Prognostic value of high serum levels of CA‐125 in malignant secretory peritoneal mesotheliomas affecting young women. A case report with differential diagnosis and review of the literature

Abstract

Aims: Very few cases of diffuse, malignant, peritoneal mesothelioma have been reported in young women. Distinction between peritoneal mesothelioma and serous epithelial tumours, including papillary serous carcinomas and borderline serous tumours, can be difficult. Differential diagnosis based on clinical appearance and imaging techniques is broad and inconclusive, thus the diagnosis must be confirmed by histological examination. Because the vast majority of tumours involving the peritoneal and serosal surfaces are due to primary or metastatic serous epithelial tumours, there is a tendency on the part of pathologists to disregard the possibility of mesothelioma when examining a biopsy or excision specimen. This is especially likely to occur when mesothelioma is associated with highly elevated serum levels of CA‐125, which is the typical tumoral marker of epithelial serous tumours from the ovary. The association between peritoneal mesothelioma and high serum levels of CA‐125 has been reported in the literature only in two cases. Case details: In order to avoid a misdiagnosis of this neoplasm we describe a new case of peritoneal mesothelioma in an 18‐year‐old woman with high serum levels of CA‐125. Conclusions: Besides its clinicopathological characteristics and its histological, immunohistochemical and ultrastructural features, we describe its biological behaviour, which seems to be worst when CA‐125 levels are high.

An Unusual Case of Ascites: Pitfalls in Diagnosis of Malignant Peritoneal Mesothelioma

“…14,34 Although it is not uniformly accepted, 3,30,35 asbestos is believed to be the main aetiological factor in MPM. 7,13,26,31,36–42 With regard to asbestos fibre type, crociodolite (blue asbestos) is certainly the most potent cause of mesothelioma, followed by amosite and tremolite. There are few data, however, to support any link with chrysotile in humans.…”

“…Normal liver function and albumin point away from chronic liver disease as the more likely cause of ascites. There are several reports that CA‐125 may be used as a marker of the disease, 41,55,56 but the sensitivity and specificity of this test is low and its place rests more in monitoring response to treatment in patients with elevated serum levels. Ascitic fluid analysis usually reveals an exudative process, but cytology is rarely diagnostic, having a sensitivity in the order of 25%, 11,13,31,32,57 demonstrated by the present case where only reactive mesothelial cells were seen.…”

“… 7,76 Positive staining for monoclonal antibodies to keratin and vimentin are useful adjuncts in diagnosis. 41,59 Ultrastructural features on electron microscopy include long, slender microvilli and diffuse cytoplasmic or perinuclear distribution of tonofilaments. 31,41,74,76 …”

“… 41,59 Ultrastructural features on electron microscopy include long, slender microvilli and diffuse cytoplasmic or perinuclear distribution of tonofilaments. 31,41,74,76 …”

“…The modalities used include surgical resection (debulking and peritonectomy), irradiation (total abdominal and intraperitoneal radioisotopes) and chemotherapy (systemic and intraperitoneal). Response rates to chemotherapy vary from 0 to 40% in various series, 78 with cisplatinum‐ or doxorubicin‐based regimens proving most effective, 18,41,79 but without significant prolongation of median survival. 10,11,15 Several studies have found marked improvement in survival following aggressive multimodality plans combining surgical debulking, intraperitoneal 198 Au/ 32 P or doxorubicin/ cisplatinum, total abdominal irradiation and systemic chemotherapy.…”