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Malignant peritoneal mesothelioma in patients with endometriosis
  1. Kelly J Butnor1,
  2. Justin Rueckert1,
  3. Elizabeth N Pavlisko2,
  4. Thomas A Sporn2,
  5. Victor L Roggli2
  1. 1 Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
  2. 2 Department of Pathology, Duke University Health System, Durham, North Carolina, USA
  1. Correspondence to Dr Kelly J Butnor, Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT 05401, USA; kelly.butnor{at}


Aims Florid mesothelial hyperplasia is known to result from endometriosis. Well-differentiated papillary mesothelioma and multiloculated peritoneal inclusion cysts have also been described in women with endometriosis. To our knowledge, peritoneal diffuse malignant mesothelioma (MM) arising in the setting of endometriosis has not been reported. The purpose of this study is to report the clinicopathological characteristics of women with MM and endometriosis.

Methods The surgical pathology files of a tertiary academic medical centre and the consultation files of one of the study authors were reviewed for cases of MM in females with and without endometriosis.

Results Six women with MM and endometriosis ranging in age from 29 to 55 years (median=45 years) were identified. All had peritoneal MM and endometriosis involving the peritoneum and/or adnexa. Five had epithelioid MM and one had biphasic MM. Two had paraoccupational exposure to asbestos. The median age of women with MM and endometriosis (44.5 years) was significantly less than the median age of cases without endometriosis (58.0 years) (p value=0.01).

Conclusions To our knowledge, this is the first report of MM in women with endometriosis. Interestingly, MM in the setting of endometriosis has only been observed in the peritoneum and not in other serosal cavities. The findings in the present study suggest that chronic serosal inflammation secondary to endometriosis may be an inducing factor in rare cases of MM of the peritoneum.

  • malignant tumours
  • pelvic inflammatory
  • cancer

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  • Handling editor Dhirendra Govender.

  • Contributors All authors have made the following contributions: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; final approval of the version published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Duke University IRB.

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