Pathological classification of malignant peritoneal mesothelioma and comparative analysis with peritoneal carcinomatosis / 中华劳动卫生职业病杂志

Objective: To analyze the pathological classification of malignant peritoneal mesothelioma (MPeM) and screen the immunohistochemical markers that can distinguish MPeM from peritoneal metastatic carcinoma (PC) . Methods: In June 2020, the pathological results of peritoneal biopsy of 158 MPeM and 138 PC patients from Cangzhou Central Hospital, Cangzhou People's Hospital, and Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from May 2011 to July 2019 were retrospectively analyzed, and the pathological classifications of MPeM in Cangzhou were summarized. Immunohistochemical markers of MPeM and PC patients were analyzed, and receiver operating characteristic curve (ROC curve) was drawn for differential diagnosis of MPeM and PC. Results: There were 55 male and 103 female MPeM patients in Cangzhou, with an average age of 57.1 years old. The asbestos exposure rate was 91.14% (144/158). The most common pathological classifications were cutaneous type, accounting for 90.51% (143/158). There were significant differences in the expression of calreticulum protein, CK5/6, vimentin, D2-40, carcinoembryonic antigen (CEA) and tail type homologous nuclear gene transcription factor 2 (CDX-2) between MPeM and PC (P<0.05). Among the 6 positive markers, the sensitivity of calreticulum protein was the highest (0.905) and CEA was the lowest (0.428) . Conclusion: Calreticulum protein, CK5/6, vimentin, D2-40, CEA and CDX-2 may be used as specific markers to distinguish the diagnosis of MPeM from PC.

Epidemiological Study of New Cases of Peritoneal Metastases / 肿瘤防治研究

Peritoneal metastases (PM) are defined as the primary or secondary occurrence/progression of malignant tumor in peritoneum. PM were previously thought to be a terminal disease without effective treatment, with short survival and poor prognosis. With the change in the understanding of PM, the oncology communities regard it as a curable regional cancer metastasis, and create a comprehensive treatment technology system with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as the core, and establish professional PM treatment centers based on this. The professional PM treatment centers have significantly prolonged the survival of patients, and some patients can even achieve clinical cure. However, in China, there are very few professional PM treatment centers, but the number of PM patients is huge, and most of the patients can't receive professional treatment, resulting in poor survival and prognosis. Based on the cancer statistics in 2015 published by China National Cancer Center Registry and clinical outcome literature on peritoneal metastasis, this paper uses clinical epidemiology methodology to calculate the number of newly diagnosed patients with peritoneal metastasis, to estimate the number of specialized peritoneal cancer centers required, to provide data support for the promotion of professional treatment technology system for PM in our country, and to boost the development of peritoneal oncology.

Mesotelioma Peritoneal Maligno. Presentación de un caso / Malignant Peritoneal Mesothelioma. Case presentation

El mesotelioma es un tumor poco frecuente, sobretodo en localización peritoneal. Originado en las células mesoteliales de superficies serosas. Su etiología es desconocida, aunque en muchos casos se relaciona con exposición a asbestos. Su frecuencia va en aumento en los últimos años, tiene mayor incidencia en varones de edad media. Se presentó un paciente de 73 años diabético e hipertenso que llevaba 21 días con sensación de llenura, aumento de volumen del abdomen, decaimiento marcado, pérdida del apetito. En este período presentó una pérdida de peso corporal de 10 kilos. Por todo lo anterior se decidió su ingreso para estudio y tratamiento (AU).

The mesothelioma is a little frequent tumor, especially in peritoneal location, originated in the mesothelial cells of serous surfaces. Its etiology is unknown, although in many cases it is related with exposition to asbestos. Its frequency increases in the last years, showing higher incidence in medium-age male people. The case of a diabetic, hypertensive patient aged 73 years was presented. He was already 21 days feeling bloating, having increase of the abdominal volume, remarked weakness, appetite loss. In this period he had a body weight loss of 10 kg. For that all, his admission was decided for study and treatment (AU).

Clinical Analysis of the Localized Malignant Peritoneal Mesothelioma / 中国医科大学学报

Objective To summarize the diagnosis and treatment of localized malignant peritoneal mesothelioma(LMPM). Methods A total of 68 cases of LMPM were analyzed retrospectively,including 65 patients in the literature concerning LMPM published in Chinese medical journals be-fore October 2014 plus 3 cases of LMPM admitted in The First Hospital of China Medical University in the same period. Results Among the 68 cas-es,30 cases were male,38 cases were female,with a male to female ratio of 1:1.27. Mean age was 57.6 years. Major clinical manifestations includ-ed abdominal pain or discomfort(76.9%)and palpable abdominal masses(58.5%). Patients(41.7%)had the history of exposure to asbestos. Among the 48 cases(92.3%)that underwent CT examination,ascites was found in 16 cases,and hepatic metastasis was found in 11 cases. Most of the tumors were epithelial type(76.7%),with a mean diameter of 12.2 cm. The main therapeutic strategy was combination therapy of cytoreductive surgery with intraperitoneal hyperthemic chemotherapy. Conclusion LMPM is a rare malignant tumor that occurs predominantly in old people. Symptoms and imaging examinations are untypical. The diagnosis is dependent on pathological examination. Combining several laboratory tests could help the diagnosis. Combination therapy of cytoreductive surgery with intraperitoneal hyperthemic chemotherapy provides an adequate and efficient treatment for LMPM.

