Benign multicystic mesothelioma of appendiceal origin treated by hyperthermic intraperitoneal chemotherapy: A case report

Our plain-English summary of Benign multicystic mesothelioma of appendiceal origin treated by hyperthermic intraperitoneal chemotherapy: A case report, by S.J. Lee, J.H. Nahm, J. Kang, et al (International Journal of Surgery Case Reports, 2022).

The study

• Authors: S.J. Lee, J.H. Nahm, J. Kang, S.H. Baik, E.J. Park
• Journal: International Journal of Surgery Case Reports
• Published: 2022;99:107665
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction And Importance: Peritoneal benign cystic mesothelioma is a rare benign tumor that originates from a mesothelial proliferative lesion of the peritoneum. However, proper surgical management remains unclear due to its low incidence. We report a clinical case of peritoneal benign cystic mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).

Case Presentation: A 60-year-old female who underwent laparoscopic appendectomy in 2015 presented with abdominal pain in right lower quadrant area. Computed tomography of the abdomen and pelvis revealed a ruptured appendiceal mucocele or mucinous neoplasm, and several seeding-like small nodules in the greater omentum and right peritoneum. Cytoreductive surgery followed by HIPEC was performed; right hemicolectomy and lymph node dissection, omentectomy, and right abdominal partial peritonectomy. HIPEC with mitomycin was conducted for 90 min and an anastomosis between the ileum and colon was made after HIPEC. The pathologic results revealed the colonic mass was a multi-loculated cyst lined by mesothelial cells containing amorphous eosinophilic fibrinoid material, which are common features of benign cystic mesothelioma.

Clinical Discussion: Peritoneal benign cystic mesothelioma is known as a borderline disease of mesothelial tumors. Because its etiology is unknown, treatment strategies are not determined.

Conclusion: Cytoreductive surgery followed by HIPEC can be considered to treat peritoneal benign cystic mesothelioma and prevent its malignant transformation.

Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

In plain English

This article was a case report about one patient, a 60-year-old woman treated in Seoul, Republic of Korea. She had earlier had laparoscopic removal of her appendix for an appendiceal mucocele, and she came to the hospital with four days of pain in the right lower abdomen. A CT scan suggested a ruptured appendiceal mucocele or mucinous neoplasm, with several small nodules in the omentum and right peritoneum. The surgeons removed the right colon, nearby lymph nodes, the omentum and part of the right abdominal lining. They then gave heated chemotherapy inside the abdomen (HIPEC) with mitomycin-C for 90 minutes. After surgery she had high potassium and low neutrophil counts on day 7, and she went home on day 11. Pathology found a multiloculated cyst lined by mesothelial cells, consistent with benign cystic mesothelioma. The article did not mention asbestos. The authors concluded that cytoreductive surgery followed by HIPEC can be considered to treat peritoneal benign cystic mesothelioma and prevent its malignant transformation.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 60-year-old woman with a previous laparoscopic appendectomy for appendiceal mucocele, treated at Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea
• Exposure: Not reported; the article does not mention asbestos or any other exposure
• Main results:
  • In this patient, CT of the abdomen and pelvis showed a ruptured appendiceal mucocele or mucinous neoplasm and several small seeding-like nodules in the greater omentum and right peritoneum
  • In this patient, serum CA 19-9 was less than 0.8 U/mL and CEA was 3.2 ng/mL
  • During surgery, most of the jelly-like mucin masses were easily removed by hand because they did not infiltrate the peritoneum
  • After cytoreductive surgery, HIPEC with mitomycin-C at 35 mg/m2 was given for 90 minutes
  • On postoperative day 7 the patient had hyperkalemia (high potassium) with neutropenia (low neutrophil count)
  • The patient was discharged on postoperative day 11
  • Pathology showed the colonic mass was a multiloculated cyst lined by mesothelial cells containing amorphous eosinophilic fibrinoid material, consistent with benign cystic mesothelioma
  • On immunohistochemical staining only calretinin was positive; CD34, CDX-2, MUC-2, Alcian blue and PAS were negative
• The authors' conclusion: The authors concluded that cytoreductive surgery followed by HIPEC can be considered to treat peritoneal benign cystic mesothelioma and prevent its malignant transformation

Topics

Medical terms in this study, explained in our Lexicon: Multicystic Mesothelioma (MCM), HIPEC, Mesothelioma, Peritoneum, Cytoreductive Surgery, Neoplasm, Omentum, Mesothelial Cells.

Related studies

• Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — D. Baratti, M. Vaira, et al. (2010)
• A proposal of Brazilian Society of Surgical Oncology (BSSO/SBCO) for standardizing cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) procedures in Brazil: pseudomixoma peritonei, appendiceal tumors and malignant peritoneal mesothelioma — T.P. Batista, B.J.Q. Sarmento, et al. (2017)
• Peritoneal carcinomatosis from unusual cancer origins: Is there a role for hyperthermic intraperitoneal chemotherapy? — C. Honoré, D. Goéré, et al. (2016)
• Multicystic peritoneal mesothelioma treated with complete cytoreductive surgery, peritonectomy and hyperthermic intra-peritoneal chemotherapy-A case report — N. Padmanabhan, H. Ishibashi, et al. (2020)
• Outcomes of multicystic peritoneal mesothelioma treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — A. Zahid, L. Clarke, et al. (2021)
• Unresectable peritoneal metastasis treated by pressurized intraperitoneal aerosol chemotherapy (PIPAC) leading to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy — M. Alyami, F. Mercier, et al. (2021)

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