Shukla S, Pujani M, Singh SK.

Department of Pathology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi, India.

Abstract

Ectopic decidual reaction is commonly seen in the ovary and cervix; however, peritoneal localization is rare. Peritoneal deciduosis is usually an incidental histological finding. It may present a diagnostic dilemma by mimicking grossly peritoneal carcinomatosis or tubercles and deciduoid mesothelioma, microscopically. We report three cases of ectopic decidual reaction discovered incidentally during caesarian sections, as whitish yellow nodules resembling tubercles. Histology revealed extensive decidualisation. To the best of our knowledge, this is the first report of ectopic decidua mimicking peritoneal tubercles.

Glossary

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.)

Anna Scattone ¹, Antonio Pennella ², Mattia Gentile ³, Marina Musti ⁴, Pietro Nazzaro ⁵, Antonia Lucia Buonadonna ³, Andrea Marzullo ¹, Donenica Cavone ⁴, Lucio Pollice ¹ and Gabriella Serio ^1*

¹ Dpt. of Pathology, Medical School, University of Bari, Italy
² Dpt. of Surgery and Pathology, Medical School, University of Fo, Italy
³ Medical Genetics, "De Bellis" IRCCS Hospital, Castellana Gro, Italy
⁴ Dpt. of Internal and Public Medicine, Medical School, University, Italy
⁵ Dpt. of Clinical Methodology, Medical School, University of Bari., Italy

^* To whom correspondence should be addressed. E-mail: g.serio@anatopat.uniba.it.

Accepted 23 November 2005

Abstract

Background: Malignant deciduoid mesothelioma (MMD) is a rare variant of epithelioid mesothelioma. Generally, this tumour generally has poor prognosis, and it can be asbestos-related. Aim of the study was to identify peculiar genetic alterations responsible for critical phases in MMD pathogenesis and their with prognostic significance.

Methods: Comparative Genomic Hybridization (CGH) was performed oin six cases of malignant pleural deciduoid mesothelioma, four sporadic and two familial. All cases were asbestos-related. Four patients died within during follow-up. Mean survival was 29.5 +/- 14.2 months (range 12-43).

Results: In all tumours genetic abnormalities were found in all the tumour tissues being most frequently chromosomal gains of 1p, 12q, 17, 8q, 19, and 20. Losses occurred at 13q, 6q, and 9p. Survival was longer in those patients who presented a smaller number of losses in the tumoral chromosomes (</= 2).

Conclusions: Although deciduoid mesotheliomas present numerous genetic changes, we highlighted demonstrated that certain chromosomal regions are preferentially affected. Our findings show that the number of losses is predictive of the clinical outcome for this subtype of mesothelioma subtype.

Keywords: CGH, Genetic, Mesothelioma, Pleural

Glossary

prognosis

(prog-no-sis) a prediction of the course of disease; the outlook for the cure of the patient. For example, women with breast cancer that was detected early and who received prompt treatment have a good prognosis.

mesothelioma

a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.

Morini M, Bettini G, Morandi F, Burdisso R, Marcato PS.

Dipartimento di Sanita Pubblica Veterinaria e Patologia Animale, Servizio di Anatomia Patologica, Universita degli Studi di Bologna, via Tolara di Sopra 50, 40064 Ozzano Emilia, Bologna (Italy). bettini@vet.unibo.it.

Abstract

Deciduoid mesothelioma is a rare variant of epithelial mesothelioma, up to now only described in human pathology, which bears remarkable cytomorphologic resemblance to the endometrium of pregnancy, termed decidua. A case of peritoneal mesothelioma with deciduoid features in a 10-year-old, female dog is reported. Multiple whitish-gray nodules (1–5 mm in diameter) in parietal peritoneum and mesentery were histologically composed of large, proliferating, polygonal or ovoid cells with an abundant eosinophilic, glassy cytoplasm. Immunohistochemical evaluation indicated that the neoplastic cells coexpressed cytokeratin and vimentin with strong and diffuse cytoplasmic staining, and ultrastructural analysis showed long and slender mesothelial-type microvilli; these findings confirmed the mesothelial origin of the tumor.

Keywords: Deciduoid mesothelioma; dog; mesothelioma; peritoneum.

Glossary

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.)

Fenjvesi A, Zivkovic S.

Zdravstveni centar Dr Gere Istvan, Senta, Opsta bolnica, Odeljenje za patologiju.

Abstract

Introduction: The occurrence of ectopic decidua (deciduosis) has been observed most often in the ovaries, uterus, and cervix. It has been established in approximately 90% of patients who have undergone laparotomy during pregnancy. A peritoneal localization is less frequent and usually an asymptomatic incidental finding, but is occasionally associated with massive and potentially fatal hemoperitoneum, abdominal pain and dystocia. Ectopis decidua is a physiological phenomenon of pregnancy and arises from a progesterone-induced metaplasia of subserosal stromal cells.

