Deciduoid mesothelioma in the pelvic cavity

Abstract

A very rare case of deciduoid mesothelioma in the pelvic cavity is presented. A 24-year-old woman (gestational stage: 28 weeks and 6 days) was admitted because of a tumor mass in the abdominal cavity. A well-circumscribed and fibrously encapsulated tumor mass was revealed in the Douglas cavity. Histologically, tumor cells were arranged in a solid sheet with deciduoid appearance and showed partial glandular and papillary structures. The tumor cells contained PAS positive and diastase-digested granules in the cytoplasm as well as alcian-blue positive and hyaluronidase-digested substances in the stroma. The cellularity of the tumor cells was moderate and mitoses were rare. There was partial tumor necrosis and tumor cells had infiltrated through the fibrous capsule. Immunohistochemically, the tumor cells were reactive for pancytokeratin, cytokeratin5/6, vimentin, HBME-1, calretinin and thrombomodulin. Ultrastructurally, numerous, long microvilli, tonofilaments and desmosome junctions could be seen. Consequently, this case was diagnosed as deciduoid mesothelioma and 2 years and 4 months after operation, the patient's clinical course has been good. This case is considered to be the first reported in Japan.

Deciduoid mesothelioma: report of 21 cases with review of the literature

“…It should be mentioned, however, that rare cases of mesotheliomas producing HCG have been documented in the literature. 48,49 That all 13 of the reported cases of deciduoid mesothelioma that have been investigated for HCG expression were negative for this marker, 1,6,8,11,18,21 as were the 4 additional cases in the present study, is an indication that if HCG is expressed in deciduoid mesotheliomas, it would be extremely rare.…”

“…15 According to published reports, deciduoid mesotheliomas are composed of large, polygonal, round, or ovoid cells having well-defined cell borders, abundant eosinophilic, glassy cytoplasm, and round vesicular nuclei presenting prominent nucleoli. 8,24 Additionally, nuclear pleomorphism, nuclear pseudoinclusions, 8,18,24 and binucleated or multinucleated cells have also been mentioned as being present in some of the reported cases. 8,9,23,24 Mitotic activity has been documented as being variable and, although some reports have mentioned that the tumor had high mitotic activity and the presence of atypical mitoses, [2][3][4][5]8 others have indicated that only rare or few mitoses were present.…”

“…3 Deciduoid mesotheliomas involving the peritoneum of women should be distinguished from pseudotumoral deciduosis, a condition that, although more frequently associated with pregnancy, 42 can be idiopathic, 43 and has been reported to occur in post-menopausal women. 44 It should also be mentioned that a deciduoid mesothelioma has been reported in a pregnant woman, 18 as well as in a woman 6 months after a caesarean section who was originally diagnosed as having pseudotumoral deciduosis. 21 In those instances in which the differential diagnosis is between deciduoid mesothelioma and pseudotumoral deciduosis, the higher degree of cellular atypia and presence of mitoses would favor the former over the latter.…”

“…5 In these reports, however, it was demonstrated that mesotheliomas with deciduoid features can also originate in the pleura, occur in elderly men, and be associated with asbestos exposure. Since then, several other cases, mostly individual case reports, have been published [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] (Table 1). Although patient survival in many of the published cases has been short and limited to a few months after diagnosis, thus suggesting that deciduoid mesotheliomas have an aggressive clinical course, patients with long survival …”

Granulocyte-colony stimulating factor- and interleukin 6-producing diffuse deciduoid peritoneal mesothelioma

“…16 The cases have been reported from the viewpoint of the differential diagnosis of metastasis of anaplastic adenocarcinomas, malignant melanoma, rhabdomyosarcoma and other unspecified sarcomas involving serosal membranes. Deciduoid mesothelioma is distinguished from other tumors by positive staining for cytokeratin, vimentin, calretinin, HMBE-1, EMA, CA125 and thrombomodulin and negative staining for CEA, HMB45 and myogenin.…”