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Key Features

  • Rare malignancy of peritoneum, pleura

  • History of asbestos exposure in > 70%

Clinical Findings

  • Abdominal pain or bowel obstruction

  • Increased abdominal girth, with small to moderate ascites

Diagnosis

  • Chest radiograph shows pulmonary asbestosis in > 50%

  • Ascitic fluid is hemorrhagic, with low serum-ascites albumin gradient

  • Ascitic fluid cytology is often negative

  • Abdominal CT or positron emission tomography-CT reveals sheet-like masses involving the mesentery and omentum

  • Diagnosis at laparotomy or laparoscopy

Treatment

  • Prognosis is extremely poor

  • However, some patients survive long-term after a combination of surgical debulking and intraoperative intraperitoneal chemotherapy, followed by early postoperative intraperitoneal chemotherapy

  • Postoperative radiotherapy or combination chemotherapy may be helpful

  • Multicystic and well-differentiated papillary mesotheliomas are associated with a long survival with surgical treatment alone

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