Cast Report: A 32-year-old G1P1 female underwent cesarean section at 39 weeks gestation because of imminent fetal asphyxia. The laparotomy revealed a greyish-yellow soft nodule on the parietal peritoneum. On histologic examination the biopsy lesion was highly vascular and was composed of large polygonal decidualized cells with abundant eosinophilic, focally vacuolated cytoplasm. The nuclei were regular, with fine chromatin and inconspicuous nucleoli. Ectopic decidua was infiltrated by blood and surrounded with adipose tissue necrosis and mild chronic inflammation.

Discussion and Conclusion: The differential diagnosis of peritoneal deciduosis included deciduoid mesothelioma, metastatic carcinoma (especially if decidual cells have a vacuolated cytoplasm mimicking signet-ring cells), and metastatic melanoma. Decidual cells showed immunoreactivity for vimentin and progesteron receptors and focal positivity for desmin and smooth muscle actin. The presence of cellular atypia, mitotic activity, and immunoreactivity for cytokeratin 5/6 and calretinin will assist in making the diagnosis of deciduoid mesothelioma. The diagnosis of metastatic carcinoma is assisted by the nuclear features and cytokeratin immunoreactivity. A positive immunostain for S-100 and/or HMB-45 will assist in the diagnosis of metastatic melanoma.

Glossary

melanoma

(mel-uh-no-muh) a cancerous (malignant) tumor that begins in the cells that produce the skin coloring (melanocytes). Melanoma is almost always curable in its early stages. However, it is likely to spread, and once it has spread to other parts of the body the chances for a cure are much less.

lesion

(lee-zhun) a change in body tissue; sometimes used as another word for tumor.

diagnosis

identifying a disease by its signs or symptoms, and by using imaging procedures and laboratory findings. The earlier a diagnosis of cancer is made, the better the chance for long-term survival.

carcinoma

(car-sin-o-ma) a malignant tumor that begins in the lining layer (epithelial cells) of organs. At least 80% of all cancers are carcinomas.

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.

asymptomatic

(A-simp-toh-matic) not having any symptoms of a disease. Many cancers can develop and grow without producing symptoms, especially in the early stages. Screening tests such as mammograms help to find these early cancers, when the chances for cure are usually highest. (See also screening.)

tissue

a collection of cells, united to perform a particular function.

uterus

the womb. The pear-shaped organ in women that holds and nourishes the growing embryo and fetus. The uterus has three areas: the body or upper part, the isthmus or the narrowed central area, and the cervix, the lower portion.

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.)

Mishra A, Shet T.

Department of Pathology, Tata Memorial Hospital, Parel, Mumbai Maharashtra.

Abstract

We report a clear cell type of primary purely epithelial malignant mesothelioma with focal deciduoid features in the para-testis of a 75 year old man. This variant requires ancillary studies like immunohistochemistry for confirmation. Awareness of this variant is required to avoid misdiagnosis and treatment as either metastasis from a renal cell carcinoma or as a germ cell tumor. A diagnosis of mesothelioma must be ruled out in elderly patients with epithelial-looking tumor especially if the serum germ cell tumor markers are within normal range.

Glossary

metastasis

(meh-tas-teh-sis) the spread of cancer cells to distant areas of the body by way of the lymph system or bloodstream.

diagnosis

identifying a disease by its signs or symptoms, and by using imaging procedures and laboratory findings. The earlier a diagnosis of cancer is made, the better the chance for long-term survival.

cell

the basic unit of which all living things are made. Cells replace themselves by splitting and forming new cells (mitosis). The processes that control the formation of new cells and the death of old cells are disrupted in cancer.

carcinoma

(car-sin-o-ma) a malignant tumor that begins in the lining layer (epithelial cells) of organs. At least 80% of all cancers are carcinomas.

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.

Ordonez NG.

Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. nordonez@mdanderson.org

Abstract

Objective: Several new immunohistochemical markers that can assist in the diagnosis of mesotheliomas have been recognized recently. This article reviews the current information available on these markers and also provides a practical approach to the immunohistochemical diagnosis of epithelioid mesotheliomas.

Data Sources: Current literature concerning immunohistochemical markers for epithelioid mesotheliomas was collected and reviewed.

Study Selection: Literature emphasizing immunohistochemical diagnosis of epithelioid mesotheliomas was selected.

Data Extraction: Data deemed helpful to the general surgical pathologist for the diagnosis of epithelioid mesothelioma were included in this review.

Data Synthesis: Markers identified as potentially useful in the diagnosis of epithelioid mesothelioma include positive markers (namely, calretinin, keratin 5/6, D2-40, podoplanin, mesothelin, and Wilms tumor 1 protein [WT1]) and negative markers (namely, carcinoembryonic antigen, MOC-31, B72.3, and Ber-EP4). Thyroid transcription factor 1 (TTF-1) can assist in determining the lung origin of a carcinoma, and renal cell carcinoma marker (RCC Ma) may help establish its renal origin.

