Multicystic Mesothelioma of the Peritoneum

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A-PDF Radiologic–Pathologic Conference of Madigan Armywatermark                                                                                             Center

      Multicystic Mesothelioma of the Peritoneum
      Liem T. Bui-Mansfield 1, Gina Kim-Ahn 2, Larry K. O’Bryant 3

                   uring a pelvic examination, a 44-                lioma occurs predominantly (84% of cases) in                 images, isointense to urine. This finding corre-

          D        year-old woman was found to have
                   an abdominal mass. Pelvic sonog-
      raphy revealed a complex multiseptate cystic
                                                                    young or middle-aged women (mean age, 37
                                                                    years 10 months) [1, 2]. The tumor chiefly af-
                                                                    fects the pelvic peritoneum, particularly the
                                                                                                                                 lates with the clear watery fluid seen at gross
                                                                                                                                 pathologic examination [2].
                                                                                                                                    Differential diagnoses include lymphangioma,
      mass (Fig. 1A). MR imaging showed a 15 × 9 ×                  uterus, cul-de-sac, bladder, and rectum, growing             endometriosis, ovarian cystadenoma or cystade-
      7 cm mass arising from the uterine fundus; on                 along the serosa as multiple translucent fluid-               nocarcinoma, teratoma, pseudomyxoma perito-
      T2-weighted images, the mass exhibited inter-                 filled cysts. Multicystic mesothelioma is made                nei, necrotic leiomyoma or leiomyosarcoma, and
      mediate and high signal intensity. Fine septa-                up of mesothelium-lined cysts embedded in fi-                 epithelial inclusion cysts [1, 2]. Because of the
      tions were seen in the cystic component of the                brovascular stroma. The mesothelial cells are                rarity of multicystic mesothelioma, a correct pre-
      mass (Fig. 1B). The patient underwent a total                 typically flattened or cuboidal. In one third of              operative diagnosis is almost never rendered [1].
      abdominal hysterectomy and bilateral sal-                     patients, adenomatoid change or squamous                        Multicystic mesothelioma is not chemo- or
      pingo-oophorectomy. The hysterectomy speci-                   metaplasia of the mesothelium is found [1]. Un-              radiosensitive. No correlation exists between
      men showed an irregular multilocular cystic                   like the malignant form of mesothelioma, multi-              the extent of the tumor and the patient’s sur-
      mass attached to the uterine fundus (Fig. 1C).                cystic mesothelioma has no association with                  vival. Treatment for localized lesions is total
      Microscopic examinations found multiple                       asbestos exposure [1]. The most common pre-                  surgical excision, and for more extensive le-
      mesothelium-lined cysts surrounded by a fi-                    senting symptoms are abdominal pain (46% of                  sions, debulking procedures are performed.
      brovascular stroma with adenomatoid changes                   patients) and abdominal mass (29% of patients)
      (Fig. 1D). The pathologic diagnosis was multi-                [2]. In 18% of patients, the tumor is an inciden-            References
      cystic mesothelioma of the peritoneum.                        tal finding [2].                                               1. Weiss SW, Tavassoli FA. Multicystic mesothelioma:
         Mesotheliomas are mesenchymal neo-                             On sonography, multicystic mesothelioma                      an analysis of pathologic findings and biologic behav-
      plasms originating in the serous lining of the                appears as a multiseptate cystic mass [3]. Typi-                 ior in 37 cases. Am J Surg Pathol 1988;12:737–746
      pleura, pericardium, or peritoneum. Multicystic               cally, CT reveals a well-defined, noncalcified                  2. O’Neil JD, Ros PR, Storm BL, Buck JL, Wilkin-
      mesothelioma of the peritoneum is an interme-                 multilocular cystic mass [2], although a case of                 son EJ. Cystic mesothelioma of the peritoneum.
      diate form of mesothelioma: the severity of the               calcification in a benign cystic peritoneal me-                   Radiology 1989;170:333–337
                                                                                                                                  3. Schneider JA, Zelnick EJ. Benign cystic peritoneal
      disorder is greater than that of the localized, be-           sothelioma has been reported [4]. MR imaging
                                                                                                                                     mesothelioma. J Clin Ultrasound 1985;13:190–192
      nign adenomatoid mesothelioma but is less than                shows well-defined lesions that are hy-                        4. Hasan AKH, Sinclair DJ. Case report: calcifica-
      that of the highly lethal form of diffuse epithe-             pointense on T1-weighted images and have in-                     tion in benign cystic peritoneal mesothelioma.
      lial mesotheliomas [1]. Multicystic mesothe-                  termediate signal intensity on T2-weighted                       Clin Radiol 1993;48:66–67

                                                A                                         B                                                 C                                             D

      Fig. 1.—Multicystic mesothelioma of peritoneum in 44-year-old woman.
      A, Pelvic sonogram shows mixed solid and complex multilocular cystic mass. Fine septations are seen within cystic component.
      B, Axial T2-weighted MR image shows complex cystic mass (arrows ) adhering to uterine fundus. Fine septations are visible in cystic component.
      C, Photograph of hysterectomy specimen shows irregular, multilocular cystic mass (M) attached to uterine fundus (U).
      D, Photomicrograph of specimen shown in C shows multiple mesothelium-lined cysts surrounded by fibrovascular stroma with adenomatoid changes. (H and E, ×10)

      Received March 8, 2001; accepted after revision April 13, 2001.
      From the radiologic–pathologic correlation conferences of Madigan Army Medical Center, Tacoma, WA 98431-0001.
      The opinions and assertions contained herein are those of the authors and should not be construed as official or as representing the opinions of the Department of the Army or the
      Department of Defense.
       Department of Radiology, Keller Army Community Hospital, West Point, NY 10996-1197; Division of Radiologic Sciences, Department of Radiology, Wake Forest University School of
      Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088; and Departments of Radiology and Nuclear Medicine, Uniformed Services University of Health Sciences, 4301 Jones
      Bridge Rd., Bethesda, MD 20814-4799. Address correspondence to L. T. Bui-Mansfield at the West Point address.
          Department of Radiology, Madigan Army Medical Center, Bldg. 9040, Fitzsimmons Dr., Tacoma, WA 98431-0001.
          Department of Pathology, Madigan Army Medical Center, Tacoma, WA 98431-0001.
      AJR 2002;178:402 0361–803X/02/1782–402 © American Roentgen Ray Society

      402                                                                                                                                                        AJR:178, February 2002