Wu Chih Ching, Bassi Aman, Onitilo Adedayo, Sharma Rohit
Surgery, Marshfield Medical Center, Marshfield, USA.
General Surgery, Saint Louis University School of Medicine, St. Louis, USA.
Cureus. 2024 May 20;16(5):e60664. doi: 10.7759/cureus.60664. eCollection 2024 May.
Benign multicystic peritoneal mesothelioma (BMPM), also known as multicystic peritoneal mesothelioma (MCPM), is a rare cystic neoplasm arising from the mesothelium lining of the abdominal and pelvic peritoneum. This entity has been disproportionately described in women of reproductive age. Both the etiology and pathogenesis of the condition are not well understood. Preoperative diagnosis is challenging as differentials are varied and include endometriosis, lymphangioma, pseudomyxoma peritonei, cystic adenomatoid tumor, and malignant peritoneal mesothelioma. Management options include cytoreductive surgery (CRS) with or without heated intraperitoneal chemotherapy (HIPEC). In this case report, we highlight the complexity of preoperative diagnosis, presentation, workup, treatment, and management of BMPM. We report the case of a female patient presenting with abdominal pain and imagining consistent with cystic intra-abdominal lesions. After an inconclusive percutaneous biopsy and a multi-disciplinary tumor board discussion, the patient was offered CRS with HIPEC. Intra-operative frozen section indicated benign epithelial lined cysts. CRS and HIPEC were performed. After a second opinion, the lesions were confirmed by pathology and immunohistochemistry to be BMPM. In this report, we discuss the gold standard of care for patients with BMPM to improve the disease control rate. This pathway is proposed in our study, and, thus, we conclude that BMPM should be considered in the differential diagnosis of patients presenting with symptomatic multiple intraperitoneal cystic lesions.
良性多囊性腹膜间皮瘤（BMPM），也称为多囊性腹膜间皮瘤（MCPM），是一种罕见的囊性肿瘤，起源于腹盆腔腹膜的间皮衬里。该疾病在育龄女性中的描述不成比例。其病因和发病机制尚未完全明确。术前诊断具有挑战性，因为鉴别诊断多样，包括子宫内膜异位症、淋巴管瘤、腹膜假黏液瘤、囊性腺瘤样肿瘤和恶性腹膜间皮瘤。治疗选择包括细胞减灭术（CRS），可联合或不联合腹腔内热灌注化疗（HIPEC）。在本病例报告中，我们强调了BMPM术前诊断、表现、检查、治疗及管理的复杂性。我们报告了一例女性患者，表现为腹痛，影像学检查显示符合腹腔内囊性病变。经皮活检结果不明确且经多学科肿瘤委员会讨论后，为该患者实施了CRS联合HIPEC。术中冰冻切片显示为良性上皮内衬囊肿。实施了CRS和HIPEC。经二次会诊，病理及免疫组化结果证实病变为BMPM。在本报告中，我们讨论了BMPM患者的最佳治疗标准，以提高疾病控制率。本研究提出了该治疗路径，因此，我们得出结论，对于出现有症状的多个腹腔内囊性病变的患者，鉴别诊断时应考虑BMPM。
