Primary splenic multicystic peritoneal mesothelioma in a young healthy male

Our plain-English summary of Primary splenic multicystic peritoneal mesothelioma in a young healthy male, by M.D. Price, S. Nair, J. Harris (Journal of Surgical Case Reports, 2023).

The study

• Authors: M.D. Price, S. Nair, J. Harris
• Journal: Journal of Surgical Case Reports
• Published: 2023;2023(10):rjad551
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Multicystic peritoneal mesothelioma (BMPM) is a rare, usually benign tumor that arises from peritoneal mesothelial cells that most commonly occurs in women of reproductive age. Pathogenesis of these tumors is thought to come from chronic inflammation from prior surgery, endometriosis, trauma, or recurrent peritonitis. Here we report a case of primary splenic BMPM in a 20-year-old male with no past medical or surgical history and without any typical risk factors for this condition. He underwent an open splenectomy without complication. Pathology revealed an 18 × 4 × 11 cm3 spleen with a cyst occupying 75% of the splenic surface. Sections revealed a multilocular cyst with trabeculated walls and immunohistochemical staining positive for cytokeratin (AE1/AE3) consistent with BMPM. One year post operatively he remains asymptomatic; however, his interval computed tomography (CT) scan revealed several sub centimeter nodules that either represents small splenules or neoplastic implants. These will be followed with close interval imaging.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.

In plain English

This article was a case report describing one patient. He was a 20-year-old man with no major past medical or surgical history and no history of trauma. He had 4 months of upper abdominal pain, and a CT scan showed a complex cystic lesion in the upper pole of his spleen. He had worked in heating, ventilation, and air conditioning for 1 year. The article did not discuss asbestos exposure for this patient. Surgeons removed his spleen through an open operation, and his recovery was uncomplicated. Pathology found a cyst occupying 75% of the splenic surface, with staining consistent with a benign multicystic mesothelial cyst without malignancy. The authors explained that this benign tumor is different from malignant peritoneal mesothelioma, which they described as associated with asbestos exposure. A CT scan one year later showed several 3 to 6 mm nodules near the surgical site. These could be small lymph nodes, tiny splenules, or tumor implants, and they will be followed. The authors concluded that this case highlighted a gap in understanding what causes this tumor.

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 20-year-old male patient with no major past medical or surgical history and no history of trauma, treated at Johns Hopkins (United States)
• Exposure: No asbestos exposure was assessed or reported for the patient. His history noted 1 year of work in heating, ventilation, and air conditioning, without further discussion. The authors noted that the different disease, malignant peritoneal mesothelioma, is associated with asbestos exposure.
• Main results:
  • Preoperative CT in the patient showed a 12.0 x 10.3 x 9.1 cm complex multilobulated septated cystic lesion in the upper pole of the spleen
  • The removed spleen measured 18.0 x 4.0 x 11.0 cm and weighed 855 g, with a 10.5 cm cyst occupying 75% of the splenic surface
  • Staining of the cyst wall was positive for cytokeratin (AE1/AE3), consistent with a benign multilocular mesothelial cyst without malignancy
  • The patient had an uncomplicated post-operative course
  • A 1-year CT showed several 3 to 6 mm nodules near the splenectomy site. The possibilities included small lymph nodes, tiny splenules, or neoplastic implants, and they are to be followed with another CT in 1 year.
• The authors' conclusion: The authors concluded that, because the patient had no prior surgical or medical history, the cause of his tumor did not fit the traditional chronic-inflammation theory. In their view, this highlighted a gap in current understanding of how this tumor arises.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Mesothelial Cells, Chronic Inflammation, Pathology, Immunohistochemistry.

Related studies

• Benign Multicystic Peritoneal Mesothelioma (BMPM) as a rare cause of abdominal pain in a young male: case report and review of the literature — S. Gussago, P. Spina, et al. (2019)
• A Rare Case of Malignant Pleural Mesothelioma in a Young Healthy Male Without Asbestos Exposure — S. Khatib, O. Asad, et al. (2021)
• Peritoneal Malignant Mesothelioma Metastasizing to Lymph Node in Young Male-a Case Report — A. Singh, C. Bansal, et al. (2024)
• Benign multicystic peritoneal mesothelioma presenting as a retroperitoneal pelvic mass in a young woman: a case report — E.A. Amaireh, O. Al-Natour, et al. (2026)
• A rare case of benign multicystic peritoneal mesothelioma misdiagnosed as hydatid cyst found in the liver parenchyma and abdomen cavity of a male with asbestos exposure — A.B. Kelarji, M.S. Alshutaihi, et al. (2021)
• Multicystic peritoneal mesothelioma in a 29 year old male — P. Cregan, S. Wiley, et al. (1987)

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