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Peritoneal mesothelial hyperplasia associated with gynaecological disease: a potential diagnostic pitfall that is commonly associated with endometriosis
  1. Richard Oparka1,
  2. W Glenn McCluggage2,
  3. C Simon Herrington1,3
  1. 1Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
  2. 2Department of Pathology, Royal Group of Hospitals Trust, Grosvenor Road, Belfast, UK
  3. 3Centre for Oncology and Molecular Medicine, Division of Medical Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
  1. Correspondence to Professor C Simon Herrington, Department of Pathology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK; s.herrington{at}


Aims To describe the clinicopathological features of florid peritoneal mesothelial hyperplasia associated with gynaecological disease.

Methods Review of a series of 44 cases where there was significant peritoneal mesothelial proliferation, usually on the surface of the ovary, which resulted in diagnostic problems, often including a consideration of malignancy.

Results Florid mesothelial proliferation was associated with a variety of benign and malignant lesions, most commonly endometriosis. The most characteristic morphological appearance was that of small bland tubules and nests and cords of cells often embedded in fibrous tissue, sometimes with a linear arrangement. In a minority of cases, there were closely packed small glands and papillae resulting in mimicry of a serous proliferation; psammoma bodies were present in one such case. In several cases, the groups of mesothelial cells either exhibited true lymphovascular invasion or were surrounded by spaces closely simulating lymphovascular invasion. Although most cases were appreciated to represent a reactive mesothelial proliferation, several were referred with a presumed or possible diagnosis of mesothelioma, low-grade serous carcinoma, adenocarcinoma, adenomatoid tumour or Sertoli cell tumour. Positive staining with calretinin and negative staining with Ber-EP4 often helped to identify the cells as mesothelial rather than epithelial.

Conclusions Florid peritoneal mesothelial hyperplasia can occur in association with a variety of gynaecological disorders. Recognition of this phenomenon and appreciation that it can produce worrisome histological patterns, particularly when associated with endometriosis, is key to reaching the correct diagnosis.

  • Mesothelial proliferation
  • endometriosis
  • calretinin
  • Ber-EP4
  • gynaecological pathology
  • proliferation
  • gynaecological pathology
  • proliferation

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.