Cartilaginous Differentiation in Peritoneal Tissues: A Report of Two Cases and a Review of the Literature

Abstract

REPORT OF CASESCase 1 Patient 1 was a 53-year old Caucasian female who presented with complaints of low back discomfort. She gave a medical history of self-induced abortion at 6 months' gestation, complicated by pelvic inflammatory disease and pelvic abscesses, approximately 30 years before presentation. Those abscesses reportedly were drained through a culdotomy, although the specific details were unavailable for review. An ultrasound at current presentation revealed a septated right ovarian mass. At surgery, several firm, white nodules ranging from 2 to 7 mm were noted throughout the peritoneal cavity and were excised from several locations along the serosal surfaces and mesenteries of the small and large bowel. The patient underwent a total abdominal hysterectomy and bilateral salpingooophorectomy and has had no recurrence of pleural, peritoneal, or gynecologic diseases after a 9-year follow-up. Case 2Patient 2 was a 77-year-old Caucasian female who presented with abdominal distention, diarrhea, and abdominal pain. She gave a medical history of a total abdominal hysterectomy and bilateral salpingo-oophorectomy approximately 28 years before presentation for pelvic pain caused by uterine leiomyomata. Radiographic studies revealed an obstruction in the small bowel. During an exploratory laparotomy, a single firm, white nodule measuring 2.0 cm in maximum dimension was identified and excised from the mesentery of the ileum, just lateral of midline. There were significant adhesions involving the small and large bowel that were lysed. The last recorded follow-up was 1 year after presentation, at which time there had been no development of any peritoneal or pleural diseases.

Secondary Tumors and Tumorlike Lesions of the Peritoneal Cavity: Imaging Features with Pathologic Correlation

“…Osseous metaplasia has been described more frequently in men and chrondroid metaplasia more frequently in women (75). Its pathogenesis is not entirely clear, and it has been postulated that it represents metaplasia of the submesothelial mesenchyme, although implantation of osteoblasts or periosteum during trauma or procedures cannot be entirely excluded (76,77).…”

Perivascular epithelioid cell tumor (PEComa) of the uterine cervix associated with intraabdominal "PEComatosis": A clinicopathological study with comparative genomic hybridization analysis

“…These include leiomyomatosis peritonealis disseminata (LPD), gliomatosis peritonei and the recently described diffuse cartilaginous metaplasia of the peritoneum [50,52]. In LPD, for example, diffusely distributed peritoneal nodules of benign smooth muscle may proliferate or regress based on the hormonal milieu of pregnancy [52].…”

“…In a few patients with and without tuberous sclerosis, a distinctive diffuse pulmonary interstitial proliferation has been described [53-56]. These proliferations are composed of clear HMB-45+ cells and are inconstantly associated with LAM [50-53]. Whether a similar mechanism is operational here is not clear.…”

Heterotopic mesenteric ossification: report of a case and review of the literature

“…Ossification of the peritoneum has been reported in response to spilled contents of mature cystic teratoma, suggesting metaplastic pathogenesis in response to chemical or physical stimuli 15. Another hypothesis is that the trigger may be an infectious/inflammatory stimulus 16. Such stimuli would act on stem cells to regenerate mesoblasts, at the same time erroneously stimulating generation of osteoblasts 17.…”