Conclusions: D2-40 and podoplanin are the 2 most recently recognized markers that have been found to be useful in the diagnosis of epithelioid mesotheliomas. Since D2-40 and podoplanin appear to be highly sensitive and specific for epithelioid mesotheliomas, either may be considered for inclusion in the battery of antibodies currently recommended for distinguishing epithelioid mesotheliomas from metastatic carcinomas. However, it should be kept in mind that their utility has not yet been fully determined in routine diagnostic work.

Glossary

pathologist

(path-all-eh-jist) a doctor who specializes in diagnosis and classification of diseases by laboratory tests (such as examination of tissue and cells under a microscope). The pathologist determines whether a lump is benign or cancerous.

diagnosis

identifying a disease by its signs or symptoms, and by using imaging procedures and laboratory findings. The earlier a diagnosis of cancer is made, the better the chance for long-term survival.

cell

the basic unit of which all living things are made. Cells replace themselves by splitting and forming new cells (mitosis). The processes that control the formation of new cells and the death of old cells are disrupted in cancer.

carcinoma

(car-sin-o-ma) a malignant tumor that begins in the lining layer (epithelial cells) of organs. At least 80% of all cancers are carcinomas.

cancer

malignancy; a group of diseases typified by abnormal, generally out-of-control, cell growth.

antigen

(an-tuh-jen) a substance that causes the body's immune system to react. This reaction often involves production of antibodies. For example, the immune system's response to antigens that are part of bacteria and viruses helps people resist infections. Cancer cells have certain antigens that can be found by laboratory tests. They are important in cancer diagnosis and in watching response to treatment. Other cancer cell antigens play a role in immune reactions that may help the body's resistance against cancer.

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.

Baker PM, Clement PB, Young RH.

Abstract

Seventy-five malignant mesotheliomas of the peritoneum in women were reviewed to highlight their morphologic spectrum. The patients ranged from 17 to 92 (mean, 47.4) years of age. The clinical presentation was usually abdominal or pelvic pain, abdominal swelling (sometimes due to ascites), or a pelvic mass. On microscopic examination, the majority of the tumors had only an epithelial morphology, but 4 were biphasic and 1 was sarcomatoid. The most common epithelial patterns were tubular and papillary (which often coexisted), but 5 tumors were purely diffuse; 2 had cells with abundant glassy eosinophilic cytoplasm (so-called deciduoid mesothelioma). The cells in the tubular and papillary patterns were generally cuboidal with scant to moderate amounts of eosinophilic cytoplasm. Nuclear atypia was usually only mild, although a minority of cases had moderate or even, occasionally, severe atypia. Many tumors had foci that, viewed in isolation, resembled so-called well-differentiated papillary mesothelioma, and accordingly that diagnosis should be made cautiously. Unusual features were lymphoid follicles (13 cases), striking myxoid stroma (5 cases), prominent foamy histiocytes (5 cases), and a striking vascular proliferation (1 case). The varied morphology of peritoneal malignant mesotheliomas may raise a broad differential diagnosis, but in most cases the resemblance to other tumors is limited. Histochemistry, immunohistochemistry, and electron microscopy may provide important aid, particularly when tissue is limited, but should be needed only occasionally.

Glossary

diagnosis

identifying a disease by its signs or symptoms, and by using imaging procedures and laboratory findings. The earlier a diagnosis of cancer is made, the better the chance for long-term survival.

tissue

a collection of cells, united to perform a particular function.

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.

Najat Mourra, MD; Cecile de Chaisemartin, MD; Isabelle Goubin-Versini, MD; Rolland Parc, MD; Jean-Francois Flejou, MD

From the Departments of Pathology (Drs Mourra and Flejou) and Surgery (Drs Chaisemartin and Parc), Hôpital St-Antoine, Paris, France; and Department of Pathology, Hôpital Rene Dubois, Pontoise, France (Dr Goubin-Versini)

Abstract

Malignant deciduoid mesothelioma, a rare phenotype of epithelioid mesothelioma, arises more commonly from the peritoneum of young women, but it is also reported in the pleura of elderly people. We report a case of malignant deciduoid mesothelioma that occurred in a 41-year-old woman after cesarean section and was initially misdiagnosed as pseudotumoral deciduosis. Microscopically, the tumor was entirely composed of deciduoid areas, and only scattered tumor cells were positive for calretinin and keratin 5/6. The patient died 14 months after the first operation. This observation confirms the poor prognosis of this entity and the importance of the differential diagnosis of pseudotumoral deciduosis.

Glossary

prognosis

(prog-no-sis) a prediction of the course of disease; the outlook for the cure of the patient. For example, women with breast cancer that was detected early and who received prompt treatment have a good prognosis.

pleura

(pler-uh) the membrane around the lungs and lining of the chest cavity. (Pleural mesothelioma.)

diagnosis

identifying a disease by its signs or symptoms, and by using imaging procedures and laboratory findings. The earlier a diagnosis of cancer is made, the better the chance for long-term survival.

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.