Peritoneal Mesothelioma with Residential Asbestos Exposure. Report of a Case with Long Survival (Seventeen Years) Analyzed by Cgh-Array

AbstractPeritoneal mesothelioma is a rare tumor typically presenting with ascites and associated with occupational asbestos exposure with a latency period of 20–40 years. Intensive multi-modality approach combining cytoreductive surgery, intraperitoneal chemotherapy and possibly radiotherapy can be considered, but otherwise the prognosis is rather poor. Palliative chemotherapy may be an option in these rare cases. However, no approved systemic treatment exists for peritoneal mesothelioma. We present here a patient with peritoneal mesothelioma who was treated with the combination of pemetrexed with cisplatin shortly after the failure of hyperthermic intraperitoneal chemotherapy. The patient experienced durable partial response to the treatment, resolution of ascites, and returned to his normal daily life activities. With the exception of palliative chemotherapy in case of patients in good condition, therapeutic options in patients with peritoneal mesothelioma are currently very limited. The combination of pemetrexed and cisplatin can lead to long-term control in selected patients.

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Malignant peritoneal mesothelioma: Clinicopathological features, prognostic factors, and survival outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.650 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 650-650

Author(s):

Meera Patel ◽

Jonathan M. Loree ◽

Melissa W. Taggart ◽

Anais Malpica ◽

Aurelio Matamoros ◽

...

Keyword(s):

Prognostic Factors ◽

Asbestos Exposure ◽

Univariate Analysis ◽

The United States ◽

Peritoneal Mesothelioma ◽

Age At Diagnosis ◽

Ca 125 ◽

Survival Outcomes ◽

Histologic Subtype ◽

Neutrophil Lymphocyte Ratio

650 Background: Peritoneal mesothelioma (PeM) is an orphan disease with approximately 300-400 cases diagnosed in the United States each year. Due to its rarity, data on its presentation and prognostic factors is limited. The purpose of this study was to investigate the clinicopathological profile and outcome of Malignant PeM (MPeM). Methods: We retrospectively reviewed 128 PeM patients (pts) seen at UTMDACC (2011 - 2017) comprised of 111 MPeM and 17 variants (VPeM) [9 well-differentiated papillary and 8 multicystic]. Kaplan-Meier method was used to estimate median overall survival (mOS) and compared with log-rank tests. Results: Median age at diagnosis was 57 yrs. with a higher proportion of women (61%). The mOS for MPeM was significantly shorter than VPeM (HR 3.7, 95% CI: 1.6 – 8.4, P = 0.002). Among pts with MPeM, median age at diagnosis was 56 yrs. and 58% were women. Only 22% had prior exposure to asbestos. Epithelioid subtype was seen in 94 (85%) pts. Calretinin and WT-1 IHC were positive in 98% and 96% of cases. BerEP4 and MOC-31 IHC were negative in 90% and 84% of cases. After median follow-up of 31 months (m), the mOS for MPeM cohort was 78 m. In univariate analysis, age, prior asbestos exposure, ECOG PS, histologic subtype, CA125, neutrophil-lymphocyte ratio (NLR) and cytoreductive surgery (CRS) were found to be associated with OS. In multivariate analyses, age ≥ 65 years (HR 4.5, 95% CI: 1.3 - 15.2, P = 0.02), prior asbestos exposure (HR 4.1, 95% CI: 1.1 – 15.6, P = 0.04), poor PS (ECOG 2/3) (HR 8.9, 95% CI: 1.7 – 47.7, P = 0.01), elevated CA125 ( > 3X upper limit of normal) (HR 4.5, 95% CI: 1.3 – 15.5, P = 0.02), and high NLR (HR 3.8, 95% CI: 1.1 – 12.6, P = 0.03) were found to be independently associated with poor OS. A total of 50 (45%) pts underwent CRS and among these the completion of cytoreduction score (CCS) was strongly associated with OS (mOS: 201 m, 53 m and 36 m for CCS 0, 1, 2/3, respectively, P = 0.005). Conclusions: MPeM is associated with poor survival outcomes. Prognostic factors include age, history of asbestos exposure, CA-125 level, NLR, and PS. CRS with CCS 0 results in favorable survival. Further understanding of molecular genetics is warranted to improve prognostication and outcomes.

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Malignant Peritoneal Mesothelioma: Clinicopathological Characteristics of Two Cases

Case Reports in Surgery ◽

10.1155/2014/748469 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Mustafa Cem Algın ◽

Faik Yaylak ◽

Zülfü Bayhan ◽

Figen Aslan ◽

Nilüfer Araz Bayhan

Keyword(s):

Abdominal Pain ◽

Asbestos Exposure ◽

Final Diagnosis ◽

Clinicopathological Characteristics ◽

Clinical Findings ◽

Peritoneal Mesothelioma ◽

Abdominal Masses ◽

History Of ◽

The Right ◽

Specific Symptoms

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.

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Synchronous multiple primary malignant neoplasms: a case report of malignant peritoneal mesothelioma and neuroendocrine rectal tumor

EUREKA Health Sciences ◽

10.21303/2504-5679.2021.001898 ◽

2021 ◽

pp. 81-86

Author(s):

Oleksandr Bondar ◽

Sergiі Chetverikov ◽

Viacheslav Maksymovskyi ◽

Dmytro Atanasov ◽

Mykhailo Chetverikov ◽

...

