Malignant peritoneal mesothelioma

Our plain-English summary of Malignant peritoneal mesothelioma, by V. de Pangher Manzini (Tumori, 2005).

The study

• Author: V. de Pangher Manzini
• Journal: Tumori
• Published: 2005;91(1):1-5
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

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.

In plain English

This case series from Monfalcone Hospital, Italy, reviewed the clinical records of 15 patients with malignant peritoneal mesothelioma seen from 1982 to 2003 (12 men and 3 women, mean age 60). All had died, and 13 were studied at autopsy. All 12 men had a history of asbestos exposure, and none of the 3 women did. In 5 patients the disease first appeared as a surgical emergency, such as a trapped hernia or a blocked bowel. The author sorted the presentations into three types: classical (6 patients), surgical (5) and medical, resembling inflammatory bowel disease (4). A high platelet count was found at some point in 11 of 14 patients. Laparotomy (5 patients) and laparoscopy (7) gave a diagnosis in every case. All patients given chemotherapy (7) or immunotherapy (1) got worse during treatment. On average, diagnosis came 122 days after first symptoms, and death came 345 days after first symptoms. The author concluded that the disease is hard to diagnose, progresses quickly and responds poorly to treatment, and that the three-type classification can help with diagnosis.

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 based on review of hospital clinical records
• Who was studied: 15 patients with malignant peritoneal mesothelioma (12 men, 3 women; mean age 60 years, range 49-84; all deceased; 13 studied at autopsy) seen at Monfalcone Hospital, Italy, from 1982 to 2003
• Exposure: Asbestos exposure taken from patient history. The author describes it as easy to identify in shipyard workers and harder to identify in other cases, such as military service or other jobs. No fiber types or doses are given.
• Main results:
  • A history of asbestos exposure was present in all 12 men and absent in all 3 women.
  • In 5 patients (33%) the disease presented as a surgical emergency: incarcerated inguinal hernia in 2, incarcerated laparocele in 1, mechanical ileus in 1, and mechanical ileus followed by intestinal perforation in 1.
  • Presentations were grouped into three types: classical (6 cases), surgical (5 cases) and medical (4 cases). The medical type resembled inflammatory bowel disease.
  • Abdominal pain was the most frequent presenting symptom, in 13 of the 15 patients (87%).
  • Thrombocytosis (platelet count above 450,000 per cubic millimetre) was present in 9 of 15 patients (60%) at presentation, and in 11 of 14 patients (79%) at some point during the disease.
  • Peritoneal fluid cytology showed neoplastic mesothelial cells in 8 of 10 cases.
  • Laparotomy (5 patients) and laparoscopy (7 patients) were diagnostic in all cases. Diagnosis during life was malignant peritoneal mesothelioma in 13 patients and peritoneal carcinomatosis in 1. In 1 patient the diagnosis was made only at autopsy.
  • All 7 patients treated with chemotherapy and the 1 patient treated with immunotherapy showed disease progression during treatment.
  • Mean time from first symptoms to diagnosis was 122 days (range 4-410). Mean time from first symptoms to death was 345 days (range 45-1510). Mean time from diagnosis to death was 189 days (range 7-1331).
  • Causes of death, in various combinations, were cachexia in 10 patients, intestinal obstruction in 8, pulmonary thromboembolism in 5 and gastrointestinal bleeding in 1.
  • In the Monfalcone area from 1979 to 2003, 230 cases of malignant pleural mesothelioma were diagnosed, compared with 15 cases of peritoneal mesothelioma.
• The authors' conclusion: The author concluded that malignant peritoneal mesothelioma is very unusual, even in areas with high mesothelioma incidence. In the author's view it is characterized by difficult diagnosis, rapid evolution and poor response to treatment. The author found laparoscopy very useful for diagnosis, noted the high prevalence of thrombocytosis, and stated that the three-type clinical classification (classical, surgical, medical) can be useful for a correct diagnosis.
• Limitations the authors state:
  • The author states that larger studies are needed to establish prognostic significance.

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, Asbestos Exposure, Fluid Cytology, Ascites, Mesothelial Cells, Laparotomy, Autopsy, Chemotherapy.

Related studies

• Antemortem diagnosis in two cases of malignant peritoneal mesothelioma — B. Eslami, C.L. Lutcher (1974)
• Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for treatment of peritoneal surface malignancies — G. Passot, N. Bakrin, et al. (2014)
• Rectus abdominis muscle resection for abdominal wall recurrence of mucinous adenocarcinoma or peritoneal mesothelioma — T. Yan, P. Sugarbaker (2008)
• Preoperative Thrombocytosis Predicts Shortened Survival in Patients with Malignant Peritoneal Mesothelioma Undergoing Operative Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy — Y.C. Li, T. Khashab, et al. (2017)
• Malignant peritoneal mesothelioma: a series of 19 cases — T. van Gelder, H.C. Hoogsteden, et al. (1989)
• Peritoneal mesothelioma and asbestos exposure: a population-based case-control study in Lombardy, Italy — D. Consonni, C. Calvi, et al. (2019)

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