General
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• 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
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• Median age 52 years, range 16 to 63 years

Other sites
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• Peritoneum, pericardium, tunica vaginalis

Etiology
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• Asbestos exposure, prior radiotherapy

Clinical features
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• Abdominal or pelvic pain, abdominal swelling or adnexal mass (Am J Surg Pathol 1996;20:1067)

Laboratory
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• CA-125, CA19-9, and AFP are usually normal (Acta Cytol 1995;39:164)

Case reports
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• 50 year old woman with simultaneous occurrence of well differentiated papillary mesothelioma and endometrioid ovarian cancer (Gynecol Oncol Case Rep 2013;4:53)

Treatment
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• Surgery with / without chemotherapy or radiotherapy

Clinical images
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Large, heterogenous peritoneal lesion

Cystic and solid components

Abdomen was covered with massive nodular masses

Gross description
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• 3 to 15 cm, usually bilateral
• Solid with small cysts

Gross images
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Solid mural nodule and tumor on cyst lining

Micro description
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• 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
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Solid and tubulopapillary patterns

 

Surface of ovary

Well differentiated papillary tumor

Biphasic tumor

H&E

Calretinin+

CD10, WT1

Positive stains
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• Alcain blue+ intracytoplasmic material
• Calretinin, cytokeratin, WT1, CD10

Negative stains
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• Intraytplasmic material is PAS-
• CEA, BerEP4, TAG72, and MOC31

Differential diagnosis
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• 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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