Clear-Cell Mesothelioma of Uterine Corpus: Diagnostic Challenges in Intraoperative Frozen Sections.

Pongsuvareeyakul T, Saipattranusorn K, Sukpan K, Prapaporn Suprasert, Khunamornpong S
Diagnostics (Basel, Switzerland) · 2023 · doi:10.3390/diagnostics13061119 · PMID:36980427 · PMC10047779
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This case report describes a rare clear-cell mesothelioma of the uterine serosa initially misdiagnosed as adenocarcinoma on frozen section, highlighting the importance of immunohistochemistry to distinguish it from other clear-cell neoplasms.

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This case report describes the diagnostic difficulties encountered during intraoperative frozen section analysis of a rare clear-cell mesothelioma arising in the uterine corpus. The authors highlight the challenges pathologists face when distinguishing this malignancy from other endometrial or peritoneal lesions due to its uncommon presentation and specific histological features. The paper emphasizes that accurate diagnosis often requires extensive immunohistochemical staining and permanent sections, as frozen section results can be inconclusive or misleading. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

The clear-cell variant of epithelioid mesothelioma is an extremely rare neoplasm of the peritoneum. It shares histomorphologic features overlapping with a wide variety of tumors including carcinomas and other non-epithelial neoplasms. The diagnosis of peritoneal clear-cell mesothelioma is not always straightforward, despite known immunohistochemistry (IHC) markers. Due to its rarity, this entity may be diagnostically confused with other clear-cell neoplasms, particularly in intraoperative frozen sections. Here, we present a case of clear-cell mesothelioma originating in the uterine serosa that was initially misdiagnosed as clear-cell adenocarcinoma in the intraoperative frozen section. Microscopically, the tumor showed diffuse tubulocystic spaces of variable size lined by clear cells with moderate nuclear atypia. Immunohistochemical staining confirmed the diagnosis of clear-cell mesothelioma. Recognition of this entity, albeit rare, is important as the diagnosis may significantly affect the management considerations. The judicious use of an IHC panel helps to distinguish this tumor from other mimickers.
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Data

The data of this report are available from the corresponding authors upon request.

Author

T.P. and S.K.: Conceptualization, manuscript writing, pathologic evaluation, final approval; K.S. (Kanokkan Saipattranusorn) and K.S. (Kornkanok Sukpan): reviewing pathologic findings, final approval; P.S.: clinical management, final approval. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

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Informed

Written informed consent has been obtained from the patient to publish this paper.

Conflicts

The authors declare no conflict of interest.

Institutional

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Faculty of Medicine, Chiang Mai University (protocol code PAT-2565-09347and date of approval 17 January 2023).

Associated Data

The data of this report are available from the corresponding authors upon request.

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