Peritoneum
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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.
- Some say it is borderline.[1]
- Classically women of reproductive age.[2]
- Reported in tunica vaginalis of the testis.[3]
Gross
Features - typical:
- Multiple peritoneal nodules.
- Ascites.
DDx:[2]
- Tuberculosis.
- Carcinomatosis.
- Primary peritoneal serous carcinoma.
Microscopic
Features:
- Papillary structures with:
- Thick fibrous cores.
- Simple cuboidal epithelium.
- Small nucleoli.
Note:
- Lack cytologic atypia.
DDx:[4]
Image:
Benign multicystic mesothelioma
- Should not be confused with malignant mesothelioma and benign papillary mesothelioma.
- AKA peritoneal inclusion cyst.[5]
- AKA inflammatory cyst of the peritoneum.
- AKA mesothelial inclusion cyst.[citation needed]
General
- Usually conservative management.
- Serum CA-125 usually low.
- May occur in men.[6]
Gross
Features:[7]
- Multilocular thin-walled cysts containing serous fluid +/- blood.
- Occasionally unilocular.
- May be up to 15 cm.
- Can be adherent to the ovary.
Microscopic
- Thin-walled, irregular-shaped, cysts - unicystic or multicystic.
- Mesothelial lining +/- squamous metaplasia.[9]
- Eosinophilic fluid.
DDx:
- Ovarian serous borderline tumour.
- Ovarian serous carcinoma.
- Primary peritoneal serous carcinoma.
- Primary peritoneal malignant mesothelioma.
Images:
IHC
Features:[10]
- Calretinin +ve.
- WT-1 +ve.
Malignant
Primary peritoneal serous carcinoma
General
- Very rare.
- Reported in men.[11]
Microscopic
Features:
- Like serous carcinoma elsewhere - see ovarian serous carcinoma.
- To exclude ovarian serous carcinoma all of the following criteria must be met:[12]
- Histology of the tumour = serous carcinoma.
- Bulk of the tumour involves the peritoneum.
- Ovarian substance tumour extent less than 5 x 5 mm in plane of section.
- Previous ovarian serous carcinoma is excluded.
- Old oopherectomies reviewed if possible.
DDx:
- Ovarian serous carcinoma.
- Other serous carcinomas - see serous carcinoma.
- Malignant mesothelioma.
IHC
- Like serous carcinoma elsewhere - see ovarian serous carcinoma.
Malignant mesothelioma
Main article: Malignant mesothelioma
This is like the tumour found in the pleural cavity.
Peritoneal metastasis
- AKA metastatic peritoneal disease.
Main article: Metastasis
General
Common causes:
- Gastrointestinal tract, esp. colorectal carcinoma.
- Gynecologic tract.
Note:
- Peritoneal disease in the context of liver metastases in colorectal carcinoma contraindicates liver resection.[13]
Microscopic
- See metastasis.
See also
References
- ↑ Bürrig, KF.; Pfitzer, P.; Hort, W. (1990). "Well-differentiated papillary mesothelioma of the peritoneum: a borderline mesothelioma. Report of two cases and review of literature.". Virchows Arch A Pathol Anat Histopathol 417 (5): 443-7. PMID 2122588.
- ↑ 2.0 2.1 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.
- ↑ Chetty, R. (Nov 1992). "Well differentiated (benign) papillary mesothelioma of the tunica vaginalis.". J Clin Pathol 45 (11): 1029-30. PMID 1452778.
- ↑ Truong, LD.; Maccato, ML.; Awalt, H.; Cagle, PT.; Schwartz, MR.; Kaplan, AL. (Jan 1990). "Serous surface carcinoma of the peritoneum: a clinicopathologic study of 22 cases.". Hum Pathol 21 (1): 99-110. PMID 1688545.
- ↑ 5.0 5.1 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Ross, MJ.; Welch, WR.; Scully, RE. (Sep 1989). "Multilocular peritoneal inclusion cysts (so-called cystic mesotheliomas).". Cancer 64 (6): 1336-46. PMID 2766227.
- ↑ 10.0 10.1 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.
- ↑ 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.
- ↑ 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/.
- ↑ 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.