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Chatterjee A, Bhatt A. Rare Variants of Malignant Peritoneal Mesothelioma: a Literature Review. Indian J Surg Oncol 2023; 14:30-38. [PMID: 37359922 PMCID: PMC10284736 DOI: 10.1007/s13193-023-01754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/22/2023] [Indexed: 06/28/2023] Open
Abstract
Primary peritoneal mesothelioma (PM) is a rare and aggressive malignancy that arises from the peritoneum and classified into diffuse malignant peritoneum mesothelioma (DMPM) and borderline variants, viz. multicystic peritoneal mesothelioma (MCPM) and well-differentiated papillary peritoneal mesothelioma (WDPPM). The borderline variants are rarer than conventional DMPM, are less aggressive form accounting for 3-5% of all cases of peritoneal mesothelioma. In this narrative review article, we have discussed the pathogenesis, clinical presentation, natural history, and management of these rarer variants of PM, viz. MCPM and WDPPM. Histologically, MCPM typically consists of small cysts composed of mesothelial epithelium with benign bland cuboidal cells with clear fluids; cells lack cellular atypia and have increased number of mitoses. WDPPM has specific papillary component with myxoid plump cores and single layer of bland mesothelial cells. Both the variants commonly present as incidental finding or symptoms of chronic abdominal pain, chronic pelvic inflammatory disease, pelvic mass, and infertility. In the absence of treatment, these diseases are slow growing with major concerns being that both the variants have malignant transformation capabilities and a high rate of recurrence. In the light of current evidences, it is recommended that MCPM and WDPPM patients should be offered a complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy consisting of cisplatin and doxorubicin. Collaborative multi-institutional studies are needed to generate more data and formulate robust guidelines.
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Affiliation(s)
- Ambarish Chatterjee
- Unit of Colorectal and Peritoneal Surface Malignancy, Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Aditi Bhatt
- Department of Surgical Oncology, KD Hospital, Ahmedabad, India
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Pina M, Fernandes R, Fonseca D, Oliveira C, Rodrigues A. A Case Report of Mesothelioma Response to Endocrine Therapy in Synchronous Breast Cancer and Pleural Epithelioid Mesothelioma: A Double Exemestane Effect. Cureus 2022; 14:e31579. [DOI: 10.7759/cureus.31579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
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Kepenekian V, Péron J, Goéré D, Sgarbura O, Delhorme JB, Eveno C, Benzerdjeb N, Bonnefoy I, Villeneuve L, Rousset P, Abboud K, Pocard M, Glehen O. Multicystic peritoneal mesothelioma treated with cytoreductive surgery followed or not by hyperthermic intraperitoneal chemotherapy: results from a large multicentric cohort. Int J Hyperthermia 2021; 38:805-814. [PMID: 34039244 DOI: 10.1080/02656736.2021.1903585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Multicystic peritoneal mesothelioma (MCPM) is a rare, slowly growing, condition prone to recur after surgery. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) added to complete cytoreductive surgery (CRS) remains controversial and difficult to assess. As patients are mostly reproductive age women, surgical approach, and fertility considerations are important aspects of the management. This observational retrospective review aimed to accurate treatment strategy reflections. METHODS The RENAPE database (French expert centers network) was analyzed over a 1999-2019 period. MCPM patients treated with CRS were included. A special focus on HIPEC, mini-invasive approach, and fertility considerations was performed. RESULTS Overall 60 patients (50 women) were included with a median PCI of 10 (4-14) allowing 97% of complete surgery, followed by HIPEC in 82% of patients. A quarter of patients had a laparoscopic approach. Twelve patients (20%) recurred with a 3-year recurrence free survival of 84.2% (95% confidence interval 74.7-95.0). The hazard of recurrence was numerically reduced among patients receiving HIPEC, however, not statistically significant (hazard ratio 0.41, 0.12-1.42, p = 0.200). A severe post-operative adverse event occurred in 22% of patients with five patients submitted to a subsequent reoperation. Among four patients with a childbearing desire, three were successful (two had a laparoscopic-CRS-HIPEC and one a conventional CRS without HIPEC). CONCLUSION MCPM patients treatment should aim at a complete CRS. The intraoperative treatment options as laparoscopic approach, fertility function sparing and HIPEC should be discussed in expert centers to propose the most appropriate strategy.
