Well-differentiated papillary mesothelioma found incidentally with concurrent struma ovarii: A case report

Our plain-English summary of Well-differentiated papillary mesothelioma found incidentally with concurrent struma ovarii: A case report, by S. Holford, W. Viner, J. Hunt (Case Reports in Women's Health, 2021).

The study

• Authors: S. Holford, W. Viner, J. Hunt
• Journal: Case Reports in Women's Health
• Published: 2021;32:e00366
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This is the first report of well-differentiated papillary mesothelioma (WDPM) found concurrently with struma ovarii. These rare tumors have no know association, and are considered benign, though malignant transformation of WDPM has been described. After treatment of WDPM, follow-up surveillance has been suggested in the literature, though a method has not been described and an evidence base is lacking. Pre-operative imaging by computed tomography and ultrasound did not identify the WDPM, calling into question the role of imaging-based follow-up. Furthermore, malignant transformation has been reported only outside of the typical 5-year follow-up window. The authors of this case report suggest rationalization of follow-up of WDPM, acknowledging the risks and unknown harms of scheduled imaging follow-up.

© 2021 The Authors. Published by Elsevier B.V.

In plain English

This article was a case report about one woman in New Zealand. She was 28 and had had 18 months of cyclical pain on the lower left side of her abdomen. She could not recall any chemical or asbestos exposure. A CT scan showed a 70 mm multicystic mass by her left ovary. During keyhole surgery to remove the left ovary and fallopian tube, the surgeons found a separate 3 cm pink, sea-anemone-like growth on the lining of the bowel (sigmoid peritoneum) and removed it. Under the microscope it was a benign well-differentiated papillary mesothelioma (WDPM), with no atypical cells or invasive features. The ovary contained struma ovarii, a benign tumor made mostly of thyroid tissue. The WDPM had not been visible on the ultrasound or CT done before surgery. At the six-week visit her pain had gone, and post-operative MRI and ultrasound scans showed no evidence of remaining disease. The patient and doctors decided together against routine follow-up. The authors considered the two tumors occurring together to be incidental. They concluded this was benign, fully removed, single-site disease with no indication for scheduled follow-up.

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 28-year-old woman described as Māori/New Zealand European, treated by the Taranaki District Health Board, New Zealand, referred for 18 months of cyclical left-sided pelvic pain; report published 2021
• Exposure: No exposure was studied. The patient could not recall any chemical or asbestos exposure.
• Main results:
  • Before surgery, CT showed a 70 mm multicystic left adnexal mass in the patient.
  • At laparoscopy, an isolated 3 cm pink sea-anemone-like structure attached to the sigmoid peritoneum was found incidentally and excised.
  • Under the microscope, the peritoneal lesion was a benign papillary mesothelial proliferation consistent with WDPM, with no cytological atypia or infiltrative features.
  • The excised ovary contained a struma ovarii made of benign thyroid tissue.
  • The 3 cm WDPM had not been visible on pre-operative ultrasound or CT.
  • At the 6-week post-operative visit, the patient's pelvic pain had resolved.
  • A shared decision was made not to perform routine follow-up, but to reassess if pelvic or abdominal symptoms occurred.
  • A post-operative staging MRI and a transvaginal pelvic ultrasound showed no evidence of residual disease. The article does not say when these scans were done relative to the 6-week visit.
• The authors' conclusion: The authors concluded this was a case of benign, fully resected, unifocal disease with no indication for scheduled follow-up. They considered the co-existence of WDPM and struma ovarii to be an incidental finding.

Topics

Medical terms in this study, explained in our Lexicon: Well-Differentiated Papillary Mesothelioma, Malignant Transformation, Ultrasound.

Related studies

• Well-differentiated papillary mesothelioma — K.J. Butnor, T.A. Sporn, et al. (2001)
• Well-differentiated papillary mesothelioma of the peritoneum is genetically defined by mutually exclusive mutations in TRAF7 and CDC42 — M. Stevers, J.T. Rabban, et al. (2019)
• Well-differentiated papillary mesothelioma of the pleura: a series of 24 cases — F. Galateau-Sallé, J.M. Vignaud, et al. (2004)
• Well-differentiated papillary mesothelioma of the female peritoneum: a clinicopathologic study of 26 cases — A. Malpica, S. Sant'Ambrogio, et al. (2012)
• Well-differentiated papillary mesothelioma with invasive foci — A. Churg, T. Allen, et al. (2014)
• BAP1 loss is unusual in well-differentiated papillary mesothelioma and may predict development of malignant mesothelioma — H.E. Lee, J.R. Molina, et al. (2018)

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