bromochloroacetic-acid and Mesothelioma--Cystic

We report a case of cystic mesothelioma of the peritoneum in a young male with local recurrences and whose diagnosis was confirmed by standard histological studies and immunohistochemistry. This rare tumor appears generally in young females through abdominal pain and mass. Local recurrences without distant metastases are a feature of this pathology. The adequate treatment requires complete resection.

Topics: Adult; Humans; Immunohistochemistry; Keratins; Male; Mesothelioma, Cystic; Peritoneal Neoplasms

Topics: Adult; Female; Humans; Immunohistochemistry; Keratins; Mesothelioma, Cystic; Peritoneal Neoplasms

A 32-yr-old man was admitted to Anjo Kosei Hospital for the examination of a cystic peritoneal lesion. This patient had a past medical history significant for an appendectomy. Ultrasonography and computed tomography revealed multiple cysts in the abdominal and pelvic cavities. An exploratory laparotomy was performed on July 1, 1993, revealing numerous thin-walled and translucent cysts in the serosal tissues of the parietal and visceral abdominal peritoneum. These cysts were excised surgically because of clinical suspicion of pseudo-myxoma peritonei. Microscopic examination revealed cysts within the thin cyst wall that were composed of fibrous connective tissue and lined by a single layer of cuboidal or flattened epithelium. Immunohistochemical and ultrastructural studies demonstrated that the lining cells were of mesothelial origin, and the diagnosis was benign cystic mesothelioma. In this paper, we present appropriate diagnostic and treatment procedures for benign cystic mesothelioma and discuss the particular usefulness of using immunohistochemical methods to achieve a histological diagnosis.

Topics: Adult; Humans; Immunohistochemistry; Keratins; Male; Mesothelioma, Cystic; Peritoneal Neoplasms

Peritoneal mesotheliomas are rare in women, compared to serous epithelial neoplasms with which they are often confused. We evaluated the clinicopathologic features of 19 true mesothelial neoplasms affecting the genital tract or peritoneum of women (other than adenomatoid tumors, benign multicystic mesotheliomas, and localized fibrous tumors) to characterize their clinicopathologic features and to determine their clinical behavior. Six tumors were localized to one anatomic site at presentation, and 13 involved more than one anatomic site. The six localized tumors were solitary, small (0.8-2.0 cm), polypoid or nodular lesions, five of which were incidental findings. All had a predominantly tubulopapillary pattern, either pure or mixed with adenomatoid-like or small solid foci. Nuclear grade ranged from 0 to 2. Mitotic figures (MF) were absent in two tumors. The mitosis count in the other four tumors was < 1 MF/10 high-power microscopic fields (HPF) (average method) and ranged from 1 to 3 MF/10 HPF (highest count method). Five patients were alive without recurrence after postoperative intervals ranging from 19 months to 9 years (median, 5 years); one patient died of metastatic gastric carcinoma at 14 months. Thirteen tumors involved more than one anatomic site and were classified as diffuse mesothelioma. Typically, these tumors were symptomatic and accompanied by ascites. The tumors had either a plaque-like or endophytic configuration. Eleven were purely epithelial mesotheliomas, and two had a minor sarcomatoid component. Tubulopapillary patterns were present in 10 tumors, usually admixed with focal adenomatoid-like or solid patterns, and three had a purely solid pattern. All 13 tumors had grade 3 nuclei. The mitosis count ranged from < 1 to 2 MF/10 HPF (average count method) with a range of 1-4 MF/10 HPF by the highest count method. Immunohistochemically, 13/13 tumors stained for cytokeratin (AE1/AE3). None were immunoreactive for polyclonal carcinoembryonic antigen (CEA), Leu-M1, or B72.3. One diffuse mesothelioma stained focally for Ber-EP4, and electron microscopy confirmed the mesothelial nature of this tumor. Nine patients died of tumor after postoperative intervals ranging from 1 month to 6 years. Eleven patients had received postoperative adjuvant intraperitoneal or systemic chemotherapy. One patient died with increased abdominal girth 8 years after operation and one course of intraperitoneal chemotherapy, though the role of mesothelioma in her death

Topics: Adenomatoid Tumor; Adult; Aged; Aged, 80 and over; Female; Fibroma; Follow-Up Studies; Genital Neoplasms, Female; Humans; Immunohistochemistry; Keratins; Mesothelioma; Mesothelioma, Cystic; Microscopy, Electron; Middle Aged; Mitosis; Peritoneal Neoplasms; Prognosis

A 2-year-old girl presented with a 3-month history of progressive painless abdominal distension. Results of the clinical examination suggested massive ascites, but no other symptoms or signs could be elicited. There was no history of any other illness preceding the onset of distension. Ultrasonography and a computed tomography scan confirmed gross ascites, with multiple thin-walled loculi throughout the abdomen, from the diaphragm to the pelvis. The preoperative diagnosis was intraabdominal lymphangioma. During laparotomy, multiple transparent cysts were found throughout the peritoneum. There was no evidence of malignancy in any organ, and the cysts appeared almost completely avascular. Histological and ultrastructural appearances were those of benign cystic mesothelioma of the peritoneum, a condition that hitherto has been recognized only in adults. It is thought to represent a borderline variant between a truly benign adenomatoid lesion and the better-known malignant mesothelioma. The experience with adult cases suggests a high potential for recurrence but no progression to malignancy. It is possible that some cases of intraabdominal lymphangioma may have been misdiagnosed in the past; future cases should be fully evaluated, both immunohistochemically and ultrastructurally, to establish the true incidence of mesothelial proliferative disease in children.

Topics: Ascites; Biomarkers, Tumor; Child, Preschool; Diagnosis, Differential; Female; Humans; Keratins; Mesothelioma, Cystic; Peritoneal Neoplasms; Peritoneum; Radiography