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Master Thesis

Étude rétrospective de 29 cas de lésions mésothéliales « bénignes » péritonéales : données clinicopathologiques, difficultés diagnostiques, modalités de prise en charge

Abstract : Benign mesothelial peritoneal tumours are rare, represented by adenomatoid tumour (AT) and welldifferentiated papillary mesothelioma (WDPM). Benign multicystic mesothelioma (BMM) is close to the mesothelial cyst (MC). By contrast to AT, WDPM and BMM may be difficult to diagnose, and their pathogenesis and potential of malignancy are still questioned. We retrieved the WDPM, BMM and MC treated in Bordeaux’s CHU between 2000 and 2019, and listed their clinical and pathological characteristics. We collected 15 BMM, 12 WDPM and 2 MC. After revision, 10 WDPM (one with micro-invasion) and 12 BMM remained. Two WDPM were reclassified as endosalpingiosis and epithelioid malignant mesothelioma (MM). Among the BMM, 3 were reclassified as simple cysts; 3 BMM more than 10cm recurred. An adjuvant chemotherapy was indicated for 2 patients (micro-invasive WDPM and recurrent BMM). The first step was to confirm the mesothelial nature of these tumors with an adapted immunohistochemistry study, then the pathologist must look for atypical/malignant criteria. As a benign tumour, WDPM must imperatively be differentiated from MM: a supracentimetric multifocal lesion with cytological atypia and/or invasive focii should alert the pathologist. Loss of BAP1 immunohistochemistry expression, frequent in peritoneal MM, is a useful clue to confirm a MM. BMM should be considered as a tumour with potential late local recurrence, mostly for lesion bigger than 10 cm. Its main differential diagnoses are from simple cysts (which are reactive processes, without any recurrent potential) and a cystic form of MM. Systematic review is recommended for both to assert the proper diagnosis, using the WHO classification, so diagnosis and treatment will be homogeneous. Its curative treatment is complete surgical excision, sometimes accompanied by (hyperthermic intraperitoneal) chemotherapy for recurrent/multifocal tumors. Finally, patient will be watched for a long period, as late recurrence may occur.
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Submitted on : Thursday, June 11, 2020 - 10:38:52 AM
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Aude Cassagne. Étude rétrospective de 29 cas de lésions mésothéliales « bénignes » péritonéales : données clinicopathologiques, difficultés diagnostiques, modalités de prise en charge. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02864544⟩

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