A Case of Well-Differentiated Papillary Mesothelioma of the Male Peritoneum: Successful Treatment by Systemic Chemotherapy

Abstract

Well-differentiated papillary mesothelioma of the peritoneum (WDPMP) is a rare subtype of epithelioid mesothelioma, which is usually seen in young women without a history of asbestos exposure, and generally, has an indolent course. The relative rarity of this neoplasm in males prompted us to report this case of a well-differentiated papillary mesothelioma of the peritoneum in a 36-year-old man.The patient, who had no history of asbestos exposure, presented with abdominal pain and ascites of unknown etiology. Computed tomography showed abundant ascites with nodules of the peritoneal cavity. Laparoscopic examination revealed a large number of white miliary nodules diffusely covering the peritoneum. Pathology revealed a diagnosis of well-differentiated papillary mesothelioma of the peritoneum, based on histomorphology and immunohistochemistry. The patient started chemotherapy with cisplatin and pemetrexed. After six cycles of chemotherapy, the effectiveness of this chemotherapy was checked by only the computed tomography. PET scan was not used because it is not routinely recommended in WDPMP. Few data are currently available in the literature regarding the performance of the PET scan in WDPMP. Nine months later, the patient was free of symptoms.Based on reviewing the literature and our observations in this case, consultation of other pathologists is highly recommended to discern WDPMP from other disseminated peritoneal diseases, in order to offer the most effective and safe therapeutic strategy. Chemotherapy should be strongly considered if the tumor is unresectable and accompanied by symptoms. Cisplatin and pemetrexed chemotherapy could be a promising therapeutic choice.

Well-Differentiated Papillary Mesothelioma with Omental Calcifications: A Case Report and Review of the Literature

“…PAX8 has also been shown to be less useful in differentiating WDPM from serous papillary carcinoma due to crossover of the immunophenotypic patterns of PAX8 [5]. However, the presence of calretinin, as in our case, is much more likely in WDPM [4][5][6][7][8][9][10][11][12][13][14][15][16]18] and occurs in a smaller percentage of cases of serous papillary carcinoma [5,23] (Table 2). Interestingly, the calcification in our case was positive for ER, which occurs commonly in serous papillary carcinoma but generally not in WDPM [23,33].…”

“…The well-formed papillary architecture of WDPM superficially spreads and is lined by single layers of bland, cuboidal, or flattened mesothelial cells with little to no nuclear atypia, usually without mitoses [5,38]. In some instances of WDPM, psammomatous bodies [8,11,15,16,20,21] and invasive foci [5,6] have been reported. In a recent study of 75 patients with WDPM [5], the affected areas/nodules were generally less than 2 cm in diameter but ranged from 6 mm to 6.0 cm in diameter.…”

Acute severe abdominal pain in a young woman caused by a well-differentiated papillary mesothelioma of the peritoneum

“…WDPMP is a rare disease with fewer than hundred reported cases in literature. The tumour has been described to originate from the serous membranes in the pleura, tunica vaginalis, peritoneum or pericardium and it usually shows a benign course 1–4…”