Multicystic peritoneal mesothelioma: A short review

Our plain-English summary of Multicystic peritoneal mesothelioma: A short review, by C.H. Zhang, J.W. Yu, M. Luo (Current Problems in Cancer, 2017).

The study

• Authors: C.H. Zhang, J.W. Yu, M. Luo
• Journal: Current Problems in Cancer
• Published: 2017;41(5):340-348
• Type of article: Review
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Multicystic peritoneal mesothelioma (MCPM) is a rare neoplasm, predominantly affecting female patients during their reproductive years. The lesion is usually distributed diffusely in the abdomen and pelvis, but the peritoneum of the pelvic organs is the most common site. MCPM is composed of fluid-filled translucent cysts, connected by varying amounts of fibrous tissue, and lined by a layer of mesothelial cells. Because of the rarity of this disease, the pathogenesis and natural history of MCPM remain poorly understood and continuously debated. Some authors consider it to be a reactive process for its association with prior surgery or abdominal inflammation. But its high rate of local-regional recurrence, as well as its malignant potential, suggests a neoplastic etiology. Preoperative diagnosis is often very difficult. Imaging methods, such as ultrasound, computed tomography, and magnetic resonance imaging, are of little value for an accurate diagnosis of MCPM. The definitive diagnosis relies on histologic examination of target lesions combined with immunohistochemical stains. There is no consensus on the clinical management of MCPM, although surgical removal remains the first-line treatment of choice. But no standards have been reached concerning which surgical options-traditional debulking surgery or more aggressive one-should be chosen. Alternative therapeutic approaches include hand-off treatment, hormonal supplementation, laser vaporization, and sclerotherapy, and they all come with uncertain results. Moreover, the lesions show no response to adjuvant chemotherapy and radiotherapy. This article aimed to focus on those controversial problems in pathogenesis, natural history, diagnosis, and treatment strategies to help medical workers to better understand this rare disease.

Copyright © 2017 Elsevier Inc. All rights reserved.

In plain English

This article is a short review of published reports on multicystic peritoneal mesothelioma (MCPM), a rare tumor of the abdominal lining seen mainly in women of child-bearing age. The authors studied no patients of their own and noted that fewer than 150 cases had been reported. Citing earlier studies, they reported that MCPM makes up 3% to 5% of peritoneal mesotheliomas, that it recurred after surgery in 41.7%-50.0% of cases during 2-3 years of follow-up, and that 2 cases of possible malignant change and one death had been documented. In a cited series of 12 patients treated with surgery plus heated chemotherapy inside the abdomen (HIPEC), all were alive with no evidence of disease after a median 64 months. Asbestos came up only in connection with malignant peritoneal mesothelioma, a different disease. The authors concluded that MCPM is best described as a borderline disease. They suggested laparoscopic removal sparing the uterus and ovaries for young women with limited disease, and more aggressive surgery with HIPEC for extensive disease. They stated that, because MCPM is rare, many questions remain unanswered.

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: Narrative review of published literature (no original patient data)
• Who was studied: No patients were studied directly. The authors reviewed published reports on multicystic peritoneal mesothelioma, of which they stated fewer than 150 cases had been reported, mainly in women of child-bearing age.
• Exposure: The review did not study asbestos exposure and did not link MCPM to asbestos. Its only mention of asbestos was that malignant peritoneal mesothelioma (MPM), which it listed as a different disease to tell apart from MCPM, is related to asbestos exposure and mostly affects middle-aged men.
• Main results:
  • Citing an earlier study, the review stated that MCPM accounts for 3% to 5% of peritoneal mesotheliomas.
  • Citing an earlier series, the review reported that MCPM recurred after surgery in 41.7%-50.0% of cases during 2-3 years of follow-up after the first operation.
  • The review stated that, although the lesions are almost certainly benign, 2 cases of possible malignant transformation had been documented in the literature.
  • The review stated that only one patient had been reported to have died from MCPM.
  • Citing an earlier study, the review reported that estrogen and progesterone receptors were absent in most cases of MCPM: 82.3%, or 14 of 17 cases.
  • Citing a study of 12 patients with MCPM treated with surgical cytoreduction and HIPEC, the review reported that all patients survived with no evidence of disease after a median follow-up of 64 months (range 5 to 148 months).
  • Because of MCPM's tendency to recur and its potential for malignancy, the authors suggested it be described as a borderline disease.
• The authors' conclusion: The authors concluded that there is no standard treatment for MCPM. They suggested that laparoscopic complete excision, sparing the uterus and ovaries, be offered to young women with limited disease, and more aggressive cytoreductive surgery with HIPEC to cases with extensive disease.
• Limitations the authors state:
  • The authors stated that because MCPM is rare, many questions about it remain unanswered.
  • The authors stated that the long-term effects and complications of sclerotherapy for MCPM are little known because adequate long-term data are lacking.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Neoplasm, Peritoneum, Mesothelial Cells, Inflammation, Etiology, Ultrasound, Cytoreductive Surgery.

Related studies

• Remote Recurrence of Benign Multicystic Peritoneal Mesothelioma — C.E. Lee, A. Agrawal (2017)
• Multicystic mesothelioma: Operative and long-term outcomes with cytoreductive surgery and hyperthermic intra peritoneal chemotherapy — E. Nizri, D. Baratti, et al. (2018)
• Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management — A.M.C. Rapisarda, A. Cianci, et al. (2018)
• Borderline multicystic peritoneal mesothelioma — S. Landolsi, A. Bouchrika, et al. (2022)
• A recurrence of benign multicystic peritoneal mesothelioma treated through laparoscopic excision: a case report and review of the literature — T.D. Witek, J.W. Marchese, et al. (2014)
• The antiestrogen tamoxifen in the treatment of recurrent benign cystic mesothelioma — G.S. Letterie, J.L. Yon (1998)

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