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Mesothelioma, peritoneal [keywords]
- Clinical utility of 18F-Fdg positron emission tomography in malignant peritoneal mesothelioma. [JOURNAL ARTICLE]
- Q J Nucl Med Mol Imaging 2014 Apr 14.
The purpose of this study was to determine the utility of 18F-FDG-PET for evaluating the presence and the extent of malignant peritoneal mesothelioma (MPM), for disease surveillance/recurrence detection and for evaluating response to therapy.We retrospectively analyzed clinical and imaging data of 60 MPM patients (p) (34 women and 26 men, mean age 53.6y, range 18-80y) who had multiple 18F-FDG-PET/CT or PET scans(18F-FDG scans) at various stages of the disease.11p had baseline pretreatment scans and all 11 scans showed 18F-FDG avid diffuse, nodular or mixed disease distribution patterns characteristic of MPM. 4/11p had an early posttreatment 18F-FDG scan (< 6 months) and all scans were accurate in determining response to treatment. 49p with a history of treated MPM without baseline scans had multiple disease surveillance 18FFDG scans. Their initial 18F-FDG scans had accuracy of 82% and positive predictive value of 83% and negative predictive value of 80% for the detection of disease presence and disease free state, respectively. For 15p with true negative 18F-FDG scan, a second follow up scan accurately detected disease recurrence or absence of recurrence in all cases. Metastatic or remote nodal disease was more common in the biphasic histopathologic subtype group while pleural disease was predominatly seen in epithelial MPM group. No relationship was found between the uptake pattern and the histopathologic subtype.18F-FDG-PET is a valuable imaging modality in pre-surgical evaluation and management of MPM and further prospective studies are warranted.
- [Cytoreductive surgery for malignant peritoneal tumors.] [JOURNAL ARTICLE]
- Chirurg 2014 Apr 12.
Cytoreductive surgery is an essential part of a multimodality treatment concept for peritoneal metastases. Indications are primary peritoneal tumors like peritoneal mesothelioma or secondaries from colorectal cancer or pseudomyxoma peritonei. Patients with gastric or ovarian carcinoma or abdominal sarcoma with peritoneal seedings can be treated within studies. Tumor entity, tumor load, and tumor distribution are the most critical issues for patient selection. Complete macroscopic cytoreduction is the strongest prognostic factor and can be achieved by parietal and visceral peritonectomy. The operation should be performed in a standardized manner. Due to possible tumor manifestation in all four quadrants of the abdomen and extensive extraperitoneal dissection, extensive surgical and oncological expertise is prerequisite. Treatment in specialized surgical oncology centers is recommended to minimize morbidity and mortality. The German Society for General and Visceral Surgery is certifying centers of competence for surgical treatment of peritoneal malignancies. Data of all patients are documented in the HIPEC register. The inclusion of patients in studies is recommended.
- Oncolytic Vaccinia Virus as an Adjuvant Treatment to Cytoreductive Surgery for Malignant Peritoneal Mesothelioma. [JOURNAL ARTICLE]
- Ann Surg Oncol 2014 Apr 10.
Malignant peritoneal mesothelioma (MPM) is an aggressive cancer with a dismal prognosis. Oncolytic viruses are a promising new therapy for cancer because of their ability to kill tumor cells with minimal toxicity to normal tissues. This experimental study aimed to examine the potential of modified vaccinia virus (VV) to treat MPM when administered alone or as an adjuvant treatment to surgery.Two aggressive murine mesothelioma cell lines (AC29, AB12), were used. Cell viability and viral cytopathic effects were assessed using MTS and crystal violet assays. Immunocompetent mice were injected intraperitoneally with MPM cells and treated with intraperitoneal VV. Tumor-bearing mice also underwent cytoreductive surgery (CRS) followed by VV (or control) therapy.The cytotoxic effects of VV on MPM cell lines was significantly increased compared with the control non-cancer cell line. In both orthotopic models, VV induced tumor regression, prolonging median and long-term survival. VV treatment after incomplete CRS was not superior to VV alone; however, when mice with microscopic disease were treated with VV, further prolongation of median and long-term survivals was observed.VV selectively kills MPM cells in vitro and leads to improved survival and cures in immunocompetent murine models. Higher efficacy of the virus in the microscopic disease context suggests the use of the virus as an adjuvant treatment to complete surgical resection. These promising results justify further studies of VV in humans as a novel treatment for MPM.
