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.
*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:
*[[Ovarian serous carcinoma]].
 
Image:
*[http://www.webpathology.com/image.asp?n=10&Case=86 Benign papillary mesothelioma (webpathology.com)].


==Benign multicystic mesothelioma==
==Peritoneal inclusion cyst==
:Should '''not''' be confused with ''[[malignant mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.
{{Main|Peritoneal inclusion cyst}}
*[[AKA]] ''peritoneal inclusion cyst''.<ref name=pmid19386139>{{Cite journal  | last1 = Vallerie | first1 = AM. | last2 = Lerner | first2 = JP. | last3 = Wright | first3 = JD. | last4 = Baxi | first4 = LV. | title = Peritoneal inclusion cysts: a review. | journal = Obstet Gynecol Surv | volume = 64 | issue = 5 | pages = 321-34 | month = May | year = 2009 | doi = 10.1097/OGX.0b013e31819f93d4 | PMID = 19386139 }}</ref>
*[[AKA]] ''inflammatory cyst of the peritoneum''.
*[[AKA]] ''inflammatory cyst of the peritoneum''.
*[[AKA]] ''[[mesothelial inclusion cyst]]''.{{fact}}
*[[AKA]] ''[[mesothelial inclusion cyst]]''.{{fact}}
===General===
*[[AKA]] ''benign multicystic mesothelioma''.<ref name=pmid19386139>{{Cite journal  | last1 = Vallerie | first1 = AM. | last2 = Lerner | first2 = JP. | last3 = Wright | first3 = JD. | last4 = Baxi | first4 = LV. | title = Peritoneal inclusion cysts: a review. | journal = Obstet Gynecol Surv | volume = 64 | issue = 5 | pages = 321-34 | month = May | year = 2009 | doi = 10.1097/OGX.0b013e31819f93d4 | PMID = 19386139 }}</ref>
*Usually conservative management.
**Should '''not''' be confused with ''[[malignant mesothelioma]]'' and ''[[benign papillary mesothelioma]]''.
*Serum CA-125 usually low.
*May occur in men.<ref name=pmid12239771>{{Cite journal  | last1 = Cavallaro | first1 = A. | last2 = Murazio | first2 = M. | last3 = Modugno | first3 = P. | last4 = Vona | first4 = A. | last5 = Revelli | first5 = L. | last6 = Potenza | first6 = AE. | last7 = Colli | first7 = R. | title = Benign multicystic mesothelioma of the peritoneum: a case report. | journal = Chir Ital | volume = 54 | issue = 4 | pages = 569-72 | month =  | year =  | doi =  | PMID = 12239771 }}</ref>
 
===Gross===
Features:<ref name=pmid3789251>{{Cite journal  | last1 = McFadden | first1 = DE. | last2 = Clement | first2 = PB. | title = Peritoneal inclusion cysts with mural mesothelial proliferation. A clinicopathological analysis of six cases. | journal = Am J Surg Pathol | volume = 10 | issue = 12 | pages = 844-54 | month = Dec | year = 1986 | doi =  | PMID = 3789251 }}</ref>
*Multilocular thin-walled cysts containing serous fluid +/- blood.
**Occasionally unilocular.
*May be up to 15 cm.
*Can be adherent to the [[ovary]].
 
===Microscopic===
Features:<ref name=pmid19386139/><ref name=pmid18349460>{{Cite journal  | last1 = Levy | first1 = AD. | last2 = Arnáiz | first2 = J. | last3 = Shaw | first3 = JC. | last4 = Sobin | first4 = LH. | title = From the archives of the AFIP: primary peritoneal tumors: imaging features with pathologic correlation. | journal = Radiographics | volume = 28 | issue = 2 | pages = 583-607; quiz 621-2 | month = | year = | doi = 10.1148/rg.282075175 | PMID = 18349460 | URL = http://radiographics.rsna.org/content/28/2/583.full}}</ref>
*Thin-walled, irregular-shaped, cysts - unicystic or multicystic.
**Mesothelial lining +/- squamous metaplasia.<ref name=pmid2766227>{{Cite journal  | last1 = Ross | first1 = MJ. | last2 = Welch | first2 = WR. | last3 = Scully | first3 = RE. | title = Multilocular peritoneal inclusion cysts (so-called cystic mesotheliomas). | journal = Cancer | volume = 64 | issue = 6 | pages = 1336-46 | month = Sep | year = 1989 | doi =  | PMID = 2766227 }}
</ref>
**Eosinophilic fluid.
 
DDx:
*[[Ovarian serous borderline tumour]].
*[[Ovarian serous carcinoma]].
*[[Primary peritoneal serous carcinoma]].
*Primary peritoneal [[malignant mesothelioma]].
 
Images:
*[http://radiographics.rsna.org/content/28/2/583/F30.expansion.html Multicystic mesothelioma (rsna.org)].
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445851/figure/F4/ Benign multicystic peritoneal mesothelioma (nih.gov)].<ref name=pmid22583977>{{Cite journal  | last1 = Takemoto | first1 = S. | last2 = Kawano | first2 = R. | last3 = Honda | first3 = K. | last4 = Nakazono | first4 = A. | last5 = Shimamatsu | first5 = K. | title = Benign multicystic peritoneal mesothelioma mimicking recurrence of an ovarian borderline tumor: a case report. | journal = J Med Case Rep | volume = 6 | issue = 1 | pages = 126 | month =  | year = 2012 | doi = 10.1186/1752-1947-6-126 | PMID = 22583977 }}</ref>
 
===IHC===
Features:<ref name=pmid22583977/>
*Calretinin +ve.
*WT-1 +ve.


=Malignant=
=Malignant=
Line 102: Line 41:
===IHC===
===IHC===
*Like serous carcinoma elsewhere - see ''[[ovarian serous carcinoma]]''.
*Like serous carcinoma elsewhere - see ''[[ovarian serous carcinoma]]''.
===Sign out===
Should have comment something like:
<pre>
High-grade serous carcinoma of the ovary/fallopian tube/periteonum is associated
with BRCA1/2 mutation in approximately 20% of patients. Referral to genetic
counseling is recommended.
</pre>


==Malignant mesothelioma==
==Malignant mesothelioma==
Line 107: Line 54:
This is like the tumour found in the pleural cavity.
This is like the tumour found in the pleural cavity.


==Metastatic peritoneal disease==
==Peritoneal metastasis==
*[[AKA]] ''metastatic peritoneal disease''.
{{Main|Metastasis}}
{{Main|Metastasis}}
===General===
===General===
Line 114: Line 62:
*Gynecologic tract.
*Gynecologic tract.


Note:
*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>
*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>


Latest revision as of 19:07, 29 April 2022

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

Peritoneal inclusion cyst

Main article: Peritoneal inclusion cyst

Malignant

Primary peritoneal serous carcinoma

General

  • Very rare.
  • Reported in men.[2]

Microscopic

Features:

  • Like serous carcinoma elsewhere - see ovarian serous carcinoma.
  • To exclude ovarian serous carcinoma all of the following criteria must be met:[3]
    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

Sign out

Should have comment something like: 

High-grade serous carcinoma of the ovary/fallopian tube/periteonum is associated 
with BRCA1/2 mutation in approximately 20% of patients. Referral to genetic 
counseling is recommended.

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. ↑ 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. ↑ 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.
  3. ↑ 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/.
  4. ↑ 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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