Prolonged survival with systemic chemotherapy in an advanced malignant mesothelioma: A case report

Abstract

Peritoneal mesotheliomas are very rare tumors. Their prognosis is poor, average survival does not exceed 1 year after peritoneal cytoreduction. Systemic chemotherapy is considered to have no proven value in the management of peritoneal mesotheliomas. Objective responses with systemic chemotherapy are very rare. We report here a case of an advanced peritoneal mesothelioma which achieved an unexpected partial response with chemotherapy, allowing the patient to have a right colectomy. The patient was referred to a specialized center on HIPEC, but taking in account the long awaiting interval, the HIPEC was judged to be inefficient and then the poursuit of 6 cycles of systemic chemotherapy was decided. The patient is still alive without any symptom and with a good performance status at 59 months after diagnosis. Throughout our case, we provide an encouraging evidence of the role of initial systemic chemotherapy in the downstaging of initially unresectable primary malignant mesothelioma and in the improvement of overall survival.

Keywords: Peritoneal mesothelioma; chemotherapy; surgery; survival.

Figure 1.

(a and b) CT scan showing abundant ascites and a thickening of the digestive tract with a cake-like appearance dense fatty epiploic mass.

Figure 2.

CT scan after 3 cycles of chemotherapy (pemetrexed and cisplatine) showing a partial response.

Figure 3.

CT scan after 5 cycles of Carboplatine showing a stability of the epiploic mass (arrow).

Figure 4.

Right colectomy and epiploic mass resection.

Figure 5.

Histological aspects of a malignant mesothelioma.

Figure 6.

Immunohistochemical examination showing expression of carletinnie, mesotheline, and cytokeratin.