PMC4370594_01
Patient 1 pertinent radiology and pathology.. (A)Axial CT scan showing peritoneal-based pelvic mass. (B) Abdominal fluid aspiration biopsy showing papillary mesothelial proliferation (H&E stain on cell block preparation, 40X magnification). (C) Omental disease sampled at cytoreductive surgery showing malignant mesothelial cells forming gland-like structures, papillae, with spindle cell formation and sarcomatoid features. No treatment effect is appreciable (H&E 40X).
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Cross-sectional imaging identified a peritoneal mass (Fig. 1a). Core needle biopsy and peritoneal cytology confirmed the diagnosis of epithelioid mesothelioma (Fig. 1b). Histology from the cytoreductive surgery specimen showed a biphasic mesothelioma invading multiple abdominal and pelvic viscera with high-grade cytology and no appreciable treatment effect (Fig. 1c).
PMC4370594_02
Patient 2 pertinent radiology and pathology.. (A)Vaginal mass biopsy showing malignant mesothelial cells with sarcomatoid features (H&E 20X). (B) CT/PET scan showing uptake in vaginal mass. (C) CT/PET showing additional uptake in the cecum. (D) Surgical specimen from the cecum showing epithelioid mesothelial proliferation with heavy lymphoplasmacytic infiltrate (H&E 20X). (E) Post-treatment CT/PET showing resolution of the vaginal mass (as compared to B). (F) Post-treatment CT/PET showing persistence of the cecal mass (compared with C). Imaging of associated inguinal lymphadenopathy not shown.
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She presented with a vaginal wall mass, biopsy of which showed a sarcomatoid mesothelioma (Fig. 2a). Imaging by PET CT revealed several additional peritoneal lesions, including one adjacent to the right colon (Fig. 2b,c). After 4 cycles, a discordant response was observed with complete resolution of the vaginal mass (Fig. 2e) but persistence of the right colonic nodule (Fig. 2f). Final pathology from the surgical specimens showed epithelioid mesothelioma in the right colonic nodule:no sarcomatoid component was identified (Fig. 2d).