Multicystic peritoneal mesothelioma

Last revised by Joshua Yap on 11 May 2023

Multicystic peritoneal mesotheliomas are a rare benign subtype of mesothelioma

The nomenclature for this condition can be confusing due to the use of multiple interchangeable synonyms that lump it together with the peritoneal inclusion cysts. Although there is still some debate on this matter, this article will refer to multicystic mesotheliomas as true neoplasms, distinguishing them from peritoneal inclusion cysts, a term reserved for those cysts secondary to intra-abdominal inflammation and whose fluid content originates from the ovarian stroma.

In contrast to malignant peritoneal mesothelioma, there is no association with asbestos exposure 5,8

Patients generally present with non-specific symptoms such as abdominal or pelvic pain, or distension. A palpable abdominal or pelvic mass may eventually be felt on clinical examination. 

Typically comprises multiple grape-like clusters of cysts that are lined with mesothelium and separated by fibrous tissue components.

Primarily occurs in the pelvic peritoneum, but can be multicompartmental 2.

May appear as a multicystic pelvic mass 2,3.

  • typically seen as a well-defined low attenuating (cystic) pelvic mass

  • calcification is generally not a feature 

Can better delineate the pelvic cystic mass. Reported signal characteristics include:

  • T1: fluid components show low signal 

  • T2: fluid components show high signal

  • T1 C+ (Gd): may show enhancement of septa

The tumor can undergo malignant transformation. Treated with surgical removal alone, the tumor tends to recur locally (25-50% of cases) 3,6. The most widely accepted treatment therefore consists of complete surgical cytoreduction (i.e. excision) with hyperthermic intraperitoneal chemotherapy (HIPEC) 9. Nonetheless, it is thought not to be especially chemosensitive or radiosensitive 2. It may respond to hormonal therapy 5.

The general differential includes:

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