Benign Multicystic Peritoneal Mesothelioma in a Male Patient with Previous Wilms' Tumor: A Case Report and Review of the Literature

Abstract

Benign multicystic peritoneal mesothelioma (BMPM) is a rare condition, more common in females of reproductive age, which arises from the peritoneal mesothelium. A 33-year-old male presented to our unit with abdominal pain and constipation. His past medical history included a previous unilateral nephrectomy for Wilms' tumor and the previous incidental finding of some intra-abdominal cystic formations at the level of the mesentery. After performing a CT scan, an exploratory laparotomy was done and a voluminous cystic mesenteric mass, composed of 3 confluent formations, was observed. Some other similar but significantly smaller lesions were found. An en bloc resection of the mesenteric mass together with the corresponding intestinal loops, an appendicectomy, and some peritoneal biopsies were performed. The postoperative period was complicated by a peritonitis due to dehiscence of the intestinal anastomosis, which required another operation, and a delayed return of normal bowel function, which was resolved through prokinetic therapy. Through histological examination, a BMPM was diagnosed. At 8 months of follow-up, the patient is free of symptoms. BMPM exact etiopathogenesis still remains uncertain. Given his high recurrence rate, a long-term follow-up is recommended.

Figure 1

BMPM on CT scan. Contrast-enhanced CT scan shows the presence of 3 contiguous, communicating, and thin-walled cystic formations located at the level of the mesentery. The mass with larger dimensions is the most ventral one, and it is localized in contiguity with the abdominal wall, in the subumbilical region.

Figure 2

Intraoperative images of BMPM. Voluminous cystic mass incorporated in the mesentery of the last ileal loops detected during the operation.

Figure 3

Surgical specimen of BMPM. Voluminous cystic formation, composed of 3 confluent masses, with a major axis equal to about 10 cm and filled with straw-coloured fluid observed after resection.