Clinical staging of peritoneal mesothelioma

Peritoneal mesothelioma (peritoneal mesothelioma) for the primary in the peritoneal epithelium and mesothelial cancer organizations, clinical rare. Can be categorized as pathological adenomatoid mesothelioma (adenomatoid mesothelioma), cystic mesothelioma (cystic mesothelioma) and malignant mesothelioma (peritoneal malignant mesothelioma, PMM).
Peritoneal mesothelioma (peritoneal mesothelioma) for the primary in the peritoneal epithelium and mesothelial cancer organizations, clinical rare. Can be categorized as pathological adenomatoid mesothelioma (adenomatoid mesothelioma), cystic mesothelioma (cystic mesothelioma) and malignant mesothelioma (peritoneal malignant mesothelioma, PMM). The first two are benign. Cystic mesothelioma more common in women, the cause is unknown, occur in the pelvic or accessories around, showing single or multiple cystic masses; patients often palpable abdominal mass due to the treatment. Malignant peritoneal mesothelioma (PMM) account for about 30% of malignant mesothelioma; its occurrence is closely related with exposure to asbestos, about 5% of patients had history of exposure; asbestos fiber intake by mouth, after translocation through the intestinal wall into the peritoneal and pleural metastasis from disease or from. From exposure to asbestos to diagnosis, the disease incubation period of up to 25 to 40 years. But the domestic 1951 ~ 1993 20 reported in the literature 161 cases of PMM in only 1 case had history of exposure to asbestos. ZHOU Ya-kang and other reported 47 cases of mesothelioma there are eight cases of malignant peritoneal mesothelioma, as well as the author collected two cases have history of exposure to asbestos. In the absence of asbestos-exposed populations, its incidence rate is about 1 person / 1 million person-years may be related to certain viral infections and genetic factors. PMM has reported 1 cases of foreign patients come into contact with more than 40 years ago, thorium dioxide colloid (Thorotrast). PMM often occurs in men over the age of 40. Visceral or parietal peritoneum can suffer from; and tumors can be a direct violation of abdominal and pelvic organs; 50% ~ 70% of patients with lymphatic and / or hematogenous metastasis of liver, kidney, adrenal gland, lung, bone and so on.

PMM lack of specific clinical manifestations, may have abdominal pain, constipation, abdominal distention, weight loss, and other intestinal obstruction performance. Physical examination can be found such as ascites or peritoneal mass. Ascites as exudate, in part to bloody. The disease often misdiagnosed as tuberculous peritonitis, recurrent spontaneous peritonitis, mesenteric inflammation or peritoneal metastasis of cancers. Ascites hyaluronic acid were significantly higher than 0.8g / L were found only in PMM. Ascites cytology has a certain value, but the results often hard to tell. Serum carbohydrate antigen -125 (CA125) increased to help diagnose the disease.

Clinical staging: Butchart others will PMM is divided into four: I tumors confined to peritoneal; Ⅱ tumors violation of intra-abdominal lymph nodes; Ⅲ tumors outside the intra-abdominal lymph node metastasis; Ⅳ period of distant metastasis. The classification will help select treatment. PMM has no effective standard treatment. Prognosis is poor, the survival period after diagnosis the median one-year survival of more than 2 years less than 20%. Mainly from cachexia or bowel obstruction, the cause of death is rarely associated with tumor distant metastasis.