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Abstract
Background The clinical characteristics of malignant peritoneal mesothelioma are not fully known, and it appears as a variable entity with different types of clinical presentation and with a difficult diagnosis. Patients Fifteen patients with malignant peritoneal mesothelioma were analyzed for asbestos exposure, clinical presentation, thrombocytosis, X-rays and echotomographic findings, peritoneal fluid cytology, surgical investigations, diagnosis in vita, therapy, cause of death, diagnosis time, and survival time. Results Asbestos exposure was present in 12 men. Abdominal pain, ascites, abdominal mass, weight loss and fever were the most common presentation symptoms. In 5 patients, the disease presented as a surgical emergency. Assembling the presenting symptoms, malignant peritoneal mesothelioma was subdivided in 3 types: classical (6 cases), surgical (5 cases) and medical (4 cases). Thrombocytosis was present in 11 cases. Peritoneal fluid cytology was positive for neoplastic mesothelial cells in 8 of 10 cases. Laparotomy (5 patients) and laparoscopy (7 cases) were diagnostic in all cases. Diagnosis in vita was malignant peritoneal mesothelioma for 13 patients, peritoneal carcinomatosis for 1, with only 1 autopsy diagnosis. Seven patients were treated with chemotherapy, showing a progression of the disease. Mean symptoms-to-diagnosis time was 122 days (4-410), and mean symptoms-to-survival time was 345 days (45-1510). Conclusions Malignant peritoneal mesothelioma is a very unusual disease characterized by a difficult diagnosis, a rapid evolution, a poor response to therapy, and a very high prevalence of thrombocytosis. A new clinical classification into three types (classical, surgical and medical) may be useful for a correct diagnosis. The early diagnosis of malignant peritoneal mesothelioma remains an important open question.
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Affiliation(s)
- Vincenzo de Pangher Manzini
- Azienda per i Servizi Sanitari 2 Isontina, Ospedali di Monfalcone e Gorizia, Unità Operativa Complessa di Oncologia, Monfalcone, GO, Italy.
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2
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Malignant Peritoneal Mesothelioma Presenting as Mucinous Ascites. ACG Case Rep J 2018; 5:e23. [PMID: 29577057 PMCID: PMC5852305 DOI: 10.14309/crj.2018.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/25/2018] [Indexed: 11/17/2022] Open
Abstract
We present a rare case of a 46-year-old man presenting with mucinous ascites secondary to malignant peritoneal mesothelioma (MPM) that was diagnosed via colonoscopy with biopsies. Both our findings and the clinical presentation were unique. While it is widely known that asbestos exposure is commonly associated with pleural mesothelioma, 6-10% of malignant mesotheliomas arise from the peritoneum. To date, only 4 cases of MPM with the primary tumor site in the colon have been described in the literature.
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3
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Hong S, Bi MM, Zhao PW, Wang XU, Kong QY, Wang YT, Wang L. Malignant peritoneal mesothelioma in a patient with intestinal fistula, incisional hernia and abdominal infection: A case report. Oncol Lett 2016; 11:2047-2050. [PMID: 26998119 PMCID: PMC4774586 DOI: 10.3892/ol.2016.4203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/11/2016] [Indexed: 12/20/2022] Open
Abstract
Malignant mesothelioma is a rare type of cancer, most commonly associated with exposure to asbestos. Mesothelioma of the peritoneum, the membrane lining the abdominal cavity, is extremely rare. The current study reports the case of a 60-year-old female who presented with intestinal fistula, recurrent incisional hernia and abdominal infection, with no history of asbestos exposure, and was diagnosed with clear cell MPM. Computed tomography scans of the abdomen revealed extensive small bowel adhesions and massive peritoneal effusion. Histological examination of biopsy specimens indicated a diagnosis of malignant peritoneal mesothelioma with clear cell morphology. A laparotomy was performed, with subsequent resection of the bowel with fistula. Follow-up examination performed at 1-year post-surgery revealed that the patient was alive and in generally good health.
