Combined adenomatoid tumor and well differentiated papillary mesothelioma of the omentum

Herein is reported a highly rare case of combined adenomatoid tumor and well differentiated papillary mesothelioma of the omentum. A 45-year-old Japanese man was incidentally found to have a mesenteric mass during abdominal ultrasonography. Grossly, a well-circumscribed and non-encapsulated tumor, measuring 24 × 23 × 22 mm, was located in the omentum with no obvious invasion to the surrounding stomach and pancreas. Microscopically, the tumor consisted of two histological distinct components; the majority of it showed irregular arrangement of numerous cysts lined by a single layer of flattened or epithelioid cells and the multifocal minor component exhibited prominent papillary protrusions lined by a single layer of cuboidal cells with relatively uniform nucleus. Immunohistochemically, the tumor cells were diffusely positive for cytokeratin (AE1/AE3), vimentin, calretinin, D2-40 and WT-1, and negative for epithelial membrane antigen (EMA), desmin, S-100 protein and CD68. Ki-67 labeling index of the tumor cells was <5%. The postoperative course was uneventful, though he has not received any adjuvant therapy. Despite the rarity, recognition of such combined cases of mesothelial lesions is important to prevent overdiagnosis.