Mesotelioma maligno difuso primario de peritoneo / Primary diffuse malignant peritoneal mesothelioma

El mesotelioma peritoneal maligno es una neoplasia de presentación infrecuente, de curso insidioso, sintomática y de presentación poco específica en fase avanzada, de difícil diagnóstico y alta letalidad. Es la neoplasia más común de la serosa peritoneal, ocupando el segundo lugar de localización de los mesoteliomas, después del mesotelioma pleural. Es más frecuente en hombres, en mayores de 60 años y se ha relacionado en un 80% a la exposición crónica al asbesto. Generalmente su primera manifestación es ascitis, que se acompaña de dolor abdominal, astenia, hiporexia y pérdida de peso. Se puede diagnosticar a través del estudio histológico e inmunohistoquímico de líquido ascítico, biopsia peritoneal, y como métodos complementarios, TC de Abdomen y CT-PET. Presentamos el caso de un paciente masculino de 70 años de edad, con antecedente de adenocarcinoma prostático tratado con radioterapia y bloqueo hormonal, en remisión, Cardiopatía Isquémica e Hipertensiva en condición post-Bypass coronario, quien consulta por disnea, ascitis, hiporexia, astenia, con evidencia de líquido ascítico hemorrágico y GASA de bajo gradiente.

Malignant peritoneal mesothelioma is an infrequent neoplasm, of insidious course, symptomatic presentation and usually is diagnosed at an advanced stage diagnosis. It is the most common malignancy of the peritoneum and the the second location of mesothelioma, preceded by pleural mesothelioma. It is more common in men older than 60 year sand has been linked in 80% to chronic exposure to asbestos. Usually ascites, abdominal pain, fatigue, decreased appetite and weight loss are the first signs. It can be diagnosed through histological and immunohistochemical study of ascitic fluid, peritoneal biopsy, abdominal CT and CT-PET. We report the case of a male patient. 70 years with a history of heart disease and prostatic carcinoma treated with radiotherapy and immunosupressive therapy, who consults with dyspnea, ascites, hyporexia, fatigue and evidence of hemorrhagic ascites.

Primary Malignant Peritoneal Mesothelioma

A 67-year-old-man, who had a medical history of hypertension and angina pectoris, was referred to our hospital due to dysuria and a palpable lower abdominal mass. He was a farmer until at the age of 50 and then had been working at a textile factory. The physical examination revealed a fixed, firm and round mass in the lower abdomen. The laboratory data were within the normal ranges, except for elevation of CA-125 (128 U/ml). Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) showed a 6 x 5 cm round hypodense mass in the pelvic cavity. Preoperative ultrasound-guided needle biopsy resulted in a suspicious rhabdomyosarcoma. Exploratory laparotomy revealed a 10 x 8 cm size firm, round mass that was located between the superior aspect of the urinary bladder and lower anterior abdominal wall. En bloc excision of the mass with partial cystectomy was performed. The pathologic diagnosis was primary malignant peritoneal mesothelioma. The postoperative course was uneventful.

Laparoscopic Detection of Malignant Peritoneal Mesothelioma / 中国医师杂志

Objective To improve the diagnostic rate of laparoscopy for malignant peritoneal mesothelioma (MPM) and enhance acquaintance with this disease. Methods The appearance of laparoscopic detection was retrospectively analysed in 25 patients with pathologically proved MPM. Results Hyperemia, edema and faint vascular net in parietal peritoneum were seen in all patients, and the thick or thin callus-like thickened parietal peritoneum was also observed. There were some grey nodes of various size, distribution and number in parietal and visceral peritoneum in all patients. The purplish red masses with hyperemia and edema were seen in abdominal cavity in 21 patients (21/25,84%). Several small masses cold be connected each other to become one big mass. All patients had yellow turbid or bloody ascites. Conclusion MPM had special characteristics under laparoscopy. Laparoscopic detection possesses the advantages of safety, little trauma, less hurt and high diagnostic rate. Laparoscopic detection and biopsy may be the best method for diagnosis of MPM.

A Case of Multiple Small Nodular Peritoneal Mesothelioma / 대한소화기내시경학회지

Peritoneal mesothelioma is a rare disease which arises from the mesothelial lining cells in the peritoneum and spreads to the peritoneal wall, omentum and other abdomina1 organs. Aabestos is one etiologic factor and the other factors are genetic cause, radiation, exposure to toxic materials and recurrent yeritonitis. We experienced a case of multiple small nodular peritoneal mesothelioma after exposure to asbestos for over 20 years. He was a sailor and had worked in the engine department of the ship, in which he wrapped up the pipe of engine in asbestos. This person came to our hospital because of inconvenience due to a distended abdomen. Tumor markers were all within normal limits and there was no evidence of tuberculosis in the abdomen and chest. The CT findings of the abdomen were as follows: There was abundant ascites in the abdominal cavity and multiple small nodules on the parietal peritoneum and especially on the lower abdomen. The omentum thickened diffusely. It was difficult to distinguish from peritoneal mesothelioma and peritoneal carcinomatosis or intestinal tuberculosis. The laparoscopic findings were as follows: There were multiple small nodules on the parietal peritoneum and omentum. The small nodules were a gray white color and uneven compared to tuberculous peritonitis. Therefore, we observed the malignant mesothelial cells by means of the light microscope and electron microscope and concluded that this case was peritoneal mesothelioma.