CYSTIC MESOTHELIOMA OF THE PERITONEUM - A RARE CAUSE OF ASCITES IN CHILDREN

A 2-year-old girl presented with a 3-month history of progressive pain less abdominal distension. Results of the clinical examination suggest ed massive ascites, but no other symptoms or,signs could be elicited. There was no history of any other illness preceding the onset of diste nsion. Ultrasonography and a computed tomography scan confirmed gross abites, with multi pie thin-walled loculi th rough out the abdomen, fr om the diaphragm to the pelvis. The preoperative diagnosis was;intraab dominal lymphangioma. During laparotomy, multiple transparent cysts we re found throughout the peritoneum. There was no evidence of malignanc y in any organ, and the cysts appeared almost completely avascular. Hi stological and ultrastructural appearances were those of benign cystic mesothelioma of the peritoneum, a condition that hitherto has been re cognized only in adults. It is thought to represent a borderline varia nt between a truly benign adenomatoid lesion and the better-known mali gnant mesothelioma. The experience with adult cases suggests a high po tential for recurrence but no progression to malignancy. It is possibl e that some cases of intraabdominal lymphangioma may have been misdiag nosed in the past; future cases should be fully evaluated, both immuno histochemically and ultrastructurally, to establish the true incidence of mesothelial proliferative disease in children. Copyright (C) 1994 by W.B. Saunders Company