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Well-differentiated papillary mesothelioma in association with endometrial carcinoma: a case report
Vivek Rathi1, Simon Hyde, Marsali Newman
1Department of Anatomical Pathology, Austin Health, Studley Road, Heidelberg 3084, Victoria, Australia. vivrathi@yahoo.com
Background:
Well-differentiated papillary mesothelioma (WDPM) is an uncommon tumor usually arising in the peritoneum and mostly an incidental finding during abdominal and pelvic surgery. Its natural history and association with other neoplasms is not clearly understood. We present a rare case of WDPM in association with high-grade endometrial carcinoma. To our knowledge, there are only two previously reported cases in the English literature of WDPM in association with endometrial carcinoma.
Case:
A 62-year-old woman underwent pelvic surgery for a high-grade endometrial adenocarcinoma. At laparotomy an extensive peritoneal nodular fibrotic reaction was present, raising the clinical possibility of metastatic disease; however, intraoperative frozen section reported this as a mesothelial reaction. Cytologic examination of peritoneal washings revealed cohesive clusters of reactive-appearing mesothelial cells, some with papillary morphology, and no evidence of adenocarcinoma. The peritoneal biopsies showed no metastatic carcinoma. The endometrial tumor was an endometrioid adenocarcinoma.
Conclusion:
The cytologic diagnosis of WDPM may be difficult because it is an uncommon entity and there are overlapping features with other neoplastic and nonneoplastic lesions of the female genital tract and peritoneum. Compounding this, WDPM may occur in association with other neoplasms. We highlight the potential for surgical and pathologic misinterpretation of this entity.
Insights
Well-differentiated papillary mesothelioma (WDPM) is a rare peritoneal tumor. This case highlights its association with endometrial carcinoma, emphasizing diagnostic challenges and potential misinterpretations in surgical pathology.
Area of Science:
- Gynecologic Oncology
- Surgical Pathology
- Cytopathology
Background:
- Well-differentiated papillary mesothelioma (WDPM) is an uncommon peritoneal tumor.
- Its natural history and association with other neoplasms are not well-understood.
- WDPM is often an incidental finding during abdominal and pelvic surgery.
Observation:
- A 62-year-old woman presented with high-grade endometrial adenocarcinoma.
- Intraoperative findings revealed extensive peritoneal nodular fibrotic reaction.
- Cytologic examination and peritoneal biopsies showed reactive mesothelial cells, not metastatic adenocarcinoma.
Findings:
- The patient was diagnosed with high-grade endometrial adenocarcinoma.
- Peritoneal biopsies confirmed well-differentiated papillary mesothelioma (WDPM).
- This is the third reported case of WDPM associated with endometrial carcinoma.
Implications:
- Cytologic diagnosis of WDPM can be challenging due to overlapping features with other lesions.
- WDPM may be misdiagnosed as metastatic disease or reactive mesothelial proliferation.
- Accurate differentiation is crucial for appropriate patient management and treatment planning.
