| Popis: |
Benign peritoneal cystic mesothelioma is a rare disease of the abdominal cavity with grape – like cystic lesions, solitary or disseminated. The etiology is unclear, with a neoplastic or reactive origin being the prominent considerations. Because of its high recurrence rate and occasional malignant transformation, radical surgical approaches with optional hyperthermic intraperitoneal Chemotherapy have increasingly been advocated with mixed results. We present a case report with a new conservative approach using the Cavitron ultrasonic surgical aspirator for the first time in benign cystic mesothelioma of the peritoneum and a review of the literature about the treatment of this condition. A 47-year-old female with a history of abdominal surgery, including endometriosis excision and hysterectomy presented with upper abdominal discomfort. Ultrasound and magnetic resonance imaging showed two peritoneal tumors with multiple thin–layered cysts. Exploratory laparoscopy revealed multiple cystic masses. Biopsies showed no malignant cells, no positive markers for borderline – tumors (HEA125) but calretin in positive lining cells as well as PAX8 – positive covering cells, making a benign cystic mesothelioma the most likely diagnosis. The patient exhibited adhesions due to prior surgeries. Because of the high recurrence risk of benign mesotheliomas and the small chances of malignant transformation, we destroyed all cysts using ultrasound vaporization. The patient recovered without complications. Laparoscopic use of the Cavitron ultrasonic surgical aspirator system is a safe procedure with low risks and comorbidity, which minimizes adhesions formation and can be performed as a conservative alternative to currently popular radical therapy in benign peritoneal cystic mesothelioma. |
