Malignant peritoneal mesothelioma: a series of 19 cases

Our plain-English summary of Malignant peritoneal mesothelioma: a series of 19 cases, by T. van Gelder, H.C. Hoogsteden, M.A. Versnel, et al (Digestion, 1989).

The study

• Authors: T. van Gelder, H.C. Hoogsteden, M.A. Versnel, P.H. de Beer, J.P. Vandenbroucke, H.T. Planteydt
• Journal: Digestion
• Published: 1989;43(4):222-7
• Cited by: 46 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000173).

Abstract

The clinical data, diagnostic procedures and survival are reported in 19 cases diagnosed as malignant peritoneal mesothelioma. All patients were men and 74% had an occupational exposure to asbestos, whereas in 26% no information about asbestos exposure was available. The median interval between asbestos exposure and the diagnosis appeared to be 44.7 years (range 18-49 years). The most common presenting symptoms were abdominal pain, weight loss and dysphagia. Most patients presented with a large amount of ascites. In the majority of patients no therapy except pain relief was given and the median survival from the time of diagnosis was 6 months (range: 0-29 months). Some patients received surgery or chemotherapy, which however did not prolong survival. Only in 2 patients survival exceeded 1 year, although these patients did not receive therapy. The autopsy findings of some patients showed that there were positive abdominal lymph nodes in 2 of them, while in no case positive thoracic lymph nodes were found. The relative short survival period from the time of the first diagnosis in contrast to malignant pleural mesotheliomas is probably the reason for the absence of distant metastases. In this series only in a minority of patients cytology of the ascites was positive and often a laparotomy had to be done. Since cytologic specimens are often negative, we suggest that in patients suspected of a malignant peritoneal mesothelioma, laparoscopy with directed biopsies is the diagnostic procedure of first choice.

In plain English

This was a case series from the southwestern Netherlands. The authors reviewed the records of 144 patients with malignant mesothelioma and found 19 (14%) with primary malignant peritoneal mesothelioma, diagnosed between 1962 and 1985 at hospitals in Rotterdam and Vlissingen. All 19 were men, aged 36 to 79. Occupational asbestos exposure was confirmed in all 14 patients whose profession was known. For the other 5 no information was available. The fiber type could not be determined. In the 7 patients where it was known, the median time from the start of exposure to diagnosis was 44.7 years (range 18 to 49 years). Most patients had ascites (17 of 19), and weight loss (13 of 19) and abdominal pain (11 of 19) were common. Testing the abdominal fluid found cancer cells in only 5 of 19 patients. Laparotomy was done in 16 and gave a diagnosis in all 16. Ten patients received only pain relief. Median survival from diagnosis was 6 months (range 0 to 29 months), and 2 patients lived longer than 1 year. The authors concluded that laparoscopy with directed biopsies should be the first-choice diagnostic procedure.

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 hospital records)
• Who was studied: 19 men with primary malignant peritoneal mesothelioma, found among 144 mesothelioma patients living in the southwestern Netherlands. Three were seen at University Hospital Dijkzigt, Rotterdam, and 16 at the Regional Hospital, Vlissingen. All were diagnosed between 1962 and 1985.
• Exposure: Occupational asbestos exposure, confirmed in all 14 of 19 patients whose profession was known. The fiber type could not be analyzed. In the 9 patients with known duration, the mean exposure was 28.0 years (plus or minus 15.2; range 4.5 to 46 years).
• Main results:
  • Among the 7 patients with a known interval, the median time from the start of asbestos exposure to diagnosis was 44.7 years (range 18 to 49 years).
  • Among the 19 patients, 7 tumors (37%) were epithelial, 4 (21%) were connective tissue type and 8 (42%) were mixed type.
  • The most common presenting symptoms were abdominal pain (11 of 19, 58%) and weight loss (13 of 19, 68%). 17 of 19 (89%) had ascites.
  • The 3 patients who complained of breathlessness (dyspnea) had signs of asbestosis on chest X-ray.
  • Cytology of the ascitic fluid was positive for malignant mesothelioma in only 5 of 19 patients (26%).
  • Laparotomy was done in 16 of 19 patients (84%) and gave enough material for a diagnosis in all of them.
  • Treatment: 10 of 19 (53%) received only pain relief, 5 of 19 had surgery, 1 of 19 received local chemotherapy, and none had radiotherapy.
  • Among all 19 patients, median survival from diagnosis was 6 months (range 0 to 29 months).
  • Two patients survived longer than 1 year, at 17 and 29 months.
  • Autopsy findings were available for 6 patients. Two had positive abdominal lymph nodes, none had positive thoracic lymph nodes, 3 had tumor growing into the liver and 5 had diaphragm involvement.
• The authors' conclusion: The authors concluded that symptoms are nonspecific and cytology is often negative. Because invasive procedures such as laparotomy should be avoided where possible, they suggested that laparoscopy with directed biopsies be the first-choice diagnostic procedure in patients suspected of malignant peritoneal mesothelioma.
• Limitations the authors state:
  • Because the study was retrospective, the authors could not determine which asbestos fiber type the patients were exposed to.
  • Information about the suspected diagnosis before laparotomy was incomplete.
  • There was no standardized treatment program in the two centers, so therapies varied widely.

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, Occupational Exposure, Asbestos Exposure, Dysphagia, Ascites, Median Survival, Chemotherapy, Autopsy.

Related studies

• Peritoneal mesothelioma: natural history and response to chemotherapy — K.H. Antman, E.A. Pomfret, et al. (1983)
• Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) — D. Baratti, M. Vaira, et al. (2010)
• Two-Stage Cytoreductive Surgery and Intraperitoneal Chemotherapy for Diffuse Malignant Peritoneal Mesothelioma: Predictors of Overall Survival in an Intention-to-Treat Series — J.C. Leinwand, R.N. Taub, et al. (2020)
• Diffuse peritoneal mesothelioma: A case series of 62 patients including paraoccupational exposures to chrysotile asbestos — R.L. Kradin, G. Eng, et al. (2017)
• Malignant peritoneal mesothelioma: prognostic significance of clinical and pathologic parameters and validation of a nuclear-grading system in a multi-institutional series of 225 cases — D.B. Chapel, J.J. Schulte, et al. (2021)
• Primary peritoneal mesothelioma: case series and literature review — H. Sharma, I. Bell, et al. (2011)

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