Peritoneal mesothelioma

Our plain-English summary of Peritoneal mesothelioma, by W.J. Plaus (Archives of Surgery, 1988).

The study

• Author: W.J. Plaus
• Journal: Archives of Surgery
• Published: 1988;123(6):763-6
• Type of article: Case report
• Cited by: 31 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 nos. 000929, 002008).

Abstract

Peritoneal mesothelioma is a rare neoplasm often related to previous asbestos exposure. In 14 cases the diagnosis before surgery was virtually impossible, as patients presented with vague abdominal complaints and nonspecific physical examination findings. Laboratory testing (including computed tomography) was of no added diagnostic help. Widespread peritoneal neoplastic growth was the common finding at laparotomy. The tumor was grossly indistinguishable from other types of abdominal carcinomatosis. Electron microscopy proved to be the diagnostic tool of choice. Routine histologic techniques often gave nondiagnostic results. Intraperitoneal asbestos fibers were not observed. Treatment with radiation, chemotherapy, or both produced a 50% partial response rate, but survival was not affected. Malignant ascites was effectively palliated without complication in two of three patients with peritoneovenous shunting. An unusual case occurred in which histologic material from a second-look laparotomy documented complete response to a new regimen of intraperitoneal chemotherapy.

In plain English

This case series described 14 patients (five women and nine men) with peritoneal mesothelioma treated from 1975 to 1986. Five were treated by the author and nine came from the Colorado Tumor Registry. Only two patients were reported as exposed to asbestos, though the author noted others may have been exposed unknowingly. One was probably exposed as a child through his father, an asbestos worker. No asbestos fibers were found in the peritoneum. Abdominal pain was the most common symptom (79%), and mesothelioma was not diagnosed before surgery in any case. Electron microscopy, used in six cases, gave the most definitive diagnostic information. Ten patients received various treatments, not in a controlled way. The author reported a 50% partial response rate but stated that treatment did not conclusively affect survival, and all but three patients survived less than 18 months. A shunt relieved fluid buildup in the abdomen without complication in two of three patients. One 38-year-old man showed no tumor in biopsies after intraperitoneal cisplatin and systemic doxorubicin. The author cautiously advocated shunting and called for research on earlier detection and new treatments.

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: case series (author's own patients plus cases from a tumor registry)
• Who was studied: 14 patients (five women and nine men) with peritoneal mesothelioma treated from 1975 to 1986 in Colorado (University of Colorado Health Sciences Center and Rose Medical Center, Denver). Five were the author's own patients and nine were registry cases with complete enough documentation. Mean age at presentation was 56 years.
• Exposure: Asbestos exposure was reported for only two patients; no fiber types were named. Patient 2 was probably exposed as a child through his father, an asbestos worker, with the degree of exposure unknown. The delay between exposure and diagnosis was 27 years in this report. Patient 12 had received abdominal radiation for a presumed lymphoma 15 years before presentation.
• Main results:
  • Abdominal pain was the most common presenting symptom, in 79% of patients.
  • Mesothelioma was not diagnosed before surgery in any of the 14 patients.
  • Paracentesis was done in five patients; cell examination of the fluid never established the correct diagnosis.
  • Thirteen patients underwent laparotomy. Resection of the tumor for cure was not possible in any case.
  • Electron microscopy, used in six cases, gave the most definitive diagnostic information.
  • No asbestos fibers were found in the peritoneum in this series.
  • Peritoneovenous shunting relieved malignant ascites without complication in two of three patients. The third patient (patient 9) developed severe disseminated intravascular coagulation, and the shunt was tied off after 11 days.
  • Among the treated patients, the partial response rate was 50%, but treatment did not conclusively affect survival.
  • All but three of the 14 patients survived less than 18 months. Mean survival was 24.8 months.
  • Patient 14, a 38-year-old man, received intraperitoneal cisplatin and systemic doxorubicin. At second-look surgery, biopsies of apparent tumor nodules showed only sclerosis and no tumor.
• The authors' conclusion: The author cautiously advocated peritoneovenous shunting to relieve malignant ascites in peritoneal mesothelioma. The author also stated that research would best be directed at earlier detection for those at risk and rigorous testing of new treatments.
• Limitations the authors state:
  • Patients were treated in an uncontrolled way with a variety of regimens.
  • Only nine of the 21 registry cases had complete enough documentation to be included.
  • Asbestos exposure status may be inaccurate, because other patients may have been exposed unknowingly.
  • Some patients were too ill at presentation for aggressive treatment.
  • In two cases the diagnosis remained debated even with electron microscopy.

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, Neoplasm, Asbestos Exposure, Laparotomy, Chemotherapy, Ascites.

Related studies

• The role of "closed abdomen" hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliative treatment of neoplastic ascites from peritoneal carcinomatosis: report of a single-center experience — L. Orgiano, F. Pani, et al. (2016)
• Malignant peritoneal mesothelioma after Thorotrast exposure — C. Stey, U. Landolt-Weber, et al. (1995)
• Acute popliteal thrombus workup leads to discovery of primary peritoneal mesothelioma in the absence of any known asbestos exposure — S.T. Ahmed, M. Barvo, et al. (2020)
• Value of laparoscopy before cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis — L.H. Iversen, P.C. Rasmussen, et al. (2013)
• Laparoscopy is Safe and Accurate to Evaluate Peritoneal Surface Metastasis Prior to Cytoreductive Surgery — R.A. Marmor, K.J. Kelly, et al. (2016)
• Clinical picture, response to therapy, and survival of women with diffuse malignant peritoneal mesothelioma — G.H. Eltabbakh, M.S. Piver, et al. (1999)

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