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Table of Contents
Definition / General | Epidemiology | Sites | Etiology | Clinical Features | Laboratory | Case Reports | Treatment | Gross Description | Gross Images | Micro Description | Micro Images | Positive Stains | Negative Stains | Differential DiagnosisDefinition / General
- Primary ovarian malignant mesotheliomas (POMM) are a rare, aggressive neoplasm of mesothelial cells, with poor prognosis
- Patients usually present with widespread peritoneal tumor, but occasionally involvement is limited to 1-2 ovaries
- Needs to be differentiated from secondary ovarian involvement by peritoneal malignant mesothelioma
- POMM: greater degree of ovarian enlargement, striking parenchymal replacement (Am J Surg Pathol 1996;20:1067)
Epidemiology
- Median age 52 years, range 16 to 63 years
Sites
- Peritoneum, pericardium, tunica vaginalis
Etiology
- Asbestos exposure, prior radiotherapy
Clinical Features
- Abdominal or pelvic pain, abdominal swelling or adnexal mass (Am J Surg Pathol 1996;20:1067)
Laboratory
- CA-125, CA19-9, and AFP are usually normal (Acta Cytol 1995;39:164)
Case Reports
- 50 year old woman with simultaneous occurrence of well differentiated papillary mesothelioma and endometrioid ovarian cancer (Gynecol Oncol Case Rep 2013;4:53)
Treatment
- Surgery with / without chemotherapy or radiotherapy
Gross Description
- 3 to 15 cm, usually bilateral
- Solid with small cysts
Gross Images
Images hosted on Pathout server:
Solid mural nodule and tumor on cyst lining
Micro Description
- Epithelial or biphasic tumor with papillary, tubular-glandular or solid patterns with features of malignancy
- Tumor cells have moderate atypia and low mitotic rate
- Stroma is hyalinized, occasionally with striking hyalinized cores and psammoma bodies
Micro Images
Images hosted on Pathout server:
Solid and tubulopapillary patterns
Surface of ovary
Images hosted on other servers:
Well differentiated papillary tumor
Biphasic tumor
Calretinin+
Positive Stains
- Alcain blue+ intracytoplasmic material
- Calretinin, CD10, cytokeratin, WT1
Differential Diagnosis
- Primary peritoneal malignant mesthelioma: main tumor bulk is outside ovary
- Reactive mesothelial hyperplasia: no atypia
- Serous papillary adenocarcinoma: multilayering, cell stratification, cytologic atypia, mitosis (Am J Surg Pathol 2010;34:627)
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