Multicystic peritoneal mesothelioma.
ABSTRACT Multicystic peritoneal mesothelioma is a rare disease. It is not certain if it is a benign or a borderline tumor. Although many therapeutic approaches have been used, complete cytoreductive surgery in combination with hyperthermic intraoperative intraperitoneal chemotherapy has gained acceptance.
A case of multicystic peritoneal mesothelioma in a 16-year old patient is reported. The patient underwent complete cytoreduction and received intraoperative hyperthermic intraperitoneal chemotherapy. The patient is disease-free one year after surgery.
Complete cytoreductive surgery in combination with hyperthermic intraoperative intraperitoneal chemotherapy appears to be a rational therapeutic approach in multicystic peritoneal mesothelioma.
- SourceAvailable from: Dimitrios K Manatakis[Show abstract] [Hide abstract]
ABSTRACT: We report the case of a 36-year-old woman who presented with signs and symptoms of an irreducible inguinal hernia. Surgical exploration revealed a mesothelial cyst of the round ligament of the uterus. Mesothelial cysts of the round ligament are rare lesions, frequently masquerading as inguinal hernias, and should be included in the differential diagnosis of any inguinal mass. Clinical findings are those of a groin mass, discomfort, and bulging. Ultrasound and CT scans often demonstrate an aperistaltic cystic mass. Definitive diagnosis is usually made intraoperatively and confirmed histopathologically.Case reports in surgery. 01/2013; 2013:408078.
Multicystic peritoneal mesothelioma
Antonios-Apostolos Tentes, Georgios Zorbas, Nicolaos Pallas, Aliki Fiska
Surgical Department, Didimotichon General Hospital, Diagnostiko Center of Pathology, Didimotichon, Greece
Background: Multicystic peritoneal mesothelioma is a rare disease. It is not certain if it is a benign or a border-
line tumor. Although many therapeutic approaches have been used, complete cytoreductive sur-
gery in combination with hyperthermic intraoperative intraperitoneal chemotherapy has gained
Case Report: A case of multicystic peritoneal mesothelioma in a 16-year old patient is reported. The patient un-
derwent complete cytoreduction and received intraoperative hyperthermic intraperitoneal che-
motherapy. The patient is disease-free one year after surgery.
Conclusions: Complete cytoreductive surgery in combination with hyperthermic intraoperative intraperitoneal
chemotherapy appears to be a rational therapeutic approach in multicystic peritoneal mesothelioma.
intraperitoneal chemotherapy (HIPEC)
Author’s address: Antonios-Apostolos K. Tentes, Surgical Department, Didimotichon General Hospital, Didimotichon, 68300, Greece,
© Am J Case Rep, 2012; 13: 262-264
Multi-cystic peritoneal mesothelioma is a rare disease and
less than 200 cases have been reported in the literature
[1,2]. The short-term survival seems to be favorable but af-
ter debulking surgery the incidence of recurrence is high
. Long-term clinical study has not been reported so far.
The disease generally affects women in reproductive age
and is not related to asbestos exposure [1,2]. Cytoreductive
surgery combined with hyperthermic intraperitoneal in-
traoperative chemotherapy (HIPEC) has been considered
the standard of care for diffuse malignant peritoneal me-
sothelioma [4–6] and currently has gained acceptance for
the treatment of multicystic peritoneal mesothelioma .
A rare case of multicystic peritoneal mesothelioma in a 16-
year old patient is reported.
A 16-year old female patient presented with vague abdominal
discomfort and abdominal distention for the last two months.
Ultrasound revealed the presence of ascites. Abdominal
CT-scan confirmed the presence of ascites with peritone-
al implants at the pelvis. Laparoscopy and biopsies showed
the presence of multicystic peritoneal mesothelioma. The
patient (Figure 1) underwent complete cytoreductive sur-
gery and hyperthermic intraperitoneal intraoperative che-
motherapy (Figure 2). Cytoreductive surgery was possible
by pelvic peritonectomy procedure (resection of the pel-
vic peritoneum en bloc with the internal female genitalia,
and low anterior resection), greater and lesser omentecto-
my (Figure 3). The patient had an uneventful recovery and
one year after initial treatment remains disease free. Final
histopathology confirmed the initial diagnosis (Figure 4).
Multicystic peritoneal mesothelioma is an intermediate be-
tween benign adenomatoid tumor and diffuse malignant
peritoneal mesothelioma . The natural history of the
disease is still an issue of disagreement [1,2,8]. It is still dis-
cussed whether this is a benign or a border-line malignant
neoplasm . The recurrence rate in patients that under-
went traditional debulking surgery is high [8,9]. A few pa-
tients with multicystic peritoneal mesothelioma have been
reported to develop diffuse malignant peritoneal meso-
thelioma after treatment [10,11]. Complete surgical resec-
tion has been advocated by most authors as the treatment
of choice. More conservative treatments have also been rec-
ommended such as laparoscopic debulking, irradiation, sys-
temic or intraperitoneal chemotherapy, laser vaporization,
percutaneous cyst drainage, hormone-therapy, sclero-ther-
apy with anthracycline or simple observation with uncer-
tain results [1,2].
The recurrence rate even after complete surgical resec-
tion is approximately 50% after 3–27 months [12,13].
Cytoreductive surgery with standard peritonectomy
Figure 1. Greater omentum of the patient with multicystic peritoneal
Figure 2. The pelvis of the patient with multicystic peritoneal
Figure 3. The pelvis of the patient after pelvic peritonectomy.
Figure 4. Low grade peritoneal mesothelioma.
Tentes A-A et al – Multicystic peritoneal mesothelioma
procedures in combination with HIPEC seems to be a ra-
tionale approach for the definitive treatment of this dis-
ease. Cytoreductive surgery makes possible complete resec-
tion of the tumor. The eradication of microscopic residual
tumor is possible by heated intraperitoneal chemotherapy
thus minimizing the risk of recurrence . Modified cy-
toreductive surgery combined with HIPEC has been safely
and effectively used in patients with recurrent multicystic
peritoneal mesothelioma .
Complete cytoreductive surgery in combination with hy-
perthermic intraoperative intraperitoneal chemotherapy
appears to be a rational therapeutic approach in multicys-
tic peritoneal mesothelioma.
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