Virchows Archiv

, Volume 447, Issue 5, pp 823–827

Clear cell mesothelioma presenting as an incarcerated abdominal hernia

Original Article


A clear cell mesothelioma presenting as an incarcerated ventral abdominal hernia in a 67-year-old man who had no history of asbestos exposure is described. The cause of the cytoplasmic clearing was the presence of large amounts of glycogen. Although uncommon, this variant of mesothelioma is important to recognize because it can be easily confused with other clear cell tumors involving the serosal membranes. Significant recent advances in the immunohistochemistry of epithelioid mesothelioma are briefly reviewed because immunohistochemical studies can be helpful in establishing the correct diagnosis.


Clear cell mesothelioma Hernia Immunohistochemistry D2-40 Podoplanin 


  1. 1.
    Acherman YIZ, Welch LS, Bromley CM, Sugarbaker PH (2003) Clinical presentation of peritoneal mesothelioma. Tumori 89:269–273Google Scholar
  2. 2.
    Aggarwal M, Lakhar B, Shetty D, Ullal S (2000) Malignant peritoneal mesothelioma in an inguinal hernial sac: an unusual presentation. Indian J Cancer 37:91–94PubMedGoogle Scholar
  3. 3.
    Bethwaite PB, Evans R, Naik DK, Delahunt B, Teague CA (1996) Diffuse malignant mesothelioma arising in a paracolostomy hernial sac. Histopathology 29:282–284PubMedCrossRefGoogle Scholar
  4. 4.
    Breiteneder-Geleff S, Matsui K, Soleiman A, Meraner P, Poczewski H, Kalt R, Schaffner G, Kerjaschki D (1997) Podoplanin, novel 43-kd membrane protein of glomerular epithelial cells, is down-regulated in puromycin nephrosis. Am J Pathol 151:1141–1152PubMedGoogle Scholar
  5. 5.
    Breiteneder-Geleff S, Soleiman A, Kowalski H, Horvat R, Amann G, Kriehuber E, Diem K, Weninger W, Tschachler E, Alitalo K, Kerjaschki D (1999) Angiosarcomas express mixed endothelial phenotypes of blood and lymphatic capillaries: podoplanin as a specific marker for lymphatic endothelium. Am J Pathol 154:385–394PubMedGoogle Scholar
  6. 6.
    Cavazza A, Pasquinelli G, Agostini L, Leslie KO, Colby TV (2002) Foamy cell mesothelioma (Letter). Histopathology 41:369–371PubMedCrossRefGoogle Scholar
  7. 7.
    Chang HT, Yantiss RK, Nielsen GP, McKee GT, Mark EJ (2000) Lipid-rich diffuse malignant mesothelioma: a case report. Hum Pathol 31:876–879CrossRefPubMedGoogle Scholar
  8. 8.
    Chu AY, Litzky LA, Pasha TL, Acs G, Zhang PJ (2005) Utility of D2-40, a novel mesothelial marker, in the diagnosis of malignant mesothelioma. Mod Pathol 18:105–110CrossRefPubMedGoogle Scholar
  9. 9.
    Dessy E, Falleni M, Braidotti P, Del Curto B, Panigalli T, Pietra GG (2001) Unusual clear cell variant of epithelioid mesothelioma. Arch Pathol Lab Med 125:1588–1590PubMedGoogle Scholar
  10. 10.
    Grove A, Jensen ML, Donna A (1989) Mesotheliomas of the tunica vaginalis testis and hernial sacs. Virchows Archiv A Pathol Anat 415:283–292CrossRefGoogle Scholar
  11. 11.
    Kerrigan SAJ, Cagle P, Churg A (2003) Malignant mesothelioma of the peritoneum presenting as an inflammatory lesion. Am J Surg Pathol 27:248–253CrossRefPubMedGoogle Scholar
  12. 12.
    Kahn HJ, Bailey D, Marks A (2002) Monoclonal antibody D2-40, a new marker of lymphatic endothelium, reacts with Kaposi's sarcoma and a subset of angiosarcomas. Mod Pathol 15:434–440CrossRefPubMedGoogle Scholar
  13. 13.