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Affiliation(s)
- Sen Hong
- Department of Colon and Anal Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Miao-Miao Bi
- Department of Ophthalmology, The China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Ping-Wei Zhao
- Department of Colon and Anal Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - X U Wang
- Department of Colon and Anal Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Qing-Yang Kong
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin 130021 P.R. China
| | - Yong-Tao Wang
- Department of Colon and Anal Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Lei Wang
- Department of Colon and Anal Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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4
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Deraco M, Baratti D, Hutanu I, Bertuli R, Kusamura S. The role of perioperative systemic chemotherapy in diffuse malignant peritoneal mesothelioma patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol 2013; 20:1093-100. [PMID: 23456386 DOI: 10.1245/s10434-012-2845-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effects of perioperative systemic chemotherapy (CT) on short-term surgical and long-term oncologic results in diffuse malignant peritoneal mesothelioma (DMPM) patients treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). PATIENTS AND METHODS We retrospectively analyzed data obtained from an institutional prospective database at NCI of Milan. The study group comprised 116 DMPM patients treated with CRS + HIPEC from August 1995 to October 2011. A total of 60 cases underwent preoperative CT (PRECT), 30 underwent postoperative CT (POSTCT), and 26 did not undergo any CT (NOCT). Also, 55 cases used the perioperative combination of platinum and pemetrexed. We tested whether covariates related to clinical, histologic, PRECT, and surgical treatment were correlated with completeness of cytoreduction (CC), postoperative G3-5 morbidity, and progression-free survival and overall survival (OS). Univariate and multivariate analyses were performed. RESULTS Factors independently associated with CC were ECOG performance status (PF) of 0, and PCI <20. Factors independently associated with postoperative G3-5 morbidity were ECOG >1, bowel anastomosis, and number of peritonectomy procedures. Preoperative platelet count >400 × 103/mm(3), histological subtype (biphasic and sarcomatoid vs epithelial), CC, and G3-5 morbidity were independent prognostic factors. PRECT was not associated with CC or G3-5 morbidity. There was no significant difference in terms of survival between the PRECT, POSTCT, and NOCT groups. CONCLUSIONS The CC, G3-5, and OS were not influenced by aspects related to perioperative CT. The present data warrants confirmation reconducting the comparative analysis in a larger multi-institutional series preferably using matching control techniques.
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Affiliation(s)
- Marcello Deraco
- Peritoneal Surface Malignancy Program, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
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Manzini VDP, Recchia L, Cafferata M, Porta C, Siena S, Giannetta L, Morelli F, Oniga F, Bearz A, Torri V, Cinquini M. Malignant peritoneal mesothelioma: a multicenter study on 81 cases. Ann Oncol 2010; 21:348-353. [PMID: 19635740 DOI: 10.1093/annonc/mdp307] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- V de Pangher Manzini
- Division of Medical Oncology, Department of Internal Medicine and Oncology, Monfalcone Hospital, Monfalcone.
| | - L Recchia
- Division of Medical Oncology, Department of Internal Medicine and Oncology, Monfalcone Hospital, Monfalcone
| | - M Cafferata
- Division of Medical Oncology, Department of Internal Medicine and Oncology, Casale Monferrato Hospital, Casale Monferrato
| | - C Porta
- Department of Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, San Matteo University Hospital Foundation, Pavia
| | - S Siena
- The Falck Division of Medical Oncology, Niguarda Ca' Granda Hospital, Milan
| | - L Giannetta
- The Falck Division of Medical Oncology, Niguarda Ca' Granda Hospital, Milan
| | - F Morelli
- Department of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Casa Sollievo della Sofferenza, San Giovanni Rotondo
| | - F Oniga
- Division of Medical Oncology, Department of Oncology, Venice-Mestre Hospital
| | - A Bearz
- Department of Medical Oncology, Centro di Riferimento Oncologico - Istituto di Ricovero e Cura a Carattere Scientifico, Aviano
| | - V Torri
- Department of Oncology, Mario Negri Institute, Milan, Italy
| | - M Cinquini
- Department of Oncology, Mario Negri Institute, Milan, Italy
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6
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Filiberti R, Marroni P, Neri M, Ardizzoni A, Betta PG, Cafferata MA, Canessa PA, Puntoni R, Ivaldi GP, Paganuzzi M. Serum PDGF-AB in pleural mesothelioma. Tumour Biol 2005; 26:221-6. [PMID: 16103743 DOI: 10.1159/000087376] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2004] [Accepted: 04/06/2005] [Indexed: 11/19/2022] Open
Abstract
Overexpression of platelet-derived growth factor (PDGF) has been observed in lung and pleural tumors. The aim of this study was to evaluate the diagnostic and prognostic role of serum PDGF in pleural mesothelioma (PM). Four groups of subjects were studied: 93 malignant PM patients, 33 primary non small cell lung cancer patients, 51 subjects exposed to asbestos, defined as high-risk controls, and 24 healthy controls. PDGF-AB mean concentration was higher in PM patients (45.8 ng/ml) than in high-risk controls (33.1 ng/ml) and healthy controls (26.8 ng/ml). Using the cut-off level of 49.8 ng/ml, corresponding to the mean+2SD of PDGF-AB in healthy controls, 43% of PM patients showed positive PDGF-AB levels. Survival was evaluated in 82 PM patients. At the end of the follow-up (median 9.8 months) 80.5% of patients had died. Median survival was 13.1 and 7.9 months for patients with PDGF-AB lower and higher than the cut-off, respectively. Adjusting for age, sex, histology and platelet count, positive PDGF-AB levels were associated with lower survival (OR=1.2, 95%CI: 0.9-1.6), even if not significantly so. In conclusion, serum PDGF may represent a useful additional parameter to prognostic factors already available for PM.