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Affiliation(s)
- Vahan Kepenekian
- Service de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Julien Péron
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Université Lyon 1, Villeurbanne, France.,Department of Oncology, Hospices Civils de Lyon, Lyon, France
| | - Diane Goéré
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olivia Sgarbura
- Department of Surgical Oncology, Cancer Institute of Montpellier, University of Montpellier, Montpellier, France
| | - Jean-Baptiste Delhorme
- Service de chirurgie générale et digestive, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,IRFAC, INSERM U1113, Strasbourg, France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, UMR-S1277 - CANTHER Laboratory "Cancer Heterogeneity, Plasticity and Resistance to Therapies", Lille, France
| | - Nazim Benzerdjeb
- Laboratoire d'Anatomie et Cytologie Pathologiques, Institut de Pathologie Multisite, Centre de Biologie Sud, Centre Hospitalier Sud, Hospices Civils de Lyon, Lyon, France
| | - Isabelle Bonnefoy
- Service de Recherche et Epidémiologie Cliniques, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Laurent Villeneuve
- Service de Recherche et Epidémiologie Cliniques, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Pascal Rousset
- EMR 3738, Lyon 1 University, Lyon, France.,Service d'Imagerie Médicale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Karine Abboud
- Service de Chirurgie générale et thoracique. Centre hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Marc Pocard
- Université de Paris, INSERM UMR 1275 CAP Paris-Tech, Paris, France.,Service de chirurgie digestive et cancérologique, Hôpital Lariboisière, Paris, France
| | - Olivier Glehen
- Service de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.,EMR 3738, Lyon 1 University, Lyon, France
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Zahid A, Clarke L, Carr N, Chandrakumaran K, Tzivanakis A, Dayal S, Mohamed F, Cecil T, Moran BJ. Outcomes of multicystic peritoneal mesothelioma treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. BJS Open 2020; 5:6043736. [PMID: 33688945 PMCID: PMC7944491 DOI: 10.1093/bjsopen/zraa001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Multicystic peritoneal mesothelioma (MCPM) is a rare neoplasm, generally considered a borderline malignancy, best treated by cytoreductive surgery (CRS) to remove macroscopic disease, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Owing to its rarity, little has been published on clinical presentation, clinical behaviour over time, or an optimal treatment approach. METHODS A prospectively developed peritoneal malignancy database was interrogated for the years 2001-2018. Details on all patients with MCPM as a definitive diagnosis after CRS and HIPEC were analysed, including previous interventions, mode of presentation, surgical treatment, postoperative outcomes, and late follow-up information from abdominal CT and tumour markers. RESULTS Some 40 patients with MCPM underwent CRS and HIPEC between 2001 and 2018. Of these, 32 presented with abdominal pain, distension or bloating, six patients presented with recurrence following previous surgery at the referring hospitals, and two had coincidental diagnoses during a surgical procedure. CRS involved peritonectomy in all 40 patients. Bowel resection was required in 18 patients, and seven had a temporary stoma. Thirty-eight patients were considered to have undergone a complete macroscopic tumour removal (completeness of cytoreduction CC0), and two had residual tumour nodules less than 2.5 mm in size, classified as CC1. Median duration of follow-up was 65 (range 48-79) months. There were no deaths during follow-up. The Kaplan-Meier-predicted recurrence-free interval was 115.4 months. CONCLUSION MCPM is a rare peritoneal neoplasm with a heterogeneous pattern of presentation. CRS and HIPEC is an effective management option for this group of patients, with favourable long-term survival.
