Peritoneal Mesothelioma: A Review

Alessio Bridda, MD, Ilaria Padoan, MD, Roberto Mencarelli, MD, Mauro Frego, MD

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Epidemiology

Mesotheliomas are aggressive tumors arising from serous surfaces: pleura (65%-70%), peritoneum (30%), tunica vaginalis testis, and pericardium (1%-2%).[1] Peritoneal mesothelioma was first described in 1908 by Miller and Wynn. It is a rare neoplasm with a rapid fatal course (median survival 6-12 months,[2] mean symptoms-to-survival time 345 days[3]). In the United States, the overall prevalence is 1-2 cases per million, with an estimated incidence of 200-400 new cases annually. It was exceedingly rare until 1930, when industry increased the use of asbestos, which is the principal risk factor for the disease. It can occur in any age group, although the 50- to 69-year age group is the most affected[4,5]: only an estimated 2% to 5% of all cases present in the first 2 decades of life.[6] It is more common in men, possibly because of the higher male occupational exposure to asbestos.[7] The main risