Fact-sheet: Peritoneal mesothelioma


Updated on 04/19/2018 at 11:39 AM

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Definition

Peritoneal mesothelioma (PM) = Primary malignant peritoneal tumor arising from the parietal cells (mesothelium) of the peritoneal cavity

  • Arises from the coelomic cavities (pleural > peritoneal > pericardial > vaginal localization)
  • May be benign or malignant
  • Risk factor: Asbestos +++

Clinical features

  • General health deterioration
  • Ascites
  • Abdominal pain
  • Bowel transit disorders
  • Palpable abdominal mass

CT

Highly variable

  • Ascites: 80%
  • Greater omentum: 75%
  • Nodules of the extra-omental peritoneal fat: 40%
  • Densification of the extra-omental peritoneal fat: 40%
  • Thickening of the peritoneal fascia: 25%
  • Pleural involvement: 25%
  • Mesentery: 20%
  • Adjacent cysts: 10%

Summary

  • Ascites very common but absent in sarcomatoid PM
  • Encasement of organs but never scalloping
  • Nodules of the peritoneal fat and thickening of the peritoneal fascia: exclusively malignant PM
  • Non-nodular fat densification: most often malignant PM (occasionally benign)

Management

  • Malignant PM
  • Cytoreductive surgery + HIPEC
  • 5-year survival: 50%
  • Median 60 months
  • Chemotherapy.
  • Benign PM
  • Surgical treatment (no indication for chemotherapy)
  • Excellent prognosis -> e.g., multicystic PM: 90% 5-year survival.

Classification

  • Malignant PM
  • epithelioid
  • biphasic
  • sarcomatoid
  • Benign PM
  • well-differentiated papillary
  • multicystic
  • adenomatoid
  • peritoneal inclusion cyst

Differential diagnosis

  • Neoplastic
    Peritoneal carcinomatosis (primary lesion, visceral metastases)
  • Peritoneal pseudomyxoma (scalloping)
  • Desmoplastic small round cell tumor (young male, large tissue masses +/- calcified, metastases)
  • Primary peritoneal papillary serous carcinoma
  • Peritoneal lymphoma (coalescent nodal masses with homogeneous enhancement)
  • Infectious Peritoneal tuberculosis (loculated ascites, numerous lymphadenopathies)