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Affiliation(s)
| | | | | | | | | | | | | | | | - B J Moran
- Correspondence to: Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke RG24 9NA, UK (e-mail: )
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Abstract
BACKGROUND Mesothelioma is a rare and deadly form of cancer, linked to asbestos exposure. Although the United Kingdom has banned asbestos, the incidence rate remains high. Previous research has indicated that female individuals have better survival than male individuals, but this has never been examined in the United Kingdom. MATERIALS AND METHODS Pleural mesothelioma cases from 2005 to 2014 were extracted from the United Kingdom Lung Cancer Dataset. Multivariable logistic regression was used to assess the clinical and demographic factors associated with gender. A multivariable Cox proportional hazards model and propensity matching methods were used to assess gender differences in overall survival while accounting for potential confounders. RESULTS There were 8479 (87.8%) male and 1765 (17.2%) female individuals included in the analysis. Female individuals were significantly younger, with more epithelial histology than male individuals. Female individuals had significantly better overall survival (adjusted hazard ratio, 0.85, 95% confidence interval, 0.81-0.90). Results remained similar when stratifying by age and performance status, and when limiting to patients with epithelial histology. CONCLUSIONS The study increases knowledge about gender differences in mesothelioma survival and is the first to directly examine this in the United Kingdom. It further disentangles the effects of age, histology, and health status. Increased estrogen may improve survival and could provide a potential target for future therapies.
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Kusamura S, Kepenekian V, Villeneuve L, Lurvink RJ, Govaerts K, De Hingh IHJT, Moran BJ, Van der Speeten K, Deraco M, Glehen O. Peritoneal mesothelioma: PSOGI/EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. Eur J Surg Oncol 2020; 47:36-59. [PMID: 32209311 DOI: 10.1016/j.ejso.2020.02.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- S Kusamura
- Department of Surgery, Peritoneal Surface Malignancy Unit, Fondazione IRCCS Instituto Nazionale Dei Tumori di Milano, Via Giacomo Venezian 1, Milano, Milan, Cap 20133, Italy
| | - V Kepenekian
- Service de Chirurgie Digestive et Endocrinienne, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - L Villeneuve
- Service de Recherche et Epidémiologie Cliniques, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - R J Lurvink
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - K Govaerts
- Department of Surgical Oncology, Hospital Oost-Limburg, Genk, Belgium
| | - I H J T De Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - B J Moran
- Peritoneal Malignancy Institute, North-Hampshire Hospital, Basingstoke, United Kingdom
| | - K Van der Speeten
- Department of Surgical Oncology, Hospital Oost-Limburg, Genk, Belgium
| | - M Deraco
- Department of Surgery, Peritoneal Surface Malignancy Unit, Fondazione IRCCS Instituto Nazionale Dei Tumori di Milano, Via Giacomo Venezian 1, Milano, Milan, Cap 20133, Italy.
| | - O Glehen
- Department of Digestive Surgery, Centre Hospitalier Lyon Sud, Lyon, France
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Kyang LS, Alzahrani NA, Valle SJ, Rahman MK, Arrowaili A, Liauw W, Morris DL. Long-term survival outcomes of cytoreductive surgery and perioperative intraperitoneal chemotherapy: Single-institutional experience with 1225 cases. J Surg Oncol 2019; 120:794-802. [PMID: 31309588 DOI: 10.1002/jso.25642] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 07/05/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES To review long-term survival outcomes of patients with Peritoneal metastasis (PM) who underwent colorectal cancer (CRS) and intraperitoneal chemotherapy (PIC). METHODS Patients that underwent CRS, with or without PIC, from January 1996 to March 2018 at the Peritonectomy Unit of St. George Hospital, Sydney were retrospectively analyzed from a prospectively maintained database. RESULTS The study comprised of 1225 cases, including 687 females (56.1%) and 538 males (43.9%). Diagnoses included CRC (n = 363), followed by HAMN (n = 317), LAMN (n = 297), mesothelioma (n = 101), ovarian cancer (n = 55), and others including gastric, sarcoma, and neuroendocrine tumor (n = 92). The median OS, 5- and 10-year survivals for CRC were 35 months, 33% and 8%, respectively. Patients with LAMN, in relative to HAMN, experienced a higher median OS, 5- and 10-year survivals (248 months vs 63 months; 82% vs 52% and 59% vs 28%). The median OS for mesothelioma was 60 months with 5- and 10-year survivals of 48% and 19%, respectively. In ovarian cancer, the median OS was 30 months with 5- and 10-year survivals of 26% and 10%, respectively. For the remaining histological diagnoses, median OS and 5-year survival were 28 months and 27%, respectively. CONCLUSION Our large-cohort data showed that CRS/PIC can provide long-term survival benefit to patients with PM of gastrointestinal and ovarian origin.
