Metastasis of Malignant Peritoneal Epithelioid Mesothelioma in Endoscopic Gastric Biopsy: A Diagnostic Pitfall
Wednesday, September 17th, 2008.
International Journal of Surgical Pathology. 2008 Sep 14. [Epub ahead of print] [Link]
Daniele L, Righi A, Ferraris A, Macrì L, Asioli S.
Department of Biomedical Sciences and Human Oncology.
Abstract
Aim: To describe a case of metastasis of malignant peritoneal epithelioid mesothelioma in gastric antral mucosa in a patient with a cryptogenic liver cirrhosis associated with esophageal varices, abdominal pain and distension, ascites, and weight loss.
Materials and Method: The patient underwent esophageal gastric endoscopy for varices, and a biopsy of a polypoid antral lesion was performed. The latter revealed a proliferation of polygonal cells with moderately atypical nuclei and pale eosinophilic, peripherally condensed cytoplasm infiltrating into the lamina propria between the normal mucosal glands of the antrum. The tumor cells were diffusely positive to anticalretinin antibody, whereas anti-claudin 4 and anti-CEA antisera were negative.
Conclusions: Metastases of malignant peritoneal mesotheliomas are unusual, and a predominantly gastrointestinal localization is rare. Pathologists should be aware of this possibility to avoid misdiagnosis, particularly in small biopsy specimens.
Glossary
- oncology
- (on-call-o-jee) the branch of medicine concerned with the diagnosis and treatment of cancer.
- metastasis
- (meh-tas-teh-sis) the spread of cancer cells to distant areas of the body by way of the lymph system or bloodstream.
- lesion
- (lee-zhun) a change in body tissue; sometimes used as another word for tumor.
- glands
- a cell or group of cells that produce and release substances used nearby or in another part of the body.
- endoscopy
- (en-dos-ko-pee) inspection of body organs or cavities using a flexible, lighted tube called an endoscope.
- CEA
- carcinoembryonic antigen (car-sin-o-em-bre-ON-ic an-tuh-jin), antigens found in fetal tissue. If found in an adult, they may be specific to cancerous tumors. Tests for these antigens may help in diagnosing cancer and in finding out if the cancer has spread
- biopsy
- (buy-op-see) the removal of a sample of tissue to see whether cancer cells are present. There are several kinds of biopsies. In some, a very thin needle is used to draw fluid and cells from a lump. In a core biopsy, a larger needle is used to remove more tissue.
- atypical
- (A-tip-uh-kul) not usual; abnormal. Often refers to the appearance of cancerous or precancerous cells. (See also hyperplasia.)
- antibody
- a protein in the blood that defends against foreign agents, such as bacteria. These agents contain certain substances called antigens. Each antibody works against a specific antigen. (See also antigen.)
- tumor
- an abnormal lump or mass of tissue. Tumors can be benign (not cancerous) or malignant (cancerous).
- mesothelioma
- a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.
- peritoneal
- (pair-uh-tuh-nee-al) the serous membrane that lines the cavity of the abdomen. (More on Peritoneal Mesothelioma.)
- ascites
- (uh-sigh-tees) excess fluid accumulation in the abdominal (peritoneal) cavity.