- Malignant peritoneal mesothelioma: clinicopathological characteristics of two cases. [Journal Article]
- Case Rep Surg 2014.:748469.
Introduction.Peritoneal mesothelioma is a rare tumor, presenting difficulties in diagnosis and treatment. Peritoneum is the second most common area of the mesothelioma after pleura, and even synchronous pleural and peritoneal mesotheliomas are observed in 30-45% of all cases. The diagnosis may be difficult due to lack of specific symptoms and clinical findings. In addition, a delay in the diagnosis is not rare especially in the absence of previous asbestos exposure. Here we report two cases of malignant peritoneal mesotheliomas. The diagnostic and therapeutic approaches for these rare neoplasms are discussed. Case Presentation. The cases were two men (one aged 54 years old and the other 40 years old). Prolonged abdominal pain and swelling were the primary presentation symptoms and findings. The mesotheliomas were developed in the right upper quadrant of abdomen in both of the cases. Both cases were treated with surgical resection. Final diagnosis were possible with histological and immunohistochemical documentation of tumor characteristics, which were consistent with dictating a mesothelial origin. No history of asbestos exposure was reported.
Conclusion.Peritoneal mesotheliomas are rare clinical entities. However, patients with prolonged abdominal pain and abdominal masses should be considered to have atypical pathologies such as peritoneal mesotheliomas.
- Multicystic benign cystic mesothelioma presenting as a pelvic mass. [Journal Article]
- Case Rep Obstet Gynecol 2014.:852583.
Background.Benign cystic mesothelioma (BCM) is a rare tumor that arises from the abdominal peritoneum with a predilection to the pelvic peritoneum. For this reason, it can often mimic gynecologic malignancies. Case. A 47-year-old perimenopausal female presented reporting several weeks of abdominal distention associated with abdominal tenderness and constipation. Computed tomography revealed a 24 cm multiloculated pelvic mass, and tumor markers were notable for an elevated CA-125. The patient was taken to the operating room for an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingoophorectomy, and removal of pelvic mass. Final pathologic evaluation revealed a benign cystic mesothelioma.
Conclusion.Classically these tumors present as large multicystic masses with thin-walled septations and on preoperative evaluation BCM can mimic many different disease entities including ovarian malignancies and cystic lymphangioma. Often diagnosis can only be made at time of surgery.
- Telomerase activity analyzed with trap in situ provides additional information in effusions remaining equivocal after immunocytochemistry and hyaluronan analysis. [JOURNAL ARTICLE]
- Diagn Cytopathol 2014 Apr 1.
Cytology is central in the diagnosis of malignancy in effusions. Ancillary techniques, mainly immunocytochemistry, have considerably improved the sensitivity but some 10% of all cases remain equivocal and require the addition of new diagnostic modalities. We have previously shown that strong nuclear telomerase activity determined with Telomere Repeat Amplification Protocol (TRAP) in situ is specific for malignant cells and could be a candidate for an additional test. Thirty effusions remaining diagnostically equivocal after the use of immunocytochemistry and the determination of the hyaluronan content were reviewed and their TRAP in situ reactivity was related to the definitive diagnoses based on all available data. There were seven effusions from patients with definitive benign diagnoses and 23 effusions from patients with definitive malignant diagnoses. Strong telomerase activity was seen only in effusions from patients with definitive malignant diagnosis, all effusions from patients with benign disease lacking strong telomerase activity, whereas eight of the malignant cases, including three cases of epithelial mesothelioma, showed strong reactivity. Strong nuclear TRAP in situ reactivity was demonstrated only in effusions from patients with verified malignant disease. Although the study is small, it suggests that TRAP in situ activity provides diagnostic information in about one-third of effusions remaining cytologically equivocal after the use of current ancillary techniques. The most striking diagnostic improvement appears to be gained in epithelial mesotheliomas. Diagn. Cytopathol. 2014. © 2014 Wiley Periodicals, Inc.
