CT findings and serum ca 125 levels in malignant peritoneal mesothelioma: report of 11 new cases and review of the literature

Our plain-English summary of CT findings and serum ca 125 levels in malignant peritoneal mesothelioma: report of 11 new cases and review of the literature, by M. Kebapci, E. Vardareli, B. Adapinar, et al (European Radiology, 2003).

The study

• Authors: M. Kebapci, E. Vardareli, B. Adapinar, M. Acikalin
• Journal: European Radiology
• Published: 2003;13(12):2620-6
• Cited by: 54 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The aim of this study was to review and reappraise the clinical and CT features of malignant peritoneal mesothelioma (MPM), and to discuss differential diagnosis. The history, clinical, and laboratory data, and imaging studies of 11 patients with a histologically proven diagnosis of MPM, were retrospectively reviewed. Our patients consisted of 7 women and 4 men, with a median age of 48 years (age range 40-55 years). There was a definite history of significant asbestos exposure in 6 patients. Abdominal swelling (9 of 11) was the most common presenting symptom. The mean serum CA-125 (normal value 1.2-32 U/ml) level was 230 U/ml (range 19-1000 U/ml). The most common radiological findings were extensive or moderate amounts ascites (11 of 11), irregular or nodular peritoneal thickening (11 of 11), omental involvement (10 of 11), mesentery involvement (9 of 11), pleural thickening, plaques or calcification (7 of 11), pleural effusion (6 of 11), and bowel wall thickening (5 of 11). Two patients had large upper abdominal masses. Computed tomography findings of MPM are nonspecific and inadequate to pinpoint specific diagnosis. The diagnosis requires histological demonstration which is commonly made by an image or laparoscopic-guided biopsy. Pleural changes suggesting asbestosis combined with CT findings and high CA-125 levels can suggest, but are not diagnostic of, mesothelioma. Suggesting the diagnosis of MPM is important because histological and immunohistochemical tests are needed for diagnostic accuracy.

In plain English

This article from a university hospital in Eskisehir, Turkey, described 11 patients with malignant peritoneal mesothelioma (cancer of the abdominal lining) confirmed by tissue examination, and compared them with earlier published reports. The authors reviewed the records and CT scans of 7 women and 4 men, median age 48. Six had a definite history of environmental asbestos exposure. Five had no proven exposure but had lived in villages where exposure might have been expected. On CT, all 11 had abdominal fluid (ascites) and thickening of the abdominal lining. Ten had involvement of the omentum, 9 had involvement of the mesentery, and 2 had large upper-abdominal masses. Pleural thickening, plaques or calcification appeared in 7 of 11. The blood marker CA-125 was measured in 8 patients and was above normal in 7. Seven patients died, and their median survival was 9.5 months. The authors concluded that CT findings were nonspecific. In their view, pleural changes, CT findings and high CA-125 can suggest, but not diagnose, mesothelioma, so tissue tests are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case series (review of records and CT scans of 11 patients), with discussion of earlier published reports
• Who was studied: 11 patients with histologically proven malignant peritoneal mesothelioma (7 women, 4 men; median age 48, range 40 to 55), diagnosed at Osmangazi University School of Medicine, Eskisehir, Turkey; study dates not given
• Exposure: Environmental asbestos exposure: a definite history of significant exposure in 6 patients. The other 5 had no proven exposure but had lived in villages where exposure might have been expected. Fiber type not stated.
• Main results:
  • Ascites was seen on CT in all 11 patients: extensive in 8, moderate in 2, slight in 1
  • Parietal peritoneum: slight smooth thickening (2 to 3 mm) with enhancement in 4 patients, irregular thickening (2 to 25 mm) in 7 patients
  • Omental involvement in 10 of 11 patients
  • Mesenteric involvement in 9 of 11 patients
  • Two patients (patients 3 and 8) had large upper abdominal masses
  • Bowel involvement in 5 patients
  • Pleural thickening, plaques or calcification in 7 of 11 patients; pleural effusions in 6 of 11
  • Enlarged lymph nodes in 3 patients, including the cardiophrenic region in 2 of 11
  • Pretreatment CA-125 was known for 7 women and 1 man; 7 had values above 32.0 U/ml (normal 1.2 to 32 U/ml) and 1 was normal; the abstract gives a mean of 230 U/ml (range 19 to 1000 U/ml)
  • In three women (patients 4, 5 and 11), elevated CA-125 levels returned to normal after chemotherapy; no correlation was found between CA-125 levels and survival time
  • Of 11 patients, 7 died; their median survival was 9.5 months (range 2 to 21 months)
  • All tumors were of the epithelial type (4 solid, 7 tubopapillary)
• The authors' conclusion: The authors concluded that CT findings of malignant peritoneal mesothelioma are nonspecific. Pleural changes suggesting asbestosis, combined with CT findings and high CA-125 levels, can suggest but are not diagnostic of mesothelioma, and histological and immunohistochemical tests are needed. They also wrote that their findings may support using CA-125 as a tumor and follow-up marker.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Differential Diagnosis, Asbestos Exposure, CA-125, Ascites, Omental Involvement, Mesentery, Pleural Thickening.

Related studies

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• Giant benign cystic peritoneal mesothelioma: US, CT, and MRI findings — A. Ozgen, D. Akata, et al. (1998)
• Symptoms, signs and radiologic findings in patients having reoperative surgery for malignant peritoneal mesothelioma — M.D. Llanos, P.H. Sugarbaker (2017)
• Malignant peritoneal mesothelioma in two pediatric patients: MR imaging findings — M. Haliloglu, F.A. Hoffer, et al. (2000)
• Peritoneal mesothelioma: CT and MRI findings — M. Puvaneswary, S. Chen, et al. (2002)
• Deciduoid peritoneal mesothelioma: CT findings with pathologic correlation — D.J. Chung, Y.W. Kang, et al. (2003)

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