After the introduction of cytoreductive surgery followed by intraperitoneal hyperthermic perfusion, a significant prolongation in the median survival has been achieved, with approximately half the patients alive at 5 years.[48,62] Tumor histopathology, previous mesothelioma surgical score, lesion size, gender, distribution (assessed with Gilly classification and peritoneal cancer index), and completeness of cytoreduction score[45,62] represent the main prognostic index.
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]
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.
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]
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.
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