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Mesothelioma
Treatment
Articles
and Abstracts
'Mucin-positive'
epithelial mesothelioma of the peritoneum:
an unusual diagnostic pitfall
Histopathology
2000 Jul;37(1):33-6
Cook
DS, Attanoos RL, Jalloh SS, Gibbs
AR
Departments
of Histopathology, Llandough Hospital,
Cardiff, Milton Keynes General Hospital,
Milton Keynes, UK.
AIMS:
The histopathological, immunohistochemical
and ultrastructural features of a primary
'mucin-positive' epithelial mesothelioma
of the peritoneum are reported to draw
attention to a potential cause of
diagnostic error. METHODS AND RESULTS:
Light microscopy showed an infiltrative
neoplasm within the gastric wall and
omentum which was composed of sheets of
'signet- ring' tumour cells and contained
abundant diastase-resistant periodic
acid-Schiff-positive material.
Immunohistochemistry supported a
mesothelial phenotype (cytokeratin AE1/3,
thick membranous HBME-1, focal
thrombomodulin and calretinin expression
and no reactivity for carcinoembryonic
antigen, Leu-M1 and Ber-EP4).
Ultrastructural features showed large
cells with prominent intercellular
desmosomes and numerous delicate,
elongated microvilli. Within
intracytoplasmic neolumina, crystalloidal
'fern-like' bodies were identified with
features similar to the ultrastructural
appearances of hyaluronic acid crystals.
Repeat histochemical analysis following
hyaluronidase pretreatment revealed a
significantly diminished
diastase-resistant periodic acid-Schiff
reaction. CONCLUSIONS: This case of
primary peritoneal 'mucin-positive'
epithelial mesothelioma demonstrates
morphological and histochemical mimicry
with diffuse gastric adenocarcinoma. A
similar case has not been previously
reported in the peritoneum and an
awareness of the tumour (with application
of suitable ancillary studies) prevents
misdiagnosis and assists in potentially
difficult medicolegal cases.
PMID:
10931216, UI:20389629
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