Excision of benign multicystic peritoneal mesothelioma and deep infiltrating endometriosis with bowel involvement - A case report

Our plain-English summary of Excision of benign multicystic peritoneal mesothelioma and deep infiltrating endometriosis with bowel involvement - A case report, by Z. Azeem, J. Sharma, R. Johnson, et al (Case Reports in Women's Health, 2024).

The study

• Authors: Z. Azeem, J. Sharma, R. Johnson, N. Price, M.Z. Yabar, D. Ghosh
• Journal: Case Reports in Women's Health
• Published: 2024;44:e00658
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Benign multicystic peritoneal mesothelioma (BMPM) is a rare peritoneal tumour. Treatment involves complete surgical resection, although recurrence rates are high. Notably, there are 7 documented cases of BMPM coexisting with endometriosis on histology and in the case reported here it was associated with deep infiltrating endometriosis. Examination of the 26-year-old nulliparous woman with deep dyspareunia, dyschezia and occasional rectal bleeding revealed restricted uterine mobility and a rectovaginal nodule. Magnetic resonance imaging (MRI) showed multiple clear cystic structures in the pelvis of unknown aetiology. Following discussion by a multidisciplinary team, a diagnostic laparoscopy was performed. Intraoperatively, bilateral endometriomas were identified, along with multiple fluid-filled cystic structures in the pelvis and on the anterior abdominal wall. An adhesiolysis and drainage of endometriomas was performed and the cystic structures were sent for histology. Histopathology confirmed BMPM, positive for AE1/3 and calretinin. The patient was referred to a mesothelioma malignancy institute and advised to undergo definitive surgery by the local endometriosis team. A joint surgical procedure with a colorectal team involved laparoscopic excision of peritoneal cysts, cystectomy for bilateral endometriomas, and excision of deep infiltrating endometriosis with bowel shaving. Histopathology revealed benign mesothelial cysts with foci of endometriosis. The patient had an uncomplicated recovery and is planned for long-term follow-up with the mesothelioma malignancy institute due to the high recurrence rate (up to 50 %). This case report suggests a definitive role of this two-stage procedure in patients with this diagnostic complexity and emphasises the role of multidisciplinary management.

© 2024 The Authors. Published by Elsevier B.V.

In plain English

This case report described one 26-year-old woman in the United Kingdom with benign multicystic peritoneal mesothelioma (BMPM), a rare non-cancerous tumour of the abdominal lining, together with deep infiltrating endometriosis involving the bowel. She had severe lower abdominal pain, pain during sex and bowel movements, and occasional rectal bleeding. MRI showed multiple clear cysts of unclear cause in the pelvis and endometriomas on both ovaries. At a first, diagnostic keyhole operation, the endometriomas were drained and the peritoneal cysts were removed. Tissue testing showed benign multicystic mesothelioma. A second operation, done jointly by gynaecology and bowel surgeons, excised all visible pelvic cysts and the endometriosis, including shaving a nodule from the rectovaginal septum. Tissue from this operation showed benign mesothelial cysts with areas of endometriosis. She recovered uneventfully. The authors concluded that multidisciplinary care was crucial and that a two-stage procedure has a role when diagnosis is difficult. Citing other work, they noted that malignant forms are associated with asbestos exposure. The report did not describe asbestos exposure in this patient.

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
• Who was studied: One 26-year-old nulliparous woman with severe lower abdominal pain, dysmenorrhea, deep dyspareunia, dyschezia and occasional rectal bleeding. The authors are at Worcestershire Acute Hospitals NHS Trust, United Kingdom. Dates of care are not given.
• Main results:
  • MRI showed multiple clear cystic structures in the pelvis, adenomyosis and bilateral endometriomas.
  • At the first laparoscopy, the left endometrioma was approximately 10 cm and the right approximately 6 cm. Both were drained. The peritoneal cysts were removed for histology.
  • Histology from the first operation showed benign peritoneal multicystic mesothelioma, positive for AE1/3 and calretinin.
  • At the second laparoscopy, both endometriomas had recurred. All visible pelvic cysts were excised, and the endometriotic nodule was shaved from the wall of the rectovaginal septum.
  • Histopathology from the second operation showed benign mesothelial cysts with foci of endometriosis.
  • The patient recovered without complications after the second operation and is under long-term follow-up at a national mesothelioma specialist centre and the local endometriosis centre.
  • The authors observed very few peritoneal cysts at the follow-up surgery. They suggested that removing the primary pathology, such as endometriosis, may result in natural resolution of the disease.
• The authors' conclusion: The authors concluded that multidisciplinary team involvement is crucial in managing BMPM with co-existing endometriosis, and that there is a definitive role for a two-stage procedure in cases with diagnostic difficulty.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Surgical Resection, Histology, Multidisciplinary Team, Diagnostic Laparoscopy, Bilateral, Histopathology, Calretinin.

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