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Case Report
A case of myxoid variant of epithelioid mesothelioma of the peritoneum with signet ring cells: A diagnostic pitfall on fine needle aspirate cytology
1 Department of Pathology and Laboratory Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
2 Department of Radiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
3 Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
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Najla Saleh Ben Ghashir
Department of Pathology and Laboratory Medicine, Sheikh Shakhbout Medical City, P.O. Box 11001, Abu Dhabi,
UAE
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Article ID: 100093Z11NG2025
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How to cite this article
Ben Ghashir NS, Mohamed BA, Tawil M, Al Harthi S. A case of myxoid variant of epithelioid mesothelioma of the peritoneum with signet ring cells: A diagnostic pitfall on fine needle aspirate cytology. J Case Rep Images Pathol 2025;11(2):6–10.ABSTRACT
The myxoid variant of epithelioid mesothelioma is a rare subtype of malignant mesothelioma. Peritoneal involvement by malignant mesothelioma is much less common than pleural involvement. We present a rare case of epithelioid mesothelioma of the peritoneum with extensive myxoid change in a 44-year-old man. The patient presented with lower abdominal pain; imaging studies revealed a pelvic mass. An ascitic fluid aspirate performed at an outside facility has been misinterpreted as a signet ring carcinoma associated with pseudomyxoma peritonei. Histologic examination of the laparoscopically obtained biopsy performed in our facility confirmed epithelioid mesothelioma with extensive areas of myxoid stroma and focal areas of classical epithelioid mesothelioma, proven by immunohistochemical studies. Although rare, the myxoid variant of mesothelioma should always be remembered and included in the differential diagnoses of myxoid lesions of the peritoneum, including pseudomyxoma peritonei. This is particularly important when dealing with a case of diffuse peritoneal-based pathology. We hope to add our case to increase knowledge and awareness of this rare entity and avoid diagnostic misinterpretation.
Keywords: Malignant mesothelioma, Myxoid, Nongynecologic cytology, Signet ring cells
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Author Contributions
Najla Saleh Ben Ghashir - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree 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.
Babitha Alingal Mohamed - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree 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.
Mohamed Tawil - Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree 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.
Salem Al Harthi - Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree 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.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Najla Saleh Ben Ghashir et al.. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
