Mesothelioma, Peritoneal

Rare malignancy of peritoneum, pleura

History of asbestos exposure in > 70%

Abdominal pain or bowel obstruction

Increased abdominal girth, with small to moderate ascites

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

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