15-12: Mesothelioma

(See Chapter 39.)

Primary abdominal malignant mesothelioma is a rare tumor. Up to 50% of cases have a history of asbestos exposure. Presenting symptoms and signs include abdominal pain or bowel obstruction, increased abdominal girth, and small to moderate ascites. The chest radiograph reveals pulmonary asbestosis in over 50%. The ascitic fluid is hemorrhagic, with a low serum-ascites albumin gradient. Cytology is often negative. Abdominal CT or PET-CT may reveal sheet-like masses involving the mesentery and omentum. Diagnosis is made by core needle biopsy or at laparotomy or laparoscopy. The prognosis is extremely poor, but long-term survivors have been described with a combination of surgical debulking of tumor followed by heated intraoperative intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy. Postoperative combination chemotherapy may be helpful. Multicystic and well-differentiated papillary mesotheliomas are associated with a long survival with surgical treatment alone.