Peritoneal well-differentiated papillary mesothelioma associated with infertility in a 37-year-old woman

Our plain-English summary of Peritoneal well-differentiated papillary mesothelioma associated with infertility in a 37-year-old woman, by B. Pang, C. Hu, Q. Liu, et al (The Journal of International Medical Research, 2021).

The study

• Authors: B. Pang, C. Hu, Q. Liu, J. Yu, Z. Wei, X. Yu
• Journal: The Journal of International Medical Research
• Published: 2021;49(1):300060520986680
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Well-differentiated papillary mesothelioma (WDPM) is an uncommon mesothelial tumor. The lesions may be single or multiple and usually behave in a benign or indolent fashion, sometimes persisting for many years. In the present case, a 37-year-old woman had experienced primary infertility for 12 years, and a diagnostic laparoscopy was performed. Approximately 200 mL of dark red, free fluid in the pelvis and more than 10 yellow-white nodules on the surface of the right round ligament, sacrum ligament, right fallopian tube, and both sides of the uterus were found. A lesionectomy was performed and immunohistochemical markers indicated WDPM with adenomatoid tumor. The patient was monitored by computed tomography and serum CA125 (cancer antigen 125) levels for 49 months with no recurrence. WDPM and adenomatoid tumor are both benign tumors of mesothelial origin. Because of the lack of effective radical treatment, regular follow-up is sufficient. However, the effects of estrogen and progesterone on WDPM and adenomatoid tumors during ovulation or pregnancy remains unclear. Although WDPM is not life threatening, a strategy to fulfill the fertility requirements of women with this condition is a new challenge for infertility doctors.

In plain English

This article is a case report about one patient: a 37-year-old woman who had been unable to become pregnant for 12 years (primary infertility). She was seen at the authors' Department of Gynecology at the First Hospital of Jilin University in China. Before assisted reproduction, doctors did a diagnostic laparoscopy, a keyhole examination of the abdomen. They found about 200 mL of dark red fluid in the pelvis and more than 10 yellow-white nodules, up to 1.5 cm across. The nodules were on the round ligament, the sacrum ligament, the right fallopian tube and both sides of the uterus. Her blood CA125 level was 43.53 U/mL, against a normal range of 0 to 35 U/mL. Lesions removed from the fallopian tube were diagnosed as well-differentiated papillary mesothelioma (WDPM) with adenomatoid tumor. The authors describe both as benign tumors of mesothelial origin. She was monitored with CT scans and CA125 tests for 49 months with no recurrence. The article does not mention asbestos or any other exposure. The authors concluded that, without an effective radical treatment for WDPM, she cannot become pregnant using assisted reproductive technology.

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 37-year-old woman with no previous pregnancies and 12 years of primary infertility, seen at the authors' Department of Gynecology (First Hospital of Jilin University, Changchun, China) about four years before the report
• Main results:
  • Before laparoscopy, the patient's serum CA125 level was 43.53 U/mL (normal range 0 to 35 U/mL), and hysterosalpingography showed only one fallopian tube open (unilateral patency)
  • At laparoscopy, about 200 mL of dark red free fluid was found in the pelvis, along with more than 10 yellow-white polypoid nodules or papillary formations up to 1.5 cm in diameter on the round ligament, sacrum ligament, right fallopian tube and both sides of the uterus
  • Pathology of the lesions removed from the fallopian tube surface indicated well-differentiated papillary mesothelioma (WDPM) with adenomatoid tumor, with immunostaining positive for mesothelial markers (including calretinin, CK5/6, D2-40 and WT-1) and negative for estrogen and progesterone receptors
  • The patient was monitored with computed tomography and serum CA125 for 49 months with no recurrence
• The authors' conclusion: The authors concluded that, although the diagnosis does not affect the patient's daily life, she cannot become pregnant using assisted reproductive technology because there is no effective radical treatment for WDPM, and that this is an urgent problem for infertility doctors. They also advised caution about raising estrogen to supraphysiological levels in such patients.
• Limitations the authors state:
  • The authors state that immune and other factors cannot be ruled out as causes of the patient's infertility
  • The authors state that it is unknown whether oocyte retrieval could spread the tumor in the pelvis
  • The authors state that there are no reports on how estrogen and progesterone affect the outcome of WDPM

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Well-Differentiated Papillary Mesothelioma, Diagnostic Laparoscopy, Adenomatoid Tumor.

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