Mesotelioma peritoneal multiquístico benigno: reporte de un caso y revisión de la literatura / Benign multicystic peritoneal mesothelioma: case report and literature review

INTRODUCCIÓN: El mesotelioma peritoneal multiquístico benigno (MPMB) es una entidad con muy baja incidencia que se presentan con mayor frecuencia en mujeres jóvenes. CASO CLÍNICO: Paciente de 17 años que consulta por amenorrea secundaria. Además, refería pérdida de peso, estreñimiento y molestias abdominales. La exploración fue normal y en las pruebas de imagen se objetivó una pelvis ocupada por una masa multiquística, de unos 20 cm de diámetro máximo, de paredes finas y contenido anecoico. Se solicitaron marcadores tumorales de los cuales sólo se encontró elevado el CA 19.9 (35,2 U/mL). Se decidió realizar una laparoscopia exploradora para establecer un diagnóstico y ante los hallazgos y al considerarse la masa fácilmente resecable, en el mismo acto quirúrgico se extirpó por completo para su estudio anatomopatológico, que confirmó un MPMB. Se desestimaron tratamientos adicionales y actualmente se encuentra en seguimiento y asintomática. CONCLUSIÓN: La patogénesis del MPMB no está clara. Algunos autores defienden que se trata de una reacción peritoneal a un daño inflamatorio, otros apoyan que se trata de una neoplasia benigna. Esta naturaleza incierta, junto con la escasa experiencia, hacen que el manejo resulte complejo. Es necesario individualizar cada caso e intentar ser conservadores especialmente en pacientes jóvenes. Si se opta por un manejo activo, lo más acertado es la citorreducción completa seguida de quimioterapia hipertérmica peritoneal. El seguimiento, en cualquier caso, debe ser exhaustivo y multidisciplinar principalmente con pruebas de imagen.

BACKGROUND: Benign Multicystic Peritoneal Mesothelioma (BMPM) is an entity with a very low incidence that occurs more frequently in young women. CASE REPORT: A 17-year-old woman attended for secondary amenorrhea. She also referred to weight loss, constipation and abdominal discomfort. The examination was normal and echography revealed a pelvis occupied by a 20 centimeters multicystic mass, with thin walls and anechoic content. A preoperative study with tumor markers was requested in which only a CA 19.9 elevation was observed (35.2 U/ml 0-27). It was decided to perform an exploratory laparoscopy to establish a diagnosis. Due to the findings and because of the fact that the mass was considered easy to remove, it was completely removed in the same surgical act. The pathological result confirmed a BMPM. Additional treatments have been dismissed and are the patient is currently being followed up without symptoms. CONCLUSION: The pathogenesis of BMPM is unclear. Some authors argue that it is a peritoneal reaction to inflammatory damage, others support that it is a benign neoplasm. This uncertain nature coupled with limited experience make management complex. It is necessary to evaluate each case and try to be conservative especially in young patients. If surgery management is chosen, complete cytoreduction followed by hyperthermic peritoneal chemotherapy is the most successful option. The follow-up in any case must be exhaustive and multidisciplinary, mainly with imaging tests.

Mesotelioma benigno como causa de dolor abdominal inespecífico en un paciente con Enfermedad de Crohn / Benign multicystic peritoneal mesothelioma in a patient with Crohn disease

Benign multicystic peritoneal mesothelioma is an uncommon lesion arising from the peritoneal mesothelium. It is asymptomatic or presents with unspecific symptoms. Imaging techniques may reveal it, however the final diagnosis can only be made by histopathology. Surgery is the only effective treatment considering its high recurrence rate. We report a 19 years old male with Crohn’s disease. Due to persistent abdominal pain, an abdominal magnetic resonance imaging was performed, showing a complex cystic mass in the lower abdomen. The patient underwent surgery and the lesion was completely resected. The pathological study reported a benign multicystic peritoneal mesothelioma.

Quiste mesotelial simple gigante abdomino-pélvico / Giant pelvic and abdominal omental cyst: report of one case

Se presenta el caso de una mujer de 41 años que consulta por dolor abdominal y pelviano de carácter sordo de 6 semanas de evolución sin compromiso del estado general. Refiere el antecedente de una histerectomía por mioma realizada hace 3 años. La ecotomografía y la TAC de abdomen y pelvis revelan una lesión quística gigante de 15 x 8 x 12 cm que ocupa parte del abdomen y la pelvis. Luego de una resección parcial y marsupialización es referida a cirugía por recidiva precoz del tumor quístico. Es reintervenida, lográndose una extirpación completa más anexectomía bilateral con buena evolución posterior. El estudio histopatológico confirma el diagnóstico inicial de quiste mesotelial simple. La ubicación pelviana de la lesión, el comportamiento clínico (recidiva precoz con crecimiento rápido) y las dimensiones son más característicos de un mesotelioma quístico benigno. Sin embargo, el carácter unilocular permite catalogarlo como un quiste mesotelial de crecimiento excepcional. La distinción entre ambas entidades no es menor, toda vez que el mesotelioma quístico benigno tiene una recidiva alta y puede malignizarse.

We report a 41 years old women presenting with abdominal and pelvic pain lasting six weeks. She had a history of hysterectomy three years ago. Abdominal ultrasound and CAT scan showed a giant cystic lesion of 15 x 8 x 12 cm that occupied a great portion of the abdomen and pelvis. After a partial resection and marsupialization, she was refereed to surgery due to an early relapse of the cyst. She was operated again, performing a complete cyst excision and bilateral anexectomy, with a good postoperative evolution. Pathology confirmed the diagnosis of a simple omental cyst. The unilocular feature of the lesion is characteristic of omental cysts. However, due to the pelvic location and dimensions, the differential diagnosis must be made with benign cystic mesothelioma, that had a high rate of relapse and may become malignant.

Benign mesothelioma of peritoneum presenting as a pelvic mass

A large solitary multiloculated pelvic cyst in a 40-year-old woman with chronic pelvic pain was diagnosed to be a Multicystic Benign Mesothelioma [MBM] of peritoneum at laparotomy. Operative findings showed dense adhesions between uterus and bladder anteriorly, small intestines and pouch of Douglas posteriorly, a right ovarian cyst cm containing clear serous fluid and two nodular deposits were seen in the pouch of Douglas, small multiple deposits was found over the mesentery of small intestine and parietal peritoneum. Total abdominal hysterectomy with bilateral oophorectomy and infracolic omentectomy was done. During surgery, there was injury to the small intestine hence, resection of 10 inches of small intestine with re-anastomosis was carried out. Postoperative recovery was satisfactory. At 3 years follow-up, patient is symptom-free

Cisto paraovariano gigante / Giant ovarian cyst

No mesossalpinge, entre a trompa e o ovário, está situado o paraovário. Os cistos paraovarianos originam-se de estruturas vestigiais de Wolff, do epitélio tubário ou de incluções peritoneais. Raramente atinguem tamanho de cisto do próprio ovário. Os autores relatam um raro caso de cisto paraovariano gigante