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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 .
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 .
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 . 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 . 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- . In 18% of patients, the tumor is an inciden- References
cystic mesothelioma of the peritoneum. tal ﬁnding . 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 . 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 , 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 . 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 . 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