Keyword(s):

Minimally Invasive ◽

Argon Plasma Coagulation ◽

Asbestos Exposure ◽

Rectal Tumor ◽

Peritoneal Mesothelioma ◽

Special Treatment ◽

Malignant Neoplasms ◽

Malignant Peritoneal Mesothelioma ◽

Invasive Treatment ◽

Abdominal Tumor

We report a rare case of synchronous malignant peritoneal mesothelioma of the biphasic histological type and neuroendocrine tumor (NET) of the rectum without history of asbestos exposure. During 2 years since manifestation of the disease the patient underwent 3 cytoreductive surgeries (CRS): removal of the tumor of the sigmoid mesentery, resection of the rectosigmoid junction completeness of cytoreduction (CC) 0 (2017), omentectomy and partial parietal peritonectomy CC-0 (2017), atypical resection of S2, S4, S5 liver, the removal of the abdominal tumor with left-sided en-block hemicolectomy, partial parietal peritonectomy, argon-plasma coagulation of tumor foci on the mesentery of the small intestine CC-2 (2018) and Transanal Minimally Invasive Surgery-removal of neuroendocrine rectal tumor (2017). The patient underwent hyperthermic intraperitoneal chemotherapy (HIPEC) twice (during 2nd and 3rd CRS). Different regimens of HIPEC were performed: cisplatin + doxorubicin (2017) and metamycin C (2018). The patient received 4 courses of adjuvant chemotherapy with cisplatin plus pemetrexed in 2017 and 3 courses of the chemotherapy with gemcitabine and carboplatin plus bevacizumab in 2018. The patient survived 21 months after the detection of malignant peritoneal mesothelioma in 2017 and died 4 months after the last cytoreductive surgery from the progression of the disease. Histological subtype of MPMP remains important factor in the prognosis of the disease even on the early stages though patient had received the most aggressive variant of special treatment. Minimally invasive treatment tactics of NET demonstrated clinical effectiveness.

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Two cases of malignant peritoneal mesothelioma without asbestos exposure

Current Gynecologic Oncology ◽

10.15557/cgo.2019.0024 ◽

2019 ◽

Vol 17 (4) ◽

pp. 185-188

Author(s):

Jung-Woo Park ◽

Keyword(s):

Asbestos Exposure ◽

Peritoneal Mesothelioma ◽

Malignant Peritoneal Mesothelioma

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Peritoneal mesothelioma mortality in Italy: Spatial analysis and search for asbestos exposure sources

Cancer Epidemiology ◽

10.1016/j.canep.2019.04.001 ◽

2019 ◽

Vol 60 ◽

pp. 162-167 ◽

Cited By ~ 1

Author(s):

A. Zona ◽

L. Fazzo ◽

G. Minelli ◽

M. De Santis ◽

C. Bruno ◽

...

Keyword(s):

Spatial Analysis ◽

Asbestos Exposure ◽

Peritoneal Mesothelioma

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A single-center retrospective cohort study evaluating the role of neoadjuvant chemotherapy in malignant peritoneal mesothelioma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e21093 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e21093-e21093

Author(s):

Xiao Wang ◽

Sharyn I. Katz ◽

Leonid Roshkovan ◽

Suzanne Walker ◽

Sally McNulty ◽

...

Keyword(s):

Overall Survival ◽

Cohort Study ◽

Systemic Therapy ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Asbestos Exposure ◽

Symptom Relief ◽

Peritoneal Mesothelioma ◽

Malignant Peritoneal Mesothelioma ◽

Single Center

e21093 Background: Malignant peritoneal mesothelioma (MPM) is a rare variant of malignant mesothelioma, representing < 30% of cases. Standard of care is cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) when feasible. The benefit of systemic chemotherapy (chemo) (Neoadjuvant- N, Adjuvant- A, or 1st-line metastatic –M) is not well established and some retrospective studies report worse outcomes with N chemo. However, our institution has favored use of N chemo prior to surgery for symptom relief and surgical optimization. We conducted a single-center retrospective cohort study of MPM patients treated at our institution to evaluate the effect of N vs. A chemo on outcomes. Methods: We identified non-papillary MPM patients via ICD9/10 codes seen at our institution between 1/1/2009 and 9/1/2019. Pts were followed until 1/1/2020. Patients without pathologic diagnosis were excluded. We explored the effect of receipt of CRS, type of systemic therapy, and histology on overall survival. Median overall survival (mOS) from diagnosis was estimated from Kaplan-Meier curves. A Cox proportional hazard model computed hazard ratios (HR) to assess the effect of the exposure on OS. Results: We identified 47 patients with non-papillary MPM: median age 62 years, 77% epithelioid histology, 74.5% white, 55.3% known asbestos exposure. CRS was performed in 24 (51%) and 18/24 (75%) received HIPEC. The majority received systemic therapy (34/47 (72%)). Among those that received chemo and surgery, N chemo was more common than A chemo (N:12 (all platinum/pemetrexed), A:7). Median OS was 52.7 months (mo) overall and 77.2 mo with surgery vs 20.2 mo without (log rank p = 0.006). Toxicity from N chemo did not prevent surgery with 8/12 successfully receiving surgery (1 surgery scheduled, 2 lost to follow up). Of the 10 pts with evaluable scans: 5 had radiographic reduction of disease (2 complete responses by RECIST 1.1), 4 stable disease and 1 with disease growth. N chemo reduced ascites in 3 out of 4 pts with baseline ascites. N chemo was not associated with worse mOS compared to A chemo (HR 0.64, 95% CI 0.1-3.0, p = 0.62). Non-epithelioid histology was not associated with a worse OS compared to epithelioid (HR 1.5, 95% CI 0.6-4.1, p = 0.4). Conclusions: N chemo was not associated with worse outcomes compared to A chemo and toxicity from N chemo did not preclude surgery. In addition, N chemo resulted in reduction of disease burden and ascites in pts with MPM.

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