Multicystic mesotheliomas are a rare benign subtype of mesothelioma commonly seen in young women.
They are most common in young females.
- previous abdominal surgery
- previous pelvic inflammatory disease
- no recognised association with asbestos exposure 5
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 which are lined with mesothelium and separated by fibrous tissue components.
Primarily occurs in the pelvic peritoneum 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
- C+ (Gd): may show enhancement of septa
Treatment and prognosis
Surgery is the preferred option for localised lesions. The tumour tends to recur locally (25-50% of cases) 3,6. Not thought to be chemo- or radiosensitive 2. May respond to hormonal therapy 5.
The general differential includes:
- abdominopelvic cystic lymphangioma: tends to affect younger patients
- ovarian cystadenoma
- ovarian cystadenocarcinoma
- cystic teratoma
- pseudomyxoma peritonei
- cystic mucinous tumour of pancreas
- 1. Koo PJ, Wills JS. Case 146: Benign multicystic mesothelioma. Radiology. 2009;251 (3): 944-6. doi:10.1148/radiol.2513071235 - Pubmed citation
- 2. Bui-mansfield LT, Kim-ahn G, O'bryant LK. Multicystic mesothelioma of the peritoneum. AJR Am J Roentgenol. 2002;178 (2): 402. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. O'Neil JD, Ros PR, Storm BL et-al. Cystic mesothelioma of the peritoneum. Radiology. 1989;170 (2): 333-7. Radiology (abstract) - Pubmed citation
- 4. Wong WL, Johns TA, Herlihy WG et-al. Best cases from the AFIP: multicystic mesothelioma. Radiographics. 24 (1): 247-50. doi:10.1148/rg.241035068 - Pubmed citation
- 5. Park JY, Kim KW, Kwon HJ et-al. Peritoneal mesotheliomas: clinicopathologic features, CT findings, and differential diagnosis. AJR Am J Roentgenol. 2008;191 (3): 814-25. doi:10.2214/AJR.07.3628 - Pubmed citation
- 6. Pickhardt PJ, Bhalla S. Primary neoplasms of peritoneal and sub-peritoneal origin: CT findings. Radiographics. 25 (4): 983-95. doi:10.1148/rg.254045140 - Pubmed citation
- 7. Elsayes KM, Staveteig PT, Narra VR et-al. MRI of the peritoneum: spectrum of abnormalities. AJR Am J Roentgenol. 2006;186 (5): 1368-79. doi:10.2214/AJR.04.1522 - Pubmed citation