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LETTER TO EDITOR  
Year : 2013  |  Volume : 56  |  Issue : 4  |  Page : 476-477
Pleural multicystic mesothelial proliferation: A mimicker of benign peritoneal mesothelioma


1 Department of Pathology, LRS Institute of TB & Respiratory disease, Sri Aurbindo Marg, New Delhi, India
2 Department of Thoracic Surgery, LRS Institute of TB & Respiratory disease, Sri Aurbindo Marg, New Delhi, India

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Date of Web Publication18-Jan-2014
 

How to cite this article:
Agarwal S, Mullick S, Gupta K, Prasad S. Pleural multicystic mesothelial proliferation: A mimicker of benign peritoneal mesothelioma. Indian J Pathol Microbiol 2013;56:476-7

How to cite this URL:
Agarwal S, Mullick S, Gupta K, Prasad S. Pleural multicystic mesothelial proliferation: A mimicker of benign peritoneal mesothelioma. Indian J Pathol Microbiol [serial online] 2013 [cited 2019 Dec 7];56:476-7. Available from: http://www.ijpmonline.org/text.asp?2013/56/4/476/125389


Sir,

We present two cases of pleural multicystic mesothelial proliferation, histologically mimicking peritoneal multicystic mesothelioma. Both patients were adult male smokers who were referred for dyspnea, chest pain, and recurrent pneumothorax. The first patient was 50 years with no history of asbestos exposure. Chest X-ray & CT scan showed a mass measuring 6 × 5.3 × 5.4 cm in the right lower lobe, with mild pleural thickening. Video-assisted thoracoscopic surgery was done. A biopsy from the mass lesion was obtained and yellow pleural tissue measuring 4 × 3 × 0.6 cm with focal pearly white nodularity was submitted for histopathology. The second patient was a 40-year-old farmer with mild pleural thickening on chest X-ray. Right-sided pleurectomy was done and flattened, glistening tissue pieces measuring 8 × 7 cm with focal pearly white nodular areas was obtained [Figure 1]a . The cut section showed occasional microcysts with a magnifying glass. Microscopy in both showed multiple cystic spaces of varying sizes, containing proteinaceous material, lined by a single layer of flattened to cuboidal mesothelial cells [Figure 1]b,c. In Case 1, a focal small area of mesothelial proliferation was also noted. The lung mass in Case 1 which had also been biopsied showed features of organizing pneumonia with interstitial fibrosis. Case 2 also showed a pleural plaque measuring about 3 mm comprising of underlying paucicellular dense collagenous connective tissue with basket weave pattern. The cyst lining epithelium in both cases was positive for calretinin and cytokeratin [Figure 1]d and negative for carcinoembryonic antigen (CEA) and thyroid transcription factor-1 (TTF-1). The immunohistochemical profile was consistent with a mesothelial origin. No psammomatous or asbestos bodies were found. No atypia, necrosis, and mitotic activity were noted. Diagnosis of benign cystic mesothelial proliferation was rendered in both the cases with changes of interstitial fibrosis and organizing pneumonia in Case 1 and pleural plaque formation in Case 2.
Figure 1

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Pleural multicystc mesothelial proliferations are rare lesions of unknown etiology and histogenesis. [1],[2],[3],[4],[5] Their histological features are similar to the benign cystic peritoneal mesotheliomas. [1],[2],[3],[5] Peritoneal mesotheliomas are uncommon lesions, usually seen in females. They are regarded as benign neoplasms with the ability for local recurrence and occasional malignant transformation. [2],[5] Analogy of pleural cystic proliferation with similar disease in peritoneal space suggest that they may also be a reactive change caused by pleuritis of unknown etiology. [4] Grossly, peritoneal lesions are usually multifocal with numerous translucent cysts. [2],[5] However, both the current cases in pleura presented with thickened pleura with focal nodular areas. The main histological differential includes adenomatoid tumor and localized fibrous pleural mesothelioma. Various factors like dusts, talc, mycobacterial infections, and trauma have been implicated in the pathogenesis of these lesions. [2],[4] As very few cases have been reported in literature precise incidence and natural history of these lesion in pleura largely remains unknown. Further studies at molecular and genetic level will also help to elucidate their true histogenesis. Reports of frequent relapse and occasional malignant transformation in peritoneum [5] implies that course of this disease may not be as favorable as thought earlier and indicates the need for follow up.

 
   References Top

1.Ball NJ, Urbanski SJ, Green FH, Kieser T. Pleural multicystic mesothelial proliferation: The so called multicystic mesothelioma. Am J Surg Pathol 1990;14:375-8.  Back to cited text no. 1
    
2.Pelosi G, Zannoni M, Caprioli F, Faccincani L, Battistoni MG, Balercia G, et al. Benign multicystic mesothelial proliferation of the peritoneum: Immunohistochemical and electron microscopy study of a case and review of the literature. Histol Histopathol 1991;6:575-83.  Back to cited text no. 2
    
3.Debnath S, Mishra V, Singh PA, Singh M. Low grade cystic mesothelioma of rectus sheath. J Clin Diag Res 2007;3:173-6.  Back to cited text no. 3
    
4.Katoh S, Satoh M, Oouchi H, Imai S, Kusajima K. Pleural Multicystic Mesothelial Proliferation. Chest 1994;105:295-6.  Back to cited text no. 4
    
5.Pitta X, Andreadis E, Ekonomou A, Papachristodoulou A, Tziouveras C, Papapaulou L, et al. Benign multicystic peritoneal mesothelioma: A case report. J Med Case Rep 2010;4:385.  Back to cited text no. 5
    

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Correspondence Address:
Swati Agarwal
Department of pathology, LRS institute of TB and Respiratory disease, Sri Aurobindo marg, New Delhi - 30
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.125389

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