Multiple adenomatoid tumours in the liver and peritoneum

Hayes, Stephen; Clark, Peter; Mathias, Richard T.; Formela, Laura; Vickers, J; Armstrong, G. R.

doi:10.1136/jcp.2005.035386

Cited by 31 publications

(38 citation statements)

References 19 publications

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“…The mesothelial histogenesis still cannot explain the tendency for such tumours to occur much more frequently in the genital tract and more rarely on the serosal surface. 3,4,6,7 Most peritoneal adenomatoid tumours are asymptomatic. When present, signs and symptoms include abdominal pain, weight loss, anorexia, nausea, ascites or a palpable pelvic mass.…”

Section: Discussionmentioning

confidence: 99%

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Transmural peritoneal adenomatoid tumour in the ileocaecal region causing massive haemoperitoneum and low gastrointestinal bleeding: differential diagnosis with capillary haemangiomas

Ruíz-Tóvar

Santos

López-Delgado

et al. 2011

annals

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Peritoneal adenomatoid tumours are rare benign neoplasms originating from mesothelial cells.1 They usually appear between 25 and 55 years of age.2 Their aetiology has not been established. Few patients present symptomatology related to the tumour and they are incidentally discovered during radiological examinations, surgery or postmortem examinations. 3 We present a case of a peritoneal adenomatoid tumour penetrating into the bowel wall and causing massive intra-and extraluminal bleeding. Case historyA 48-year-old woman, with personal history of enolic liver cirrhosis, came to the emergency department of our institution complaining of massive rectal bleeding during the previous 24 hours. Physical examination revealed mucocutaneous pallor, tachycardia and hypotension at 80/40mmHg. The abdomen was slightly distended without tenderness. Rectal examination revealed massive rectal bleeding without evidence of a possible cause. Laboratory data showed haemoglobin at 6g/dl and haemostatic disorder (Quick rate 36% and activated partial thromboplastin time of 52 seconds). The patient was transferred to the intensive care unit because of haemodynamic instability. Resuscitation was started with a crystalloid infusion and transfusion of 4 units of packed red blood cells. A colonoscopy observed the whole colon full of fresh red blood, without evidence of bleeding point. The patient remained haemodynamically unstable and an exploratory laparotomy was performed revealing a 6l haemoperitoneum and the whole colon full of blood. A tortuous angiomatoid transmural lesion was located in the ileocaecal region with active intra-and extraluminal bleeding. A right hemicolectomy was performed. Postoperatively, the haemodynamic instability deceased 6 hours after surgery.The histopathological study revealed a lesion composed of both solid and tubular regions, the latter penetrating from the serosal to the mucosal layer through the muscularis propria. The tubules were lined with a single layer of flattened cells, suggestive of endothelial cells. The angiomatoid architecture led to the initial suspicion of hemangioma (Figs 1 and 2). To confirm the diagnosis, immunohistochemical staining was performed, observing CD31 (endothelial cell marker) negativity (Fig 3) and calretinin (mesothelial cell marker) positivity (Fig 4), achieving the correct diagnosis of a peritoneal adenomatoid tumour. DiscussionPeritoneal adenomatoid tumours usually involve the genital tract of both sexes, appearing more frequently among males. Among women, adenomatoid tumours are more commonly located in the myometrium, fallopian tubes, paraovarian connective tissue and, rarely, in the ovaries. Among men, they usually appear in the inferior pole of the epididymis, ejaculatory duct, spermatic cord, tunica albuginea, tunica vaginalis, testicular parenchyma and prostate. Other reported locations of adenomatoid tumours are the omentum, mesentery, pancreas, liver, bladder, mediastinum, pleura, heart and adrenal glands. Peritoneal adenomatoid tumours are rare benign neoplasms o...

