Medline ® Abstracts for References 51,54-56
of 'Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging'
Peritoneal malignant mesothelioma with multiple distant skin metastases.
Ordóñez NG, Smith JL Jr
Arch Dermatol. 1983 Oct;119(10):827-30.
Metastases in multiple distant sites, including the skin, developed in a 54-year-old man with diffuse malignant abdominal mesothelioma. To our knowledge, this represents the first reported case of cutaneous metastasis arising from malignant mesothelioma. Recent advances in diagnostic techniques, such as electron microscopy, may be helpful in differentiating this condition from metastatic adenocarcinoma.
A novel tumor-node-metastasis (TNM) staging system of diffuse malignant peritoneal mesothelioma using outcome analysis of a multi-institutional database*.
Yan TD, Deraco M, Elias D, Glehen O, Levine EA, Moran BJ, Morris DL, Chua TC, Piso P, Sugarbaker PH, Peritoneal Surface Oncology Group
Cancer. 2011 May;117(9):1855-63. Epub 2010 Nov 18.
BACKGROUND: Currently, no tumor-node-metastasis (TNM) staging system exists for patients with diffuse malignant peritoneal mesothelioma (DMPM). The primary objective was to formulate a clinicopathological staging system through the identification of significant prognostic parameters.
METHODS: Eight international institutions with prospectively collected data on patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy contributed to the registry. Two hundred ninety-four patients had complete clinicopathological data and formed the basis of this staging project.
RESULTS: Peritoneal cancer index (PCI) was categorized into T(1) (PCI 1-10), T(2) (PCI 11-20), T(3) (PCI 21-30), and T(4) (PCI 30-39). Twenty-two patients had positive lymph nodes (N(1) ) and 12 patients had extra-abdominal metastases (M(1) ). The survival for patients with T(1) (PCI 1-10) N(0) M(0) was significantly superior to the other patients. This group of patients is therefore designated as Stage I. The survival of patients with T(2) (PCI 11-20) and T(3) (PCI 21-30), in absence of N(1) or M(1) disease, was similar. This group of patients was categorized as Stage II. The survival of patients with T(4) (PCI 30-39), N(1,) and/or M(1) was similarly poor. This group of patients was therefore categorized as Stage III. Three prognostic factors were independently associated with survival in the multivariate analysis: histological subtype, completeness of cytoreduction, and the proposed TNM staging. The 5-year survival associated with Stage I, II, and III disease was 87%, 53%, and 29%, respectively.
CONCLUSIONS: The proposed TNM staging system resulted in significant stratification of survival by stage when applied to the current multi-institutional registry data.
The Baird Institute for Applied Heart and Lung Surgical Research, NSW Australia. Tristan.Yan@hotmail.com
Malignant peritoneal mesothelioma.
de Pangher Manzini V
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.
Azienda per i Servizi Sanitari 2 Isontina, Ospedali di Monfalcone e Gorizia, UnitàOperativa Complessa di Oncologia, Monfalcone, GO, Italy. email@example.com
Internal carotid artery occlusion in a patient with malignant peritoneal mesothelioma: is it a sign of malignancy-related thrombosis?
UstündağY, Can U, Benli S, Büyükasik Y, Ozbek N
Am J Med Sci. 2000;319(4):265.
To our knowledge, the occlusion of arteries and platelet hyperaggregation have not been reported in patients with malignant mesothelioma. However, venous thromboembolism, especially in the pulmonary vasculature in association with thrombocytosis and hyperfibrinogenemia, are commonly noticed in this disorder. Furthermore, we detected enhanced platelet aggregation in a case of malignant peritoneal mesothelioma with internal carotid artery occlusion in whom there were postsplenectomy thrombocytosis and hyperfibrinogenemia. The possible mechanisms of ICA occlusion in this patient, including the role of MPM and postsplenectomy state, thrombocytosis, platelet functional changes, and other factors were investigated and discussed.
Department of Gastroenterology, Başkent University School of Medicine, Ankara, Turkey. firstname.lastname@example.org