Florid Mesothelial Hyperplasia Associated with Abdominal Wall Endometriosis Mimicking Invasive Carcinoma

Abstract

Florid mesothelial hyperplasia typically occurs in the pelvis, abdomen, or chest associated with an underlying neoplastic or inflammatory process. These lesions are of clinical significance because they can mimic a neoplasm. Early reports were published in the 1970s, but only a few case series of such lesions have been published in the gynecologic pathology literature. Here, we report a case of florid mesothelial hyperplasia with an infiltrative growth pattern, mimicking an invasive carcinoma. The lesion was associated with endometriosis forming a mass lesion in the abdominal wall. Histologically, tubular arrangements and nests of mesothelial cells, some with artifactual slit-like spaces, formed a stellate lesion adjacent to endometrial glands and stroma. Cytologic atypia was mild and reactive, and positive immunostaining for calretinin, WT-1, and cytokeratin 5 identified the lesion as mesothelial and benign. We describe in detail the histologic findings in this case and review the pertinent literature. We discuss the clinically importance of this diagnostic pitfall and the path to arriving at the correct diagnosis.

Figure 1

Scanning magnification shows groups of endometriotic glands surrounded by light gray staining stroma that is pseudodecidualized due to progestin treatment. Adjacent is a focus of tubular structures and nests with a pseudoinfiltrative growth pattern (arrowheads) (a, 20x). At intermediate magnification cells form tubular structures and nests with angular pseudoinfiltrative shapes, some surrounded by slit-like spaces set in dense collagenous stroma. The endometriotic gland in the upper right corner is surrounded by pseudodecidualized stroma (b, 100x). High magnification reveals the pseudoinfiltrative growth pattern of tubular structures and nests. Cells have relatively scant eosinophilic cytoplasm and round to oval monotonous nuclei, with some nuclear overlap. Chromatin is finely distributed, and occasional small nucleoli are seen (c, d; 400x).

Figure 2

Immunohistochemical stains for the mesothelial markers calretinin (a) and WT-1 (b) are strongly positive. Cytokeratin 7 (c) and cytokeratin 5 (d) are also positive (all 40x). These immunostains highlight the pseudoinfiltrative architecture at low-magnification images.