Malignant peritoneal mesothelioma clinical analysis of 11 cases

Key words peritoneal mesothelioma

By retrospective analysis of undergraduates from January 2000 to December 2005 were treated 11 cases of pathologically confirmed malignant peritoneal mesothelioma, are reported below.

A clinical data

1.1 General information on 11 cases of female patients, aged 46 to 71 years, with a median age of 55 years. Have a clear history of exposure to asbestos, of which more than 10 years in 4 cases, 5 to 10 years in 5 cases, 5 years in 2 cases. 1 case had history of tuberculous pleurisy. 5 cases of gynecological direct income from the medicine into the 6 cases. Clinical manifestations of abdominal pain in 7 cases, 8 cases of abdominal distension, abdominal mass in 1 case, 1 case recurrent fever, fatigue, loss of appetite in 4 cases, 3 cases of weight loss, vomiting complicated by incomplete intestinal obstruction in 1 case. All patients underwent abdominal B-ultrasound, nine cases of prompt ~ a large number of peritoneal effusion, 1 case of peritoneal fluid inclusions, and 1 peritoneal effusion B-you are not prompted, but see the intraoperative peritoneal fluid 200ml, 2 Li prompted Accessories District mixed echo mass, 2 cases of peritoneal sheet enhanced echo basin. 8 cases of abdominal cavity of patients with CT examination, were prompted ascites, including three cases of prompt peritoneal thickening, two cases of pelvic masses, 1 case both sides of the broad ligament thickening. Underwent chest X-ray examination, three cases of pleural thickening, I no abnormal chest X-ray.

1.2 tumor marker CA125 in 5 cases increased up to 299.91U / L, CA153 4 cases increased up to 66.9U / L.

1.3 ascites examination of 10 cases of preoperative abdominal pumping to wear, no pits them one cases of ascites, 8 cases of yellow ascites, and 1 case for the light bloody fluid, both exudate. Nuclear-shaped cells found two cases are no typical malignant mesothelial cells, acid-fast bacilli was not found.

1.4 Preoperative diagnosis and treatment of malignant peritoneal mesothelioma diagnosed 1 case of tuberculous peritonitis in 5 cases, 3 cases of gynecologic malignancies, pelvic inflammatory disease in 2 cases. 8 cases of ascites due to an unknown line of diagnostic laparoscopy, laparoscopic biopsy parallel rapid frozen section pathologic examination showed malignant peritoneal mesothelioma or cancer, surgery to cisplatin 80 ~ 100mg, Etoposide 300mg retained in the abdominal cavity 6h, is subject to normal paraffin immunohistochemical diagnosis plus four routine cytoreductive surgery; two cases of laparoscopic surgery, after giving up the line of PEC program (cisplatin 80mg + Etoposide 300mg intraperitoneal chemotherapy, cyclophosphamide 800mg intravenous chemotherapy ) chemotherapy after two courses were to give up treatment; 1 cases to give up surgery and chemotherapy; 1 case automatically discharged. Found two cases of ascites cells, nuclear pleomorphism and 1 case due to a high degree of suspicion of malignant peritoneal mesothelioma and laparotomy prompted rapid frozen section pathologic examination of malignant peritoneal mesothelioma, or cancer that is OK cytoreductive surgery, pathological diagnosis of malignant peritoneal skin tumors. 7 routine cytoreductive surgery after PEC chemotherapy treatment ranging from 1 to 8. Endoscopic, or intraoperative see the ascites 200 ~ 2700ml ranging from the omentum was pie, peritoneal see yellow-white nodules of varying sizes change, nodular-shaped part of the aggregation clusters than crisp, varying degrees of congestive parietal peritoneum, edema, vascular dilation, vascular network vague, still visible the uneven thickness of the corpus callosum-like thickening. Between the parietal and visceral peritoneum, omentum, mesentery and the formation of adhesions between the abdominal organs, adhesion more than its predecessor, to a lesser extent, only one cases of intestinal and omental adhesions into large clumps, concurrency is not entirely intestinal obstruction. Pathological types: epithelial-like type 2 cases, 9 cases without genotyping. 11 cases of 10 patients with follow-up, 1 patient lost to follow. Survival time from diagnosis is counted. 7 routine cytoreductive surgery were six cases of concurrent chemotherapy in 9 to 29 months between the death, 1 case lost to follow. Only two cases of laparoscopy-line chemotherapy after 6,11 months, respectively, and 2 patients without chemotherapy and cytoreductive surgery died at 2,6 months.