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Affiliation(s)
- Lee Shyang Kyang
- Department of Surgery, St George Hospital & University of New South Wales, Sydney, New South Wales, Australia
| | - Nayef A Alzahrani
- Department of Surgery, St George Hospital & University of New South Wales, Sydney, New South Wales, Australia.,College of Medicine, Imam Muhammad ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Sarah J Valle
- Department of Surgery, St George Hospital & University of New South Wales, Sydney, New South Wales, Australia
| | - Mohamed K Rahman
- Department of Surgery, St George Hospital & University of New South Wales, Sydney, New South Wales, Australia
| | - Arif Arrowaili
- College of Medicine, Imam Muhammad ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Winston Liauw
- Department of Surgery, St George Hospital & University of New South Wales, Sydney, New South Wales, Australia.,Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia
| | - David L Morris
- Department of Surgery, St George Hospital & University of New South Wales, Sydney, New South Wales, Australia
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Nizri E, Baratti D, Guaglio M, Sinukumar S, Cabras A, Kusamura S, Deraco M. Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy. Eur J Surg Oncol 2018; 44:1100-1104. [PMID: 29703622 DOI: 10.1016/j.ejso.2018.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Multicystic peritoneal mesothelioma (MCPM) is an extremely rare disease with 40-50% rate of recurrence after surgical debulking. Due to the recurrent nature of the disease, the option of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) was offered for this condition. In the present study we aimed to describe the outcomes of this strategy in a single center cohort. METHODS We retrospectively reviewed a prospectively collected database of all patients with MCPM that underwent the combined procedure in our center. Clinical presentation, operative procedures and outcomes were reviewed. RESULTS Between August 1997 and October 2017, 19 patients with MCPM underwent 20 cytoreduction and HIPEC procedures in our center. The majority of the patients were females (n = 17, 89%), and mean age was 42, as reported in other series. Disease extent, as measured by mean peritoneal carcinomatosis index (PCI) was 15.5 ± 9.9 and total number of procedures performed 6.7 ± 2.6. Major complications occurred in 3 (15%) patients, with no perioperative mortality. After a median of follow-up of 69 months (range 4-220) all patients were alive and 4 patients had recurrence (21%). Patients with high PCI (defined by median PCI) had shorter recurrence free survival (RFS) than patient with low PCI (mean RFS = 106.4 ± 6.6 for high PCI vs. 125.6 ± 34.1 for low PCI, p = 0.03). CONCLUSION Cytoreduction and HIPEC offer low recurrence rate and prolonged mean RFS for patients with MCPM. The combined procedure can be offered with acceptable morbidity in specialized centers.
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Affiliation(s)
- Eran Nizri
- Peritoneal Surface Malignancies Unit, Colon and Rectal Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; Department of Surgery A, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Dario Baratti
- Peritoneal Surface Malignancies Unit, Colon and Rectal Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marcello Guaglio
- Peritoneal Surface Malignancies Unit, Colon and Rectal Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Snita Sinukumar
- Department of Oncology, Jehangir Hospital, Pune, Maharashtra, India
| | - Antonello Cabras
- Department of Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Shigeki Kusamura
- Peritoneal Surface Malignancies Unit, Colon and Rectal Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Marcello Deraco
- Peritoneal Surface Malignancies Unit, Colon and Rectal Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
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