Cytoreductive surgery and HIPEC for multicystic peritoneal mesothelioma: therapeutic approach in a rare benign neoplasm

Our plain-English summary of Cytoreductive surgery and HIPEC for multicystic peritoneal mesothelioma: therapeutic approach in a rare benign neoplasm, by G. Aleksandrić, N. Trifunović, J. Trifunović, et al (Journal of Surgical Case Reports, 2026).

The study

• Authors: G. Aleksandrić, N. Trifunović, J. Trifunović, S. Filipović, N. Mitrović
• Journal: Journal of Surgical Case Reports
• Published: 2026;2026(1):rjaf1041
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Multicystic peritoneal mesothelioma (MCPM) is an uncommon tumor of mesothelial origin, characterized by multiple interconnected cystic spaces and uncertain biological behavior. Although traditionally considered benign, its tendency to recur and occasionally spread within the peritoneal cavity challenges this perception. We describe a 32-year-old woman who experienced gradually worsening pelvic pain and a constant feeling of pressure, which intensified after childbirth. Imaging revealed a large multilocular cystic mass occupying the pelvis. At laparotomy, a gelatinous, multilocular lesion was found adherent to the pelvic peritoneum, uterus, ovaries, and rectosigmoid colon. Complete cytoreductive surgery was performed, including pelvic peritonectomy, omentectomy, appendectomy, and resection of the affected serosa, followed by closed-abdomen hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin (300 mg/m2, 42°C, 90 min). Histopathology confirmed benign multicystic mesothelioma with a mesothelial immunophenotype. The patient recovered well and remains disease-free at 6 months. MCPM requires complete cytoreduction, and HIPEC may help achieve lasting disease control.

© The Author(s) 2026. Published by Oxford University Press and JSCR Publishing Ltd.

In plain English

This case report from Clinical Hospital Center Zemun in Belgrade, Serbia, described one 32-year-old woman with multicystic peritoneal mesothelioma (MCPM), a rare tumor of the abdominal lining. The article does not mention asbestos or any other exposure. Her pelvic pain and pressure began during pregnancy and worsened after childbirth. MRI showed a large multicystic mass displacing the uterus, ovaries and rectosigmoid colon. At surgery the gelatinous mass was stuck to the pelvic lining, uterus, ovaries, appendix and rectosigmoid colon. Surgeons removed it in one piece and performed complete cytoreductive surgery, including removal of the pelvic peritoneum, omentum and appendix. They then gave heated chemotherapy with oxaliplatin inside the closed abdomen (HIPEC). The cyst fluid showed no malignancy, and the tissue showed mesothelial cells without atypia or mitoses. She went home a week after surgery. MRI at three and six months showed no recurrence. The authors concluded that MCPM should not be considered entirely benign and that complete surgery is key to long-term control. They also concluded that HIPEC can further reduce recurrence risk in selected cases. A single case cannot show a recurrence rate.

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 (single patient)
• Who was studied: one 32-year-old woman treated at the Department of General Surgery, Clinical Hospital Center Zemun, Belgrade, Serbia; no previous abdominal surgery; symptoms began during pregnancy and worsened after childbirth; dates of treatment not given
• Exposure: Not reported: the article does not mention asbestos or any other environmental or occupational exposure
• Main results:
  • MRI showed a multilocular cystic mass displacing the uterus, ovaries and rectosigmoid colon
  • At laparotomy a gelatinous multilocular mass was densely adherent to the pelvic peritoneum, uterus, ovaries, appendix and rectosigmoid colon
  • Complete cytoreductive surgery was performed: pelvic peritonectomy, omentectomy, appendectomy and resection of affected serosa
  • Surgery was followed by closed-abdomen HIPEC with oxaliplatin (300 mg/m2) at 42 degrees Celsius for 90 minutes
  • Cytology of the cyst fluid showed reactive mesothelial cells without malignancy
  • Histology showed cystic spaces lined by mesothelial cells without atypia or mitoses; immunohistochemistry showed strong CK7, WT1, calretinin and D2-40 expression and negative CEA, Ber-EP4 and EMA
  • The patient was discharged a week after surgery; follow-up MRI at three and 6 months showed no recurrence
• The authors' conclusion: The authors concluded that MCPM should not be considered entirely benign, that complete cytoreductive surgery is key to long-term control, that adding HIPEC can further reduce recurrence risk in selected cases, and that careful long-term follow-up is crucial

Topics

Medical terms in this study, explained in our Lexicon: Cytoreductive Surgery, HIPEC, Peritoneal Mesothelioma, Neoplasm, Peritoneal Cavity, Laparotomy, Peritoneum, Histopathology.

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)
• Peritoneal metastases of rare carcinomas treated with cytoreductive surgery and HIPEC - A single center case series — A. Brandl, C.B. Zielinski, et al. (2017)
• Long-term results of laparoscopic cytoreductive surgery and HIPEC for the curative treatment of low-grade pseudomyxoma peritonei and multicystic mesothelioma — F. Mercier, G. Jeremie, et al. (2020)
• Genomic sequencing of multicystic mesothelioma finds cohesin complex mutations associated with disease recurrence in patients referred for cytoreductive surgery and HIPEC — J. Gibson, N.J. Carr, et al. (2026)
• Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy (HIPEC) by Minimally Invasive Approach, an Initial Experience — A. Arjona-Sanchez, S. Rufian-Peña, et al. (2018)
• Retroperitoneal approach for recurrent benign multicystic peritoneal mesothelioma — G.D. Bakhshi, K.R. Wankhede, et al. (2013)

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