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Section: Discussionmentioning

confidence: 99%

“…Few patients present symptomatology related to the tumour and they are incidentally discovered during radiological examinations, surgery or postmortem examinations. 3 We present a case of a peritoneal adenomatoid tumour penetrating into the bowel wall and causing massive intra-and extraluminal bleeding. …”

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confidence: 99%

Transmural peritoneal adenomatoid tumour in the ileocaecal region causing massive haemoperitoneum and low gastrointestinal bleeding: differential diagnosis with capillary haemangiomas

Ruíz-Tóvar

Santos

López-Delgado

et al. 2011

annals

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“…Although extragenital adenomatoid tumors have been reported in the adrenal gland, appendix, heart, hernia sac, intestinal mesentery, liver, lymph node, mediastinum, omentum, pancreas, peritoneum, pleura, and umbilicus, [1][2][3][4][5][6][7][8][9][10][11][12] they have been characteristically described within genital tract sites of both male and female patients. Initially designated as 'benign mesothelioma of the genital tract' in 1942 by Masson et al, 13 the term 'adenomatoid tumor' was coined in 1945 by Golden and Ash 14 to denote these benign, often incidental, and typically well-circumscribed neoplasms of mesothelial origin.…”

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confidence: 99%

Adenomatoid tumors of the female and male genital tracts: a clinicopathological and immunohistochemical study of 44 cases

et al. 2009

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Adenomatoid tumors of the female and male genital tracts are well characterized as mesothelial in origin, but a detailed histological and immunohistochemical analysis comparing both traditional and newer mesothelial markers across gender and site has not been formally conducted. A variety of morphologic features previously described as characteristic of adenomatoid tumors were evaluated in 44 adenomatoid tumors from the male and female genital tracts. Immunohistochemical analysis with pankeratin (AE1/CAM5.2), WT-1, calretinin, CK5/6, D2-40, and caldesmon was also performed. The extent and intensity of staining were scored semiquantitatively on one representative section per case and mean value for each parameter was calculated. All (n ¼ 44) the adenomatoid tumors from both the female and male genital tracts demonstrated a distinctive thread-like bridging strand pattern. Lymphoid aggregates were seen in all 12 adenomatoid tumors of male patients, but in only 4 of 32 (13%) tumors in female patients (Po0.0001). The remaining morphologic features were variably present with no clear sex predilection. Pankeratin, calretinin, and D2-40 reactivity were identified in all female (n ¼ 32) and male (n ¼ 12) genital tract adenomatoid tumors. Adenomatoid tumors expressed WT-1 in 11/12 (92%) male patients and in 31/32 (97%) female patients. In male patients, reactivity for CK5/6 and caldesmon was found in 1/12 (8%) and 0/12 (0%) adenomatoid tumors (respectively), whereas reactivity in female patients was found in 5/32 (16%) and 1/32 (3%); respectively. Female tumors differ from their male counterparts by the frequent absence of lymphoid aggregates and the presence of a circumscribed margin when occurring in the fallopian tube. Of the putative mesothelial markers evaluated, calretinin, D2-40, and WT-1 show a similar immunoprofile and have a higher sensitivity than CK5/6 and caldesmon in genital tract adenomatoid tumors. However, the presence of additional, often strong expression of WT-1 in normal tissues of the female genital tract limits the utility of WT-1 in this setting.

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“…The tumours are often found incidentally during radiological examination or surgical procedures 1,2,7 . Some case reports describe multiple adenomatoid tumours occurring mainly in the genital tract 13,14,15 . Although adenomatoid tumours have a distinct histological appearance, their differential diagnosis maybe problematic, including vascular neoplasms, germ-cell tumours, malignant mesothelioma and metastatic adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Stroma may consist of loose or dense collagen tissue with hyalinisation and may contain aggregates of lymphocytes. A variety of immunohistochemical markers have been reported to identify adenomatoid tumours such as calretinin, CK5/6, D240, caldesmon, CKAE1, CKAE3, caplonin, HMBE1 and WT1 1,2,11,12,13 . Calretinin is a calcium binding protein that is located both in the cytoplasm as well as the cell nucleus and has a high sensitivity for identifying mesothelial cells.…”

Section: Discussionmentioning

confidence: 99%