2 Discussion

The cause of malignant peritoneal mesothelioma is not yet entirely clear, and foreign reports its occurrence more with asbestos dust exposure on [1], that the epidemiological evidence of this disease is 70% ~ 80% of patients had history of exposure to asbestos dust and make asbestos fibers can cause pulmonary fibrosis (asbestosis), bronchial cancer and mesothelioma. Asbestos with mitotic spindle in the interaction, leading to haploid formation and some form of chromosome damage; crocidolite fibers (rich in iron) can cause the release of ROS; asbestos can induce DNA repair enzymes and DNA apurinic endo-pyrimidine enzyme expression and activity, suggesting that ROS produced by asbestos, and the DNA-damage. Asbestos inflammatory reaction caused by a variety of cytokines, these cytokines and asbestos limitations and systemic immunosuppressive activity. To reports of asbestos dust, but there was no history of exposure to [2,3]. This group of patients had a clear history of exposure to asbestos.

Occult onset of malignant peritoneal mesothelioma, clinical manifestations are not typical, the high rate of misdiagnosis. Clinically, the disease easily misdiagnosed as tuberculous peritonitis, gynecological malignant tumors, metastatic tumors and other diseases. The disease B ultrasound and CT examination may be found in abdominal or pelvic mass, ascites, peritoneal thickening, but there is no specificity. Peritoneal lesions of early CT is not easy found that when extensive peritoneal and mesenteric thickening and adhesions, it can prompt diagnosis of the disease, but it is not easy and ovarian cancer, and so identification of tumor metastasis. CA125 and CA153 increased in some patients, but see <500U / L, non-specific. Ascites cytology positive rate is low. The group of eight routine laparoscopy and diagnosed laparoscopic characteristics as follows: greater omentum was pie, there is more intra-abdominal fluid, peritoneal see the yellow-white nodules of varying sizes change, still visible the uneven thickness of the corpus callosum-like thickening. In this group one cases of intestinal and omental adhesions into large clumps, complicated by incomplete intestinal obstruction. Laparoscopy trauma, but the final diagnosis is still relying on pathology and immunohistochemistry.

Malignant peritoneal mesothelioma there is no uniform treatment. Localized foci of infection of surgical resection, external radiation, internal radiation therapy and chemotherapy were not significantly improve overall survival rate. The first diagnosis often found in tumors confined to the peritoneal cavity, so effective local treatment of benefit to extend the survival period. Surgical resection, cytoreductive treatment of malignant peritoneal mesothelioma is still an important tool. Surgery should be as much as possible on the removal of peritoneal tumor mass. If peritoneal thickening of the tumor tissue and can not cut the net may be burning electricity coagulation tumor tissue, so that cytoreductive [4]. Application of the U.S. National Cancer Institute and cisplatin chemotherapy for peritoneal hyperthermic perfusion results show that the 2-year survival rate of 80% of patients with tumor progression-free survival of an average period of 26 months [5]. Very poor prognosis without surgery chemotherapy, multiple deaths in one year. Surgical and / or chemotherapy are also more in a ~ 2 and a half years or so deaths. Most died from complications of primary tumor.

【References】
1 Hillerdal G. Malignant mesothelioma 1982 review of 470 published cases. Br J Dis Chest, 1983,77:321.

2 Wang Hao, Li Zhou, Zong-Hai Huang. Diagnosis and treatment of malignant peritoneal mesothelioma. First Military Medical University, 2004,24 (8): 965 ~ 966.

3 Xiao Kai-yin, pear Lequn, PENG Min-hao, et al. 10 cases of malignant peritoneal mesothelioma, diagnosis and treatment analysis. Zhonghua General Surgery, 2004,19 (9): 545 ~ 546.

4 Bai Zhi-jun, CHEN Dao-da. Female diffuse malignant peritoneal mesothelioma diagnosis and treatment. Chinese Journal of Practical Surgery, 2003,23 (6): 358 ~ 359.

5 Ceelen WP, Hesse U, Hemptinne B, et al. Hyperthermic intraperitoneal chemoperfusion in the treatment of locally advanced intraabdominal cancer. Br J Surg, 2000,87:1006 ~ 1015.