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This paper reports a 21-year-old woman with chronic lower abdominal pain in whom ultrasound and laparoscopy identified adnexal cystic structures alongside a typical endometriotic cyst; laparotomy found an additional multicystic tumor composed of many small cysts in the pouch of Douglas. The excised endometriotic cyst and the tumor were histologically diagnosed as multicystic peritoneal mesothelioma. Less than one year later, ultrasound detected recurrence at the same site, and a repeat laparotomy showed another cluster of grape-like small, fluid-filled cysts adjacent to a right ovarian serous cyst, with histology matching the primary tumor. The authors note this rare tumor’s frequent recurrences and the ongoing controversy about whether it represents a reactive mesothelial proliferation rather than a true neoplasm, and this paper is centrally about endometriosis by describing recurrent multicystic peritoneal mesothelioma occurring during endometriosis in the lesser pelvis.
Abstract
In the case of a 21-year old woman, who complained of chronic pelvic pain and where cystic structures in the adnexal region had been diagnosed ultrasonically and by laparoscopy, a tumour made up of many small cysts was discovered in the pouch of Douglas next to a typical endometrial cyst. Both the endometrial cyst and the cystic tumour were excised by laparotomy. Histology established the tumour as a multicystic peritoneal mesothelioma. Postoperative recurrence was noticed by ultrasound less than one year later. Laparotomy revealed a 5 cm serous cyst of the right ovary and again countless liquid-filled grape-like small cysts in the pouch of Douglas. Histology revealed a multicystic peritoneal mesothelioma identical to the previously excised tumour. Multicystic peritoneal mesothelioma is a rare soft tissue tumour noted for its frequent recurrences. Most authors agree, that it belongs to the morphological spectrum of reactive mesothelial proliferative lesions and not the neoplastic spectrum. It appears mostly in women, often concomitant with endometriosis and pelvic inflammatory disease and frequently in women, who had previous surgical interventions in the abdominal region.
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DOI: 10.1055/s-2008-1026225
Rezidivierendes multizystisches peritoneales Mesotheliom bei Endometriose im kleinen Becken
Recurrent Multicystic Peritoneal Mesothelioma during Endometriosis of the lesser PelvisPublication History
Publication Date:
18 March 2008 (online)
Zusammenfassung
Bei einer 21jährigen Patientin, die wegen chronischer Unterbauchbeschwerden und sonographisch festgesteller Adnexzysten laparoskopiert wurde, wurde neben einer typischen Endometriosezyste ein aus vielen kleinen Bläschen aufgebauter Tumor im Douglas festgestellt. Zyste und Tumor wurden bei der Laparotomie entfernt, die Histologie ergab den Befund eines multizystischen peritonealen Mesothelioms. Knapp ein Jahr danach trat an derselben Stelle ein Rezidiv auf, gleichzeitig und in enger Nachbarschaft zu einer Serosazyste des rechten Ovars. Die Tumorbläschen wurden operativ entfernt, sie wiesen histologisch dieselbe Struktur auf wie der Primärtumor. Das multizystische peritoneale Mesotheliom ist ein durch häufige Rezidive gekennzeichneter seltener Weichteiltumor, dessen Zuordnung zu den echten Neoplasien oder den reaktiven Veränderungen umstritten ist. Der Tumor tritt hauptsächlich bei Frauen auf, auffallend oft vergesellschaftet mit Endometriose, Adnexitiden und Operationen im Unterbauch.
Abstract
In the case of a 21-year old woman, who complained of chronic pelvic pain and where cystic structures in the adnexal region had been diagnosed ultrasonically and by laparoscopy, atumour made up of many small cysts was discovered in the pouch of Douglas next to a typical endometrial cyst. Both the endometrial cyst and the cystic tumour were excised by laparotomy. Histology established the tumour as a multicystic peritoneal mesothelioma. Postoperative recurrence was noticed by ultrasound less than one year later. Laparotomy revealed a 5 cm serous cyst of the right ovary and again countless liquid-filled grape-like small cysts in the pouch of Douglas. Histology revealed a multicystic peritoneal mesothelioma identical to the previously excised tumour. Multicystic peritoneal mesothelioma is a rare soft tissue tumour noted for its frequent recurrences. Most authors agree, that it belongs to the morphological spectrum of reactive mesothelial proliferative lesions and not the neoplastic spectrum. It appears mostly in women, often concomitant with endometriosis and pelvic inflammatory disease and frequently in women, who had previous surgical interventions in the abdominal region.
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MeSH descriptors
Endometriosis
Mesothelioma
Neoplasm Recurrence, Local
Neoplasms, Second Primary
Pelvic Neoplasms
Peritoneal Neoplasms
Adult
Cysts
Cysts
Cysts
Diagnostic Imaging
Endometriosis
Endometriosis
Female
Humans
Mesothelioma
Mesothelioma
Neoplasm Recurrence, Local
Neoplasm Recurrence, Local
Neoplasms, Second Primary