    Kahn HJ, Marks A (2002) A new monoclonal antibody, D2-40, for detection of lymphatic invasion in primary tumors. Lab Invest 82:1255–1257PubMedGoogle Scholar
  14. 14.
    Kaufmann O, Fietze E, Mengs J, Dietel M (2001) Value of p63 and cytokeratin 5/6 as immunohistochemical markers for the differential diagnosis of poorly differentiated and undifferentiated carcinomas. Am J Clin Pathol 116:823–830CrossRefPubMedGoogle Scholar
  15. 15.
    Kimura N, Kimura I (2005) Podoplanin as a marker for mesothelioma. Pathol Int 55:83–86CrossRefPubMedGoogle Scholar
  16. 16.
    Marks A, Sutherland DR, Bailey D, Iglesias J, Law J, Lei M, Yeger H, Banerjee D, Baumal R (1999) Characterization and distribution of an oncofetal antigen (M2A antigen) expressed on testicular germ cell tumours. Br J Cancer 80:569–578CrossRefPubMedGoogle Scholar
  17. 17.
    McGregor DK, Khurana KK, Cao C, Tsao CC, Ayala G, Krishnan B, Ro JY, Lechago J, Truong LD (2001) Diagnosing primary and metastatic renal cell carcinoma: The use of the monoclonal antibody “Renal Cell Carcinoma Marker”. Am J Surg Pathol 25:1485–1492CrossRefPubMedGoogle Scholar
  18. 18.
    Mirabella F (1996) Peritoneal mesothelioma and abdominal hernias. Minerva Med 87:21–24PubMedGoogle Scholar
  19. 19.
    Ordóñez NG (2003) The immunohistochemical diagnosis of mesothelioma: a comparative study of epithelioid mesothelioma and lung adenocarcinoma. Am J Surg Pathol 27:1031–1051CrossRefPubMedGoogle Scholar
  20. 20.
    Ordóñez NG (2004) The diagnostic utility of immunohistochemistry in distinguishing between mesothelioma and renal cell carcinoma: a comparative study. Hum Pathol 35:697–710CrossRefPubMedGoogle Scholar
  21. 21.
    Ordóñez NG (2005) D2-40 and podoplanin are highly specific and sensitive immunohistochemical markers of epithelioid malignant mesothelioma. Hum Pathol 36:372–380CrossRefPubMedGoogle Scholar
  22. 22.
    Ordóñez NG (2005) The diagnostic utility of immunohistochemistry and electron microscopy in distinguishing between peritoneal mesotheliomas and serous carcinomas: a comparative study. Mod Pathol (in press)Google Scholar
  23. 23.
    Ordóñez NG, Mackay B (1999) Glycogen-rich mesothelioma. Ultrastruct Pathol 23:401–406CrossRefPubMedGoogle Scholar
  24. 24.
    Ordóñez NG, Myhre M, Mackay B (1996) Clear cell mesothelioma. Ultrastruct Pathol 20:331–336PubMedCrossRefGoogle Scholar
  25. 25.
    Pan C-C, Chen PC-H, Chou T-Y, Chiang H (2003) Expression of calretinin and other mesothelioma-related markers in thymic carcinoma and thymoma. Hum Pathol 34:1155–1162CrossRefPubMedGoogle Scholar
  26. 26.
    Reis-Filho JS, Simpson PT, Martins A, Preto A, Gärtner F, Schmitt FC (2003) Distribution of p63, cytokeratins 5/6 and cytokeratin 14 in 51 normal and 400 neoplastic human tissue samples using TARP-4 multi-tumor tissue microarray. Virchows Arch 443:122–132CrossRefPubMedGoogle Scholar
  27. 27.
    Tang CK, Gray GF, Keuhnelian JG (1976) Malignant peritoneal mesothelioma in an inguinal hernia sac. Cancer 37:1887–1890PubMedCrossRefGoogle Scholar
  28. 28.
    Wu M, Wang B, Gil J, Sabo E, Miller L, Gan L, Burstein DE (2003) p63 and TTF-1 immunostaining. A useful marker panel for distinguishing small cell carcinoma of lung from poorly differentiated squamous cell carcinoma of lung. Am J Clin Pathol 119:696–702CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.M.D. Anderson Cancer CenterHoustonUSA

Personalised recommendations