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Affiliation(s)
- Rosa Filiberti
- Division of Environmental Epidemiology, National Cancer Research Institute, Genova, Italy.
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7
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Abstract
Malignant pleural mesothelioma (MPM) is a uniformly fatal disease that has been recalcitrant to curative therapies. Median survivals of 8-18 months have, for the most part, led to a sense of frustration and nihilism in the medical and surgical community with regard to management of the disease, and the relatively small numbers of patients with mesothelioma have made it an orphan among other cancers with regard to research efforts and funding. This review will comment on the clinical presentation of the disease and therapeutic options that are available at this time. The role, timing, degree, and availability of cytoreductive surgery in the context of a multimodality approach for MPM will be highlighted, and various strategies that incorporate adjunctive therapies before, during, or after the operation will be discussed. Newer cytotoxic chemotherapies, either alone or in combination, are reviewed, with an emphasis on the increasing number of options with increased response rates that are becoming available for MPM patients. The results of protocols at selected centers that offer gene therapy, photodynamic therapy, hyperthermic chemotherapeutic perfusion, and intrapleural chemokines will be discussed, as well as newer preclinical approaches that base targeted therapies on novel molecular findings. In considering the newest approaches to the disease, one is encouraged to seek specialty consultation at centers that concentrate programmatic efforts on mesothelioma in order to design translational-based approaches on preclinical findings. By using such an approach, the patient and physician will find that there are considerably more options in the new century for mesothelioma.
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Affiliation(s)
- H I Pass
- Karmanos Cancer Institute, Wayne State University, Detroit 48201, USA.
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8
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Abstract
Malignant mesothelioma of the pleura occurs primarily in individuals who were exposed to asbestos either in the workplace or home. The incidence of malignant mesothelioma is rising and, reflective of the malignancy's long latency period, is expected to continue to increase into the next century. Current treatment measures, including surgery, radiation therapy, chemotherapy, intrapleural therapy, and combined-modality therapies, have had varying impacts on survival. This paper explores current trends in the treatment of malignant pleural mesothelioma.
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Affiliation(s)
- J Aisner
- Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert-Wood Johnson Medical School, Cancer Institute of New Jersey, New Brunswick, USA
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9
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Affiliation(s)
- H I Pass
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Higashihara M, Sunaga S, Tange T, Oohashi H, Kurokawa K. Increased secretion of interleukin-6 in malignant mesothelioma cells from a patient with marked thrombocytosis. Cancer 1992; 70:2105-8. [PMID: 1394040 DOI: 10.1002/1097-0142(19921015)70:8<2105::aid-cncr2820700816>3.0.co;2-r] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND A high prevalence of thrombocytosis in malignant mesothelioma has been reported, although its pathogenesis remains unknown. METHODS The case of a patient with marked thrombocytosis in peritoneal malignant mesothelioma is reported. To investigate the cytokines responsible for thrombocytosis in this patient, enzyme-linked immunosorbent assay and immunohistochemical analysis were used. RESULTS Tumor cells produced large amounts of interleukin-6 (IL-6) and small amounts of granulocyte macrophage colony stimulating factor (GM-CSF) and monocyte colony stimulating factor (M-CSF). Immunocytochemical staining of tumor cells showed strong positivity for IL-6. CONCLUSIONS These results indicated that persistent secretion of IL-6 promoted thrombogenesis in this patient.
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Affiliation(s)
- M Higashihara
- First Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan
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