Mesothelioma, Peritoneal

Key Features

• Rare malignancy of peritoneum (as well as pleura)

• History of asbestos exposure in up to 50%

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 is made by core needle biopsy or at laparotomy or laparoscopy

Treatment

• Prognosis is extremely poor

• 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