. The article does not report whether the patient had any asbestos exposure. Citing earlier studies, the authors wrote that WDPM, unlike malignant mesothelioma, has no known correlation with asbestos exposure. The authors concluded that gynaecologic surgeons should be familiar with WDPM, that it may be associated with endometriosis, and that further research is needed.

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), with a brief discussion of published literature
• Who was studied: One 62-year-old woman referred to gynaecologic oncology with a pelvic mass and a 3-month history of abdominal pain. The authors are affiliated with McMaster University and the Juravinski Cancer Centre, Hamilton, Ontario. Dates of care are not given.
• Exposure: No asbestos or other occupational exposure is reported for this patient. In the discussion, citing earlier studies, the authors state that WDPM has no known correlation with asbestos exposure, unlike malignant mesothelioma.
• Main results:
  • Before surgery, the patient's CA 125 tumour marker was 153 kU/L (reference below 35 kU/L).
  • First tumour: high-grade serous carcinoma of the ovary, positive for WT1 staining, stage IIb, involving both ovaries.
  • Second tumour: serous carcinoma of the endometrium, FIGO stage Ia, with 20% myoinvasion, no lymphovascular space invasion and no cervical stromal invasion.
  • Third tumour: well-differentiated papillary mesothelioma (WDPM), found on the surface of the sigmoid epiploica and in a peritoneal nodule from the left pelvic side wall.
  • The surgery achieved optimal cytoreduction (removal of visible tumour).
  • Six cycles of carboplatin and paclitaxel chemotherapy were recommended for the ovarian and endometrial carcinomas. No further immediate treatment was recommended for the WDPM because of its indolent growth pattern.
• The authors' conclusion: The authors concluded that gynaecologic surgeons should be familiar with WDPM, which may be associated with endometriosis. They also concluded that further research is needed on its recurrence risk, on synchronous cancers, and on optimal treatment and surveillance.
• Limitations the authors state:
  • The authors state it is unclear when this postmenopausal patient's WDPM lesions developed, or whether they had been present since her reproductive years.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Well-Differentiated Papillary Mesothelioma, Carcinoma, Multidisciplinary Team.

Related studies

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• Acute severe abdominal pain in a young woman caused by a well-differentiated papillary mesothelioma of the peritoneum — J.E. Bousema, K.M. van de Luijtgaarden, et al. (2019)
• Well-differentiated papillary mesothelioma: A 17-year single institution experience with a series of 75 cases — M. Sun, L. Zhao, et al. (2019)
• Malignant transformation of well-differentiated papillary mesothelioma 13 years after the diagnosis: a case report — L. Costanzo, S. Scarlata, et al. (2014)
• 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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