Malignant peritoneal mesothelioma

Our plain-English summary of Malignant peritoneal mesothelioma, by K.E. Bani-Hani, K.A. Gharaibeh (Journal of Surgical Oncology, 2005).

The study

• Authors: K.E. Bani-Hani, K.A. Gharaibeh
• Journal: Journal of Surgical Oncology
• Published: 2005;91(1):17-25
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background And Objectives: The incidence of malignant peritoneal mesothelioma (MPM) is rising. Our aim was to present our experience with this entity in order to increase the awareness about this disease to avoid misdiagnosis.

Methods: Records of seven patients with histologically confirmed MPM were retrospectively reviewed. Demographic and clinicopathological findings were studied in detail.

Results: There were two females and 5 males; mean age was 50.3 years (range 16-73). Asbestos exposure was recorded in two patients, familial Mediterranean fever in one and previous radiation in one. Main presentations were abdominal pain and distension. None of the patients was diagnosed preoperatively. The average delay in diagnosis was 10 months. Calretinin expression was identified in all tumors. Three patients were treated with cytoreductive surgery combined with systemic chemotherapy. Two patients who remain alive were young female patients who were diagnosed by laparoscopic incidental findings and were treated with cytoreductive surgery combined with hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). Median survival was 19.7 months. The average survival time of the five patients who died of their diseases was 10.2 months.

Conclusions: An awareness of MPM is important to prevent misdiagnosis. Immunohistochemistry has an important role in confirming the diagnosis. MPM remains a difficult therapeutic challenge. Thorough cytoreductive surgery is the cornerstone of current treatment while HIIC is a promising strategy in suitable patients.

In plain English

In this case series, the authors reviewed the records of seven patients with malignant peritoneal mesothelioma (cancer of the abdominal lining). The patients were treated at King Abdullah University Hospital and its affiliated facilities in Irbid province, Jordan, between 1990 and 2003. Five were men and two were women, with a mean age of 50.3 years (range 16 to 73). Asbestos exposure was recorded in two patients, both men. No fiber type or exposure details were given. One patient had earlier radiation treatment and one had familial Mediterranean fever. For three patients, no risk factor could be found. No patient was diagnosed before surgery, and the average delay from symptoms to diagnosis was 10 months. The two asbestos-exposed men died of tumor spread after 4 and 11 months. The two survivors were young women who had surgery plus heated chemotherapy given into the abdomen during the operation. They were free of disease 3 to 4 years later. The authors cautioned against concluding that the heated chemotherapy caused their better outcome. They concluded that awareness of the disease is important to prevent misdiagnosis.

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 medical records of seven patients)
• Who was studied: Seven patients with histologically confirmed malignant peritoneal mesothelioma, managed at King Abdullah University Hospital and affiliated facilities, Irbid province, northern Jordan, 1990 to 2003
• Exposure: Asbestos exposure was recorded in two of the seven patients. The fiber type and the nature of the exposure were not described. Other recorded risk factors were previous radiation in one patient and familial Mediterranean fever in one. Risk factors for the remaining three could not be determined.
• Main results:
  • The seven patients were two females and five males, with a mean age of 50.3 years (range 16 to 73 years).
  • None of the seven patients was diagnosed before surgery, although all had abdominal CT.
  • Across the seven patients, the average delay between symptoms and diagnosis was 10 months (range 4 to 18 months).
  • Calretinin expression was found in all 7 tumors. Thrombomodulin, cytokeratin 5/6 and CD44H were found in 5, 4 and 3 tumors, respectively.
  • One asbestos-exposed patient (patient 5, a 73-year-old man) presented with deep vein thrombosis, abdominal mass and ascites. He received chemotherapy, his tumor could not be resected, and he died of tumor dissemination at 4 months.
  • The other asbestos-exposed patient (patient 6, a 57-year-old man) had resection and chemotherapy and died of tumor dissemination at 11 months.
  • The authors reported a median survival of 19.7 months for the seven patients. They reported an average survival of 10.2 months for the five patients who died.
  • The two surviving patients, both young women, were treated with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy (HIIC). They were free of disease 3 to 4 years after treatment.
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma remains a difficult therapeutic challenge. In their view, thorough cytoreductive surgery is the cornerstone of current treatment, and HIIC is a promising strategy in suitable patients. They also concluded that awareness of the disease is important to prevent misdiagnosis.
• Limitations the authors state:
  • The authors cautioned that HIIC cannot be assumed to explain why the two female patients did better. Those patients were also young, had disease found incidentally, and had disease that was grossly completely resectable.

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, Misdiagnosis, Asbestos Exposure, Calretinin, Cytoreductive Surgery, Chemotherapy, Median Survival, Immunohistochemistry.

Related studies

• Iterative procedures combining cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for isolated peritoneal recurrence — M. Vaira, M. Robella, et al. (2014)
• Prognostic significance of Ki67 expression in malignant peritoneal mesothelioma — K. Pillai, M.H. Pourgholami, et al. (2015)
• Therapeutic strategies for well-differentiated papillary mesothelioma of the peritoneum — Y.K. Lee, H.J. Jun, et al. (2013)
• Impact of tumor angiogenesis in peritoneal mesothelioma after radical cytoreduction and hyperthermic intraperitoneal chemotherapy — T.C. Chua, P. Yao, et al. (2010)
• Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum — R.L. Attanoos, R. Webb, et al. (2002)
• Multi-institutional experience of diffuse intra-abdominal multicystic peritoneal mesothelioma — T.C. Chua, T.D. Yan, et al. (2011)

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