Diagnostic laparoscopy identifies a peritoneal adenomatoid-like mesothelioma masquerading as ovarian cancer: a case report

The authors report a rare case of peritoneal adenomatoid mesothelioma in a woman with no history of asbestos exposure. A 61-year-old woman was originally suspected of having a bilateral ovarian tumor based on chest radiography and magnetic resonance imaging (MRI). Upon referral to our hospital, the presence of two solid masses was confirmed by enhanced MRI and 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG-PET/CT). Physical examination was normal, as were serum concentrations of the tumor markers CA 19-9, CA 125, and CEA. Laparoscopic surgery showed a right ovarian tumor and laparoscopic right salpingo-oophorectomy and adhesiotomy were performed. Two months later, the patient underwent laparoscopic segmental resection of the sigmoid colon, with histological analysis identifying an adenomatoid-like tumor. The final diagnosis was peritoneal adenomatoid-like mesothelioma with invasion of the right ovary. This case report demonstrates that imaging techniques must be coupled with laparoscopic surgery for an accurate diagnosis of peritoneal mesothelioma.

Laparoscopic surgery; Methothelioma; Adenomatoid-like tumor.

[1] Raptopoulos V.: “Peritoneal mesothelioma”. Crit. Rev. Diagn. Imaging, 1985, 24, 293.

[2] Robinson B.W., Lake R.A.: “Advances in malignant mesothelioma”. N. Engl. J. Med., 2005, 353, 1591.

[3] Sugarbaker P.H., Acherman Y.I., Gonzalez-Moreno S., Ortega-Perez G., Stuart O.A., Marchettini P., et al.: “Diagnosis and treatment of peritoneal mesothelioma: The Washington Cancer Institute experience”. Semin. Oncol., 2002, 29, 51.

[4] Scholzen T., Gerdes J.: “The Ki-67 protein: from the known and the unknown”. J. Cell Physiol., 2000, 182, 311.

[5] González-Moreno S., Yan H., Alcorn K.W., Sugarbaker P.H.: “Malignant transformation of “benign” cystic mesothelioma of the peritoneum”. J. Surg. Oncol., 2002, 79, 243.

[6] Gotfried M.H., Quan S.F., Sobonya R.E.: “Diffuse epithelial pleural mesothelioma presenting as a solitary lung mass”. Chest, 1983, 84, 99.

[7] Takahashi H., Harada M., Maehara S., Kato H.: “Localized malignant mesothelioma of the pleura”. Ann. Thorac. Cardiovasc. Surg., 2007, 13, 262.

[8] Umezu H, Kuwata K, Ebe Y, Yamamoto T, Naito M, Yamato Y, et al. Microcystic variant of localized malignant mesothelioma accompanying an adenomatoid tumor-like lesion. Pathol Int, 2002; 52: 416- 22.

[9] Battifora H., McCaughey, W.T.E.: “Tumor of the serosal membranes”. In: Atlas of tumor pathology, 3rd series. Washington DC, Armed Forces Institute of Pathology, 1994.

[10] Weissferdt A., Kalhor N., Suster S.: “Malignant mesothelioma with prominent adenomatoid features: a clinicopathologic and immuno-histochemical study of 10 cases”. Ann. Diagn. Pathol., 2011, 15, 25.

[11] Alfred G.A., James E., Ash J.W.: “Adenomatoid tumors of the genital tract”. Am. J. Pathol., 1945, 21, 63.

[12] Attanoos R.L., Gibbs A.R.: “Pathology of malignant mesothelioma”. Histopathology, 1997, 30, 403.

[13] Suzuki Y.: “Diagnostic criteria for human diffuse malignant mesothelioma”. Acta Pathol. Jpn., 1992, 42, 767.

[14] Cury P.M., Butcher D.N., Corrin B., Nicholson A.G.: “The use of histological and immunohistochemical markers to distinguish pleural malignant mesothelioma and in situ mesothelioma from reactive mesothelial hyperplasia and reactive pleural fibrosis”. J. Pathol., 1999, 189, 251.

[15] Prorocic M., Vasiljevic M., Jankovic S., Dzatic O.: “Diffuse malignant peritoneal mesothelioma in a 31-year-old patient—case report”. Eur. J. Gynaecol. Oncol., 2007, 28, 147.

[16] Milingos S., Protopapas A., Papadimitriou C., Rodolakis A., Kallipolitis G., Skartados N., et al.: “Laparoscopy in the evaluation of women with unexplained ascites: an invaluable diagnostic tool”. J. Minim. Invasive Gynecol., 2007, 14, 43.

[17] Van de Walle P., Blomme Y., Van Outryve L.: “Laparoscopy and primary diffuse malignant peritoneal mesothelioma: a diagnostic challenge”. Acta Chir. Belg., 2004, 104, 114.

[18] Estrada Saiz R.V., Loscos Valerio J.M., Garcia-Paredes J., del Pozo Camaron A., Estrada Perez V.: “The role of laparoscopy in diagnosis of peritoneal mesothelioma”. Rev. Esp. Enferm. Dig., 1995, 87, 403.