Peritoneal Cystic Mesothelioma: A Case Series

Abstract

Background Cystic peritoneal mesothelioma is a rare disease associated with a favorable short-term prognosis. Longer follow-up documenting a persistence of symptoms and a high rate of recurrence after debulking surgery along with an uncertain natural history prompt a re-evaluation of prior treatment recommendations. No prior long-term clinical study of these patients is available. Methods The experience with five cases of cystic peritoneal mesothelioma, four females and one male, are reviewed. All of these patients were treated with cytoreductive surgery with peritonectomy procedures and heated intraoperative intraperitoneal chemotherapy. CT, pathology and current status were investigated in order to learn more about the natural history of this disease. Results All patients were symptomatic from abdominal distention and three of the four complained of severe pain. Female patients complained of long periods of recurrent abdominal and pelvic pain poorly managed by oral analgesics. In one patient prolonged conservative management over ten years resulted in transition to an invasive process with extensive lymph nodal metastases. Her prognosis for long-term survival is guarded because of mesothelioma extension into the chest. Disease control of both ascites and pain in the abdomen and pelvis was achieved in all five patients treated with cytoreductive surgery plus intraperitoneal chemotherapy. Conclusions Cystic peritoneal mesothelioma should no longer be referred to as “benign” cystic mesothelioma. An aggressive approach with complete disease eradication is the correct goal of treatment. From our experience, cytoreductive surgery to remove all visible tumor and intraperitoneal chemotherapy to control microscopic residual disease will help patients with peritoneal cystic mesothelioma to remain symptom- and disease-free over an extended time period with a single surgical intervention. Disease eradication may prevent the transition to an aggressive and fatal disease process.

Use of the Cavitron Ultrasonic Surgical Aspirator (CUSA) as a Conservative Surgery Alternative in Benign, Disseminated Peritoneal Mesothelioma

“…We could only find 3 case reports of malignant transformation (González-Moreno et al, 2002;Mino et al, 2014;Sethna et al, 2003), one of which showed both benign and malignant cells within the same tumor, questioning whether the patient really had benign cystic mesothelioma which transformed, or a primary malignant process. Therefore, we see little added value of radical surgery with HIPEC in terms of prevention of malignant transformation.…”

Multicystic peritoneal mesothelioma: outcomes and patho-biological features in a multi-institutional series treated by cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

“…However, only a small number of patients undergoing combined treatment has been reported in the literature. [14][15][16][17] Furthermore, the biology of peritoneal mesothelioma has been addressed only in recent years and the features of rare sub-variants, such as MCMP, are still largely unknown. The present paper reports the collaborative effort of two Italian centres to assess safety and effectiveness of the combined treatment.…”

“…[2,[11][12][13][14][15][16][17] This comprehensive strategy is successfully used to treat pseudomyxoma peritonei, a disease which shares with MCPM the low biological aggressiveness and tendency to recur after incomplete excision. [9,[14][15] In the current study, drugs were chosen for HIPEC based on their suitability to intra-peritoneal administration and synergistic effect with heat. No data are available on their activity against MCPM, although cisplatin and doxorubicin are largely used in systemic and local-regional treatment of peritoneal mesothelioma.…”

“…To date, the study by Sugarbaker group is the only published case-series entirely devoted to MCPM. [14] The number of patients treated at the Washington Cancer Center has been recently updated to seven. [27] One of the participating institution reported four cases of MCPM together with papillary well-differentiated peritoneal mesothelioma.…”

Experience with peritoneal mesothelioma at the Milan National Cancer Institute

“…Multicystic peritoneal mesothelioma (MPM) and WDPPM are exceedingly uncommon lesions with uncertain malignant potential and no uniform treatment strategy [26,27] . From the beginning of our peritoneal malignancies treatment program, MPM and WDPPM were included among the indications to cytoreduction and HIPEC, owing to their known potential to relapse and to evolve into aggressive malignant tumours [28] .…”