Huge Peritoneal Malignant Mesothelioma Mimicking
Primary Ovarian Carcinoma
Siriwan Tangjitgamol MD*, Malee Warnnissorn MD**,
Kwananong Attakettaworn MD***, Napaporn Puripat MD***
Affiliation :
* Department of Obstetrics and Gynecology, Faculty of Medicine, Vajira Hospital,
University of Bangkok Metropolis, Bangkok, Thailand
** Department of Pathology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
*** Department of Anatomical Pathology, Faculty of Medicine, Vajira Hospital,
University of Bangkok Metropolis, Bangkok, Thailand
Peritoneal malignant mesothelioma (PMM) is less commonly found in female than male. The most important
differential diagnosis of PMM in female patient is primary ovarian carcinoma because of their similar symptoms e.g.
dyspepsia, abdominal discomfort from ascites, palpable abdominal mass, etc. However, common clinical presentation of
PMM is diffuse spread of peritoneal lesions without dominating tumor mass while primary ovarian tumor usually presents
with large pelvic mass and smaller exta-ovarian metastatic lesions. The surgeon may make a provisional intraoperative
diagnosis of PMM if both ovaries are clearly identified. Unfortunately, both conditions frequently elicit fibrosis and adhesion
that the exact location or the origin of tumor cannot be clearly stated. Histopathologic diagnosis of PMM is also difficult
because it has three patterns of histopathology as biphasic tumors composed of epithelial and sarcomatous components or
it may be monophasic of either type. When only the epithelial component is found, serous ovarian carcinoma is the important
differential diagnosis while the biphasic mesothelioma must be differentiated from malignant mesodermal mixed tumor or
carcinosarcoma of the ovary. The pathologist generally requires immunohistochemical study to achieve a correct diagnosis.
The clinical feature and detailed histopathologic findings of the patient with PMM will be discussed.
Keywords : Peritoneal malignant mesothelioma, Ovarian mass, Paclitaxel/carboplatin
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