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. 2009 Nov 30;1(1):38-48.
doi: 10.4240/wjgs.v1.i1.38.

Malignant peritoneal mesothelioma

Stine Munkholm-Larsen  1 , Christopher Q Cao, Tristan D Yan
Affiliations

Malignant peritoneal mesothelioma

Stine Munkholm-Larsen et al. World J Gastrointest Surg. .

Abstract

Malignant mesothelioma is a highly aggressive neoplasm. The incidence of malignant mesothelioma is increasing worldwide. Diffuse malignant peritoneal mesothelioma (DMPM) represents one-fourth of all mesotheliomas. Association of asbestos exposure with DMPM has been observed, especially in males. The great majority of patients present with abdominal pain and distension, caused by accumulation of tumors and ascitic fluid. In the past, DMPM was considered a pre-terminal condition; therefore attracted little attention. Patients invariably died from their disease within a year. Recently, several prospective trials have demonstrated a median survival of 40 to 90 mo and 5-year survival of 30% to 60% after combined treatment using cytoreductive surgery and perioperative intraperitoneal chemotherapy. This remarkable improvement in survival has prompted new search into the medical science related to DMPM, a disease previously ignored as uninteresting. This review article focuses on the key advances in the epidemiology, diagnosis, staging, treatments and prognosis of DMPM that have occurred in the past decade.

Keywords: Asbestos; Cisplatin; Cytoreductive surgery; Doxorubicin; Intraperitoneal chemotherapy; Mesothelin; Pemetrexed; Peritoneal mesothelioma; Peritonectomy.

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Figures

Figure 1
Figure 1
Macroscopically, diffuse malignant peritoneal mesothelioma (DMPM) is characterized by thousands of whitish tumor nodules of variable size and consistency that may coalesce to form plaques or masses or layer out evenly to cover the entire peritoneal surface.
Figure 2
Figure 2
DMPM implantation in the lateral abdominal wall along previous laparoscopic trochar tracts.
Figure 3
Figure 3
Histopathology of DMPM. A: DMPM-epithelial type, characterized by cuboidal or flattened epithelial-like malignant mesothelial cells (HE, × 20); B: Sarcomatoid type, characterized by sarcomatous spindle-shaped mesothelial cells (HE, × 20); C: Biphasic type, characterized by presence of two phenotypes occurred in same tumor, but sometimes they are intimately admixed (HE, × 20).
Figure 4
Figure 4
Cumulative survival after cytoreductive surgery and perioperative intraperitoneal chemotherapy for DMPM. The prognostic significance of mesothelioma nuclear size was P < 0.001.
See this image and copyright information in PMC

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