Cystic mesothelioma of the peritoneum

We report a case of cystic mesothelioma of the peritoneum (CMP), a rare tumor. The magnetic resonance imaging (MRI) findings and the histochemical features were studied. The patient was an 18-year-old women who presented with upper abdominal pain. Abdominal ultrasonography and computed tomography showed a well defined cystic mass with a solid papillary projection in its lumen. MRI of the cyst showed high intensity on T2- and proton weighted images and low intensity on T1-weighted images, and the solid projection showed low intensity on T2- and proton-weighted images and slight low intensity on T1-weighted images, on which it was well enhanced. The lesion was suspected to be a benign cyst, such as a hemangioma, lymphangioma, or a splenic or pancreatic cyst. Complete surgical resection was performed. The resected specimen consisted of a unilocular cystic mass, with a solid projection, weighing 260 g and measuring 10 cm in diameter. The final diagnosis, arrived at by histopathological examination, was low-grade malignant CMP. The tumor cells were strongly positive for keratin, weakly positive for vimentin, and negative for epithelial membranous antigen. The patient is now well and symptom-free with no recurrence 19 months after operation. CMP is a rare tumor; only 12 cases have previously been reported in Japan.