Malignant peritoneal mesothelioma

Table 1 Symptoms and signs of DMPM

Symptoms

Abdominal pain (40%)

Abdominal distension (40%)

Constitutional symptoms, such as weight loss and fever (20%)

Incidental finding (10%)

Signs

Ascites (70%)

Abdominal or pelvic mass (30%)

Abdominal wall hernia (10%)

Guarding and rebound tenderness (10%)

Pleural effusion (5%)

DMPM: Diffuse malignant peritoneal mesothelioma.

Table 2 CT characterization of DMPM

CT characterization of DMPM

Diffuse involvement of all peritoneal surface, rarely with an epicenter

Preponderance of disease in mid-abdomen and pelvic

Presence of serous ascites rather than mucoid

Absence of metastasis, irrespective of the volume of disease

CT: Computed tomography.

Table 3 Immunostains of diffuse malignant peritoneal mesothelioma and adenocarcinoma

Immunostains	Mesothelioma	Adenocarcinoma
BER-EP4	0-11	90-100
B27.3	0-5	81
Calretinin	42-100	6-9
CA-125	14-94	90
CD15 (LEU-MI)	0-10	58-100
CEA	0-10	90-100
EMA	80-100	83
P53	45	43-53
PAN-Cytokeratin	100	100
PLAP	0	50
VIMENTIN	40	0-6
S-100	0-11	31

Table 4 Median survival of DMPM using traditional treatment modalities

Authors	n	Median survival (mo)
Chailleux et al[4], 1988	11/167	101
Antman et al[5], 1988	37/180	151
Sridhar et al[6], 1992	13/50	9.51
Markman et al[7], 1992	19	9
Yates et al[8], 1997	14/272	141
Neumann et al[9], 1999	74	12
Eltabbakh et al[10], 1999	15	12.5

¹Combined pleural and peritoneal mesothelioma.

Table 5 Recent updates on cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for DMPM

Authors	n	Median survival (mo)	Survival rates (%)
			1-yr	2-yr	3-yr	5-yr	7-yr
Yan et al[19], 2006	100	52	78	64	55	46	39
Feldman et al[14], 2003	49	92	86	77	59	59	-
Deraco et al[16], 2006	49	NR	88	74	65	57	-
Brigand et al[17], 2006	15	36	69	58	43	29	-
Loggie et al[18], 2001	12	34	60	60	50	33	33

NR: Median survival was not reached.

Table 6 Interpretative CT classification of small bowel and small bowel mesentery for DMPM

Class	Interpretative CT classification of small bowel and small bowel mesentery
0	No ascites in the region of the small bowel; no evidence of peritoneal tumor present; the jejunal and ileal vessels appear as round and curvilinear densities within the mesenteric fat
I	Free ascites only; mesentery is stranded and stratified as the fluid accumulation outlined the small bowel mesentery; small bowel vessels are easily identified within the mesenteric fat
II	Tumor involvement of small bowel and/or its mesentery; peritoneal surface is thickened and enhanced due to the presence of tumor nodules or plaques; there may be an increased amount of ascites and the mesentery may appear stellate or pleated
III	Increased solid tumor involvement and adjacent small bowel loops are matted together in some cuts; small bowel mesenteric vessels are difficult to define due to obliteration of mesenteric fat