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Multicystic mesothelioma. An analysis of pathologic findings and biologic behavior in 37 cases
1Department of Soft Tissue Pathology, Armed Forces Institute of Pathology, Washington, D.C. 20306-6000.
Abstract:
We report the clinicopathologic findings of 37 cases of multicystic mesothelioma. The tumor, which occurs most frequently in young to middle-aged women, affects chiefly the pelvic peritoneum--particularly the cul de sac, uterus, and rectum. It grows along the serosa as multiple, translucent, fluid-filled cysts. Occasionally, it manifests as a solitary or free-floating mass. The tumor is made up of mesothelial-lined cysts embedded in a delicate fibrovascular stroma. The mesothelial cells may be flattened or cuboidal. Adenomatoid change or squamous metaplasia of the mesothelium occurs in one-third of cases. In a significant percentage of cases, the stroma shows marked inflammatory changes that make it difficult to recognize the underlying neoplastic nature. Follow-up information in 25 patients showed that 21 patients were alive, two had died of tumor, and two died of other causes. One of the two patients who died of their tumors was an infant whose tumor showed transition to conventional mesothelioma; the other was a man who had refused therapy. The extent of tumor at the time of diagnosis did not predict survival. The low incidence of previous surgery, the lack of prior abdominal infections, and the documentation of disease-related mortality all support a neoplastic, rather than a reactive, basis for this lesion.
Insights
Multicystic mesothelioma is a rare tumor primarily affecting young to middle-aged women, often found in the pelvic peritoneum. Clinicopathologic findings support a neoplastic origin, with most patients surviving after diagnosis.
Area of Science:
- Oncology
- Pathology
- Gynecologic Oncology
Background:
- Multicystic mesothelioma is a rare peritoneal tumor.
- It predominantly affects young to middle-aged women.
- The tumor typically involves the pelvic peritoneum.
Purpose of the Study:
- To report the clinicopathologic findings of 37 multicystic mesothelioma cases.
- To elucidate the neoplastic nature of this rare tumor.
- To analyze survival data and prognostic factors.
Main Methods:
- Retrospective analysis of 37 cases of multicystic mesothelioma.
- Review of histopathologic features, including mesothelial cell morphology and stromal changes.
- Follow-up data analysis for 25 patients.
Main Results:
- The tumor presents as multiple, translucent, fluid-filled cysts along the serosa or as a solitary mass.
- Histologically, it consists of mesothelial-lined cysts in a fibrovascular stroma, with adenomatoid change or squamous metaplasia in one-third of cases.
- Of 25 patients with follow-up, 21 were alive, two died of tumor, and two died of other causes; tumor extent did not predict survival.
Conclusions:
- Clinicopathologic findings, including disease-related mortality, support a neoplastic origin for multicystic mesothelioma.
- The tumor's presentation and behavior are distinct, though challenging to diagnose due to stromal inflammation.
- Multicystic mesothelioma has a generally favorable prognosis, but rare cases can be fatal.