Difference between revisions of "Peritoneum"

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{{Main|Malignant mesothelioma}}
{{Main|Malignant mesothelioma}}
This is like the tumour found in the pleural cavity.
This is like the tumour found in the pleural cavity.
==Metastatic peritoneal disease==
{{Main|Metastasis}}
===General===
Common causes:
*Gastrointestinal tract, esp. [[colorectal carcinoma]].
*Gynecologic tract.
*Peritoneal disease in the context of liver metastases in [[colorectal carcinoma]] contraindicates liver resection.<ref>{{Cite journal  | last1 = Elias | first1 = D. | last2 = Rougier | first2 = P. | last3 = Mankarios | first3 = H. | last4 = Fahrat | first4 = F. | last5 = Lasser | first5 = P. | title = [Resectable liver metastases and synchronous extra-hepatic sites of colorectal origin. Surgical indications]. | journal = Presse Med | volume = 22 | issue = 11 | pages = 515-20 | month = Mar | year = 1993 | doi =  | PMID = 8511077 }}</ref>
===Microscopic===
:See ''[[metastasis]]''.


=See also=
=See also=

Revision as of 12:06, 2 December 2013

The peritoneum is a much neglected area, with relatively little pathology. It includes the omentum which is dealt with in the omentum article.

Benign

Peritoneal implants

Main article: Peritoneal implants
  • These are dealt with in the ovarian tumours article. Broadly speaking they may be: (1) desmoplastic non-invasive, (2) epithelial non-invasive, and (3) invasive.

Well-differentiated papillary mesothelioma

Should not be confused with malignant mesothelioma or benign multicystic mesothelioma.
  • AKA benign papillary mesothelioma.

General

  • Benign.
  • Classically women of reproductive age.[1]
  • Reported in tunica vaginalis of the testis.[2]

Gross

Features - typical:

  • Multiple peritoneal nodules.
  • Ascites.

DDx:[1]

Microscopic

Features:

  • Papillary structures with:
    • Thick fibrous cores.
    • Simple cuboidal epithelium.
      • Small nucleoli.

Note:

  • Lack cytologic atypia.

DDx:

Image:

Benign multicystic mesothelioma

Should not be confused with malignant mesothelioma and benign papillary mesothelioma.

General

  • Usually conservative management.
  • Serum CA-125 usually low.
  • May occur in men.[4]

Gross

Features:[5]

  • Multilocular thin-walled cysts containing serous fluid +/- blood.
    • Occasionally unilocular.
  • May be up to 15 cm.
  • Can be adherent to the ovary.

Microscopic

Features:[3][6]

  • Thin-walled, irregular-shaped, cysts - unicystic or multicystic.
    • Mesothelial lining +/- squamous metaplasia.[7]
    • Eosinophilic fluid.

DDx:

Images:

IHC

Features:[8]

  • Calretinin +ve.
  • WT-1 +ve.

Malignant

Primary peritoneal serous carcinoma

General

  • Very rare.
  • Reported in men.[9]

Microscopic

Features:

  • Like serous carcinoma elsewhere - see ovarian serous carcinoma.
  • To exclude ovarian serous carcinoma all of the following criteria must be met:[10]
    1. Histology of the tumour = serous carcinoma.
    2. Bulk of the tumour involves the peritoneum.
    3. Ovarian substance tumour extent less than 5 x 5 mm in plane of section.
    4. Previous ovarian serous carcinoma is excluded.
      • Old oopherectomies reviewed if possible.

DDx:

IHC

Malignant mesothelioma

Main article: Malignant mesothelioma

This is like the tumour found in the pleural cavity.

Metastatic peritoneal disease

Main article: Metastasis

General

Common causes:

Microscopic

See metastasis.

See also

References

  1. ↑ 1.0 1.1 Park, JY.; Kim, KW.; Kwon, HJ.; Park, MS.; Kwon, GY.; Jun, SY.; Yu, ES. (Sep 2008). "Peritoneal mesotheliomas: clinicopathologic features, CT findings, and differential diagnosis.". AJR Am J Roentgenol 191 (3): 814-25. doi:10.2214/AJR.07.3628. PMID 18716115.
  2. ↑ Chetty, R. (Nov 1992). "Well differentiated (benign) papillary mesothelioma of the tunica vaginalis.". J Clin Pathol 45 (11): 1029-30. PMID 1452778.
  3. ↑ 3.0 3.1 Vallerie, AM.; Lerner, JP.; Wright, JD.; Baxi, LV. (May 2009). "Peritoneal inclusion cysts: a review.". Obstet Gynecol Surv 64 (5): 321-34. doi:10.1097/OGX.0b013e31819f93d4. PMID 19386139.
  4. ↑ Cavallaro, A.; Murazio, M.; Modugno, P.; Vona, A.; Revelli, L.; Potenza, AE.; Colli, R.. "Benign multicystic mesothelioma of the peritoneum: a case report.". Chir Ital 54 (4): 569-72. PMID 12239771.
  5. ↑ McFadden, DE.; Clement, PB. (Dec 1986). "Peritoneal inclusion cysts with mural mesothelial proliferation. A clinicopathological analysis of six cases.". Am J Surg Pathol 10 (12): 844-54. PMID 3789251.
  6. ↑ Levy, AD.; Arnáiz, J.; Shaw, JC.; Sobin, LH.. "From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation.". Radiographics 28 (2): 583-607; quiz 621-2. doi:10.1148/rg.282075175. PMID 18349460.
  7. ↑ Ross, MJ.; Welch, WR.; Scully, RE. (Sep 1989). "Multilocular peritoneal inclusion cysts (so-called cystic mesotheliomas).". Cancer 64 (6): 1336-46. PMID 2766227.
  8. ↑ 8.0 8.1 Takemoto, S.; Kawano, R.; Honda, K.; Nakazono, A.; Shimamatsu, K. (2012). "Benign multicystic peritoneal mesothelioma mimicking recurrence of an ovarian borderline tumor: a case report.". J Med Case Rep 6 (1): 126. doi:10.1186/1752-1947-6-126. PMID 22583977.
  9. ↑ Shmueli, E.; Leider-Trejo, L.; Schwartz, I.; Aderka, D.; Inbar, M. (Apr 2001). "Primary papillary serous carcinoma of the peritoneum in a man.". Ann Oncol 12 (4): 563-7. PMID 11398893.
  10. ↑ Roh, SY.; Hong, SH.; Ko, YH.; Kim, TH.; Lee, MA.; Shim, BY.; Byun, JH.; Woo, IS. et al. (Jun 2007). "Clinical characteristics of primary peritoneal carcinoma.". Cancer Res Treat 39 (2): 65-8. doi:10.4143/crt.2007.39.2.65. PMC 273931. PMID 19746214. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC273931/.
  11. ↑ Elias, D.; Rougier, P.; Mankarios, H.; Fahrat, F.; Lasser, P. (Mar 1993). "[Resectable liver metastases and synchronous extra-hepatic sites of colorectal origin. Surgical indications].". Presse Med 22 (11): 515-20. PMID 8511077.
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