Difference between revisions of "Peritoneum"

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:Should '''not''' be confused with ''[[malignant mesothelioma]]'' or ''[[benign multicystic mesothelioma]]''.
:Should '''not''' be confused with ''[[malignant mesothelioma]]'' or ''[[benign multicystic mesothelioma]]''.
*[[AKA]] ''benign papillary mesothelioma''.
*[[AKA]] ''benign papillary mesothelioma''.
===General===
{{Main|Well-differentiated papillary mesothelioma}}
*Benign.
**Some say it is ''borderline''.<ref name=pmid2122588>{{Cite journal  | last1 = Bürrig | first1 = KF. | last2 = Pfitzer | first2 = P. | last3 = Hort | first3 = W. | title = Well-differentiated papillary mesothelioma of the peritoneum: a borderline mesothelioma. Report of two cases and review of literature. | journal = Virchows Arch A Pathol Anat Histopathol | volume = 417 | issue = 5 | pages = 443-7 | month =  | year = 1990 | doi =  | PMID = 2122588 }}</ref>
*Classically women of reproductive age.<ref name=pmid18716115>{{Cite journal  | last1 = Park | first1 = JY. | last2 = Kim | first2 = KW. | last3 = Kwon | first3 = HJ. | last4 = Park | first4 = MS. | last5 = Kwon | first5 = GY. | last6 = Jun | first6 = SY. | last7 = Yu | first7 = ES. | title = Peritoneal mesotheliomas: clinicopathologic features, CT findings, and differential diagnosis. | journal = AJR Am J Roentgenol | volume = 191 | issue = 3 | pages = 814-25 | month = Sep | year = 2008 | doi = 10.2214/AJR.07.3628 | PMID = 18716115 | URL = content/191/3/814.full.pdf}}</ref>
*Reported in tunica vaginalis of the [[testis]].<ref name=pmid1452778>{{Cite journal  | last1 = Chetty | first1 = R. | title = Well differentiated (benign) papillary mesothelioma of the tunica vaginalis. | journal = J Clin Pathol | volume = 45 | issue = 11 | pages = 1029-30 | month = Nov | year = 1992 | doi =  | PMID = 1452778 }}</ref>
 
===Gross===
Features - typical:
*Multiple peritoneal nodules.
*Ascites.
 
DDx:<ref name=pmid18716115/>
*[[Tuberculosis]].
*Carcinomatosis.
*[[Primary peritoneal serous carcinoma]].
 
===Microscopic===
Features:
*Papillary structures with:
**Thick fibrous cores.
**Simple cuboidal epithelium.
***Small nucleoli.
 
Note:
*Lack cytologic atypia.
 
DDx:<ref>{{Cite journal  | last1 = Truong | first1 = LD. | last2 = Maccato | first2 = ML. | last3 = Awalt | first3 = H. | last4 = Cagle | first4 = PT. | last5 = Schwartz | first5 = MR. | last6 = Kaplan | first6 = AL. | title = Serous surface carcinoma of the peritoneum: a clinicopathologic study of 22 cases. | journal = Hum Pathol | volume = 21 | issue = 1 | pages = 99-110 | month = Jan | year = 1990 | doi =  | PMID = 1688545 }}</ref>
*[[Ovarian serous carcinoma]].
*[[Serous borderline tumour of the ovary]].
*[[Malignant mesothelioma]].
 
Image:
*[http://www.webpathology.com/image.asp?n=10&Case=86 Benign papillary mesothelioma (webpathology.com)].


==Benign multicystic mesothelioma==
==Benign multicystic mesothelioma==

Revision as of 07:25, 8 March 2015

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.
Main article: Well-differentiated papillary mesothelioma

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.[2]

Gross

Features:[3]

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

Microscopic

Features:[1][4]

  • Thin-walled, irregular-shaped, cysts - unicystic or multicystic.
    • Mesothelial lining +/- squamous metaplasia.[5]
    • Eosinophilic fluid.

DDx:

Images:

IHC

Features:[6]

  • Calretinin +ve.
  • WT-1 +ve.

Malignant

Primary peritoneal serous carcinoma

General

  • Very rare.
  • Reported in men.[7]

Microscopic

Features:

  • Like serous carcinoma elsewhere - see ovarian serous carcinoma.
  • To exclude ovarian serous carcinoma all of the following criteria must be met:[8]
    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.

Peritoneal metastasis

  • AKA metastatic peritoneal disease.
Main article: Metastasis

General

Common causes:

Note:

Microscopic

See metastasis.

See also

References

  1. ↑ 1.0 1.1 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ Ross, MJ.; Welch, WR.; Scully, RE. (Sep 1989). "Multilocular peritoneal inclusion cysts (so-called cystic mesotheliomas).". Cancer 64 (6): 1336-46. PMID 2766227.
  6. ↑ 6.0 6.1 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.
  7. ↑ 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.
  8. ↑ 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/.
  9. ↑ 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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