Malignant Peritoneal Mesothelioma Associated With Endometriosis: A Clinicopathologic Study of 15 Cases

Abstract

Only a few cases of malignant peritoneal mesothelioma (MPeM) associated with endometriosis have been published; with chronic inflammation of the peritoneum associated with the latter being postulated as an inducing factor in the pathogenesis of this tumor. We assessed the clinicopathologic characteristics of MPeM associated with endometriosis to determine if there were other factors besides inflammation that may contribute to the pathogenesis in this patient population. Fifteen MPeM associated with endometriosis were retrieved from our files. Most presented with abdominal/pelvic pain, mass or distention; median age was 45 yr. Only 16% of patients had a history of asbestos exposure. In contrast, a third of the patients had a personal history of other neoplasms, and > 80% had a family history of malignancies. Although most tumors had gross and microscopic features typical of MPeM, some had confounding features including "adhesion-like" appearance or gelatinous cysts/ nodules, and signet ring cells. Tumors were epithelioid (9) and biphasic (6). MPeM was misdiagnosed as Müllerian carcinoma in 40% of cases. All patients (n = 15) had cytoreductive surgery in addition to other therapies. Only 2/12 patients died of disease (17%). The 3-and 5-yr overall survival was 90%. MPeM associated with endometriosis tends to occur in patients with personal/familial history of malignancies, which may be a predisposing factor. In light of this finding, the role of endometriosis in the pathogenesis of MPeM is likely less relevant. The favorable outcome seen in these patients may be related to germline mutations or the hormonal milieu and needs further investigation.

Progression of Peritoneal Mesothelioma In Situ to Invasive Mesothelioma Arising in the Setting of Endometriosis With Germline BAP1 Mutation: A Case Report

“…Endometriosis causes chronic inflammation of the peritoneal cavity and is frequently associated with florid mesothelial hyperplasia. Benign multilocular peritoneal inclusion cysts (cystic mesothelioma) and well differentiated papillary mesothelioma have also been reported in association with endometriosis, suggesting a possible role for the inflammatory and hormonal environment in promoting proliferation of the mesothelium (11). Two case series reported malignant peritoneal mesothelioma arising in women with endometriosis (combined N = 21, median age 45 yr, range 18-71 yr) (11,12).…”

Effects of the Concept of Fast-Track Surgery Combined with Empathic Nursing on Perioperative Complication Prevention and Postoperative Recovery of Gynecological Malignant Tumor Patients

“…Clinically common gynecological malignant tumors mainly include cervical cancer, ovarian cancer, and endometrial cancer, among which cervical cancer ranks first among all kinds of gynecological malignant tumors [ 1 ]. After diagnosis of gynecological malignant tumor, patients often need to receive comprehensive treatment such as surgery and multiple chemoradiotherapy, which brings great psychological and physiological pain to patients [ 2 ]. Clinically, due to the lack of disease-related cognition, patients often have a strong sense of uncertainty about the outcome of the disease [ 3 , 4 ].…”

Challenges in the diagnosis and treatment of peritoneal mesothelioma: a case study and review of the literature

“…The literature describes cases of peritoneal mesothelioma resulting in small bowel obstruction [10] or infertility [11]. Other reports call attention to the simultaneous appearance of peritoneal mesothelioma along with endometriosis [12,13] or breast cancer [14]. In a study of 164 women diagnosed with peritoneal mesothelioma, the mean age of diagnosis was 49 years, and the most frequently reported symptom was abdominal or pelvic pain.…”