- A recurrence of benign multicystic peritoneal mesothelioma treated through laparoscopic excision: a case report and review of the literature. [Journal Article]
- Surg Laparosc Endosc Percutan Tech 2014 Apr; 24(2):e70-3.
Benign multicystic peritoneal mesothelioma is a rare cystic tumor with approximately 140 cases reported to date. It is found mainly in women of reproductive age and is commonly attached to the serosal surface of pelvic viscera. The pathogenesis is uncertain and debate regarding its neoplastic or reactive nature exists. The presenting symptoms are often nonspecific and most commonly include vague lower abdominal pain and fullness. Imaging studies are used to identify the lesion, but histologic studies with the aid of immunohistochemical techniques are needed for definitive diagnosis as the differential diagnosis is quite extensive. Surgical resection is the primary form of treatment, and follow-up is important due to the high rate of recurrence and the rare possibility of malignant transformation. Here, we present a case of a 50-year-old female with a recurrence of benign multicystic peritoneal mesothelioma treated through laparoscopic excision and also a review of the literature.
- Treatment of diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery and HIPEC. [Journal Article]
- Minerva Chir 2014 Feb; 69(1):9-15.
Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and locally aggressive tumor with poor prognosis, related in most cases to asbestos exposure. It is increasing in frequency, but currently no standard therapy is available. The biology of this disease is still poorly understood. Several highly specialized centers have recently reported improved survival by means of an innovative local-regional approach. The purpose of this article is to evaluate the survival benefit and the morbidity rate of patients affected by DMPM treated at our institution by cytoreductive surgery (CRS) associated with hyperthermic intraperitoneal perioperative chemotherapy (HIPEC).This study includes 42 patients affected by DMPM treated by an uniform approach consisting of cytoreductive surgery associated with HIPEC using cisplatin and doxorubicin. The primary end point was overall survival and morbidity rate. The secondary end point was evaluation of prognostic variables for overall survival.The median follow-up period was 72 months (range 1-235 months). Thirty-five patients (83.3%) presented epithelial tumors and 7 were affected by multicystic mesothelioma. The mean peritoneal cancer index (PCI) was 13. Thirty-eight patients (90.4%) had complete cytoreduction (CC-0/1). The overall morbidity rate was 35.7% associated to a perioperative mortality of 7.1%. Median overall survival rate was 65 months with a 1- and 5-year survival rates of 63% and 44%, respectively.The treatment of DMPM by CRS+HIPEC in selected patients is a feasible technique that allows to achieve encouraging results in terms of overall survival rate, with an acceptable morbidity rate. Further investigations are needed to clarify the role and the timing of this promising technique.
- Diagnostic laparoscopy identifies a peritoneal adenomatoid-like mesothelioma masquerading as ovarian cancer: a case report. [Journal Article]
- Eur J Gynaecol Oncol 2014; 35(1):91-4.
The authors report a rare case of peritoneal adenomatoid mesothelioma in a woman with no history of asbestos exposure. A 61-year-old woman was originally suspected of having a bilateral ovarian tumor based on chest radiography and magnetic resonance imaging (MRI). Upon referral to our hospital, the presence of two solid masses was confirmed by enhanced MRI and 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG-PET/CT). Physical examination was normal, as were serum concentrations of the tumor markers CA 19-9, CA 125, and CEA. Laparoscopic surgery showed a right ovarian tumor and laparoscopic right salpingo-oophorectomy and adhesiotomy were performed. Two months later, the patient underwent laparoscopic segmental resection of the sigmoid colon, with histological analysis identifying an adenomatoid-like tumor. The final diagnosis was peritoneal adenomatoid-like mesothelioma with invasion of the right ovary. This case report demonstrates that imaging techniques must be coupled with laparoscopic surgery for an accurate diagnosis of peritoneal mesothelioma.
- Gastrointesinal: Indolent case of malignant peritoneal mesothelioma with massive ascites. [Journal Article]
- J Gastroenterol Hepatol 2014 Apr; 29(4):662.