Malignant Peritoneal Mesothelioma: An In-Depth and Up-to-Date Review of Pathogenesis, Diagnosis, Management and Future Directions

Abstract

Malignant peritoneal mesothelioma (MPM) is an extremely rare malignancy usually confined to the abdominal cavity. With an aggressive natural history, morbidity and mortality are consequences of progressive locoregional effects within the peritoneal cavity. The first reported case was in the early 20th century, however, due to the rare nature of the disease and a large gap in understanding of the clinicopathological effects, the next reported MPM cases were only published half a decade later. Since then, there has been exponential growth in our understanding of the disease, however, there are no prospective data and a paucity of literature regarding management. Traditionally, patients were treated with systemic therapy and the outcomes were very poor, with a median survival of less than one year. However, with the advent of cytoreductive surgery and locoregional chemotherapy, there have been significant improvements in survival. Even more recently, with an improved understanding of the molecular pathogenesis of MPM, there have been reports of improved outcomes with novel therapies. Given the disastrous natural history of MPM, the limited data, and the lack of universal treatment guidelines, an in-depth review of the past, present, and future of MPM is critical to improve treatment regimens and, subsequently, patient outcomes.

ED diagnosis of peritoneal carcinomatosis

“…In our study, the most common cause of new peritoneal carcinomatosis in women was of GYN origin (66%), and in men was of GI tract origin (proximal GI plus colon, 57%) (Table 1). Our study sample did not find any cases of peritoneal mesothelioma, a rare primary peritoneal tumor [8]. Among all cases of new carcinomatosis-like appearance on CT which received further workup, the positive predictive value (PPV) of pathologically confirmed new peritoneal malignancy was 82%.…”