Multicystic mesothelioma and well-differentiated peritoneal mesothelioma typically occur in the peritoneum of women without a history of asbestos exposure and show low malignant potential. Multicystic mesothelioma predominantly affects the pelvic peritoneum of young women, has a high tendency to recur locally, but no tendency to metastasis, and consequently requires only surgical treatment.[63,64]
Some theories link this type of mesothelioma to fibromatoses, suggesting a reactive hyperplastic process more than a neoplastic one.[65] A familial form of multicystic mesothelioma has also been described.[66] Sarcomatoid mesothelioma, although rare, is the most aggressive histotype, with a median survival reported of only 3.8 months.[67,68]Conclusions
Malignant mesothelioma is a highly lethal neoplasm, and diagnosis is difficult because of the frequency of vague symptoms present over a long time. Given the rarity of peritoneal mesotheliomas, it is difficult to obtain precise information regarding their incidence, natural history and optimal management. Despite many histopathologic similarities between peritoneal and pleural mesotheliomas, clinical and prognostic features may be quite different, and the precise nature of MPM cannot be extrapolated from the pleural form.
In those patients diagnosed and treated early with a multimodality approach, including cytoreductive surgery and postoperative intraperitoneal hypothermic chemotherapy, a relatively long survival can be expected, with a median survival of 50-60 months.[69,70] This represents a significant advance due to treatment improvements. As the incidence of MPM begins to decrease as asbestos exposure is eliminated, the prognosis for those diagnosed with mesothelioma will continue to improve.
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