Mesothelioma can arise both from visceral and parietal peritoneum. It is diagnosed in advanced stages in most cases, and it often takes considerable time to arrive at the correct diagnosis, as the mean symptoms-to-diagnosis time reported is 122 days.[3] The most frequently reported initial symptoms are abdominal pain (35%), abdominal swelling (31%), anorexia, marked weight loss, and ascites[3,15–17]; less frequently night sweats and hypercoagulability.
[18] Clinical presentation with fever of unknown origin,[15] intestinal obstruction,[19] or surgical emergency (due to acute inflammatory lesions)[3,20] have been reported. In particular, compression of the gastrointestinal tract can complicate the mesothelioma disease, but it is rarely the presenting symptom. Occasionally the diagnosis has been made incidentally during laparoscopy.[21] Paraneoplastic syndromes associated with mesothelioma, and in particular with peritoneal mesothelioma, are thrombocytosis,[3] hypoglycemia,[9] venous thrombosis,[22] paraneoplastic hepatopathy, and a wasting syndrome.[23]
Potentially useful serum markers for diagnosis and follow-up are the serum mesothelin-related protein (SMRP), which is elevated in more than 84% of mesotheliomas, and has a 60% sensitivity at diagnosis; CA-125, CA 15-3, hyaluronic acid, and osteopontin[24–26] are other potential markers.
Computed tomography (CT) findings of peritoneal mesothelioma are nonspecific and not sufficient to establish a diagnosis; however, CT is useful for the detection, characterization, staging, and guiding biopsy of peritoneal masses.[27] At CT, MPM appears as solid, heterogeneous, enhancing soft-tissue masses. Its growth pattern is expansive more than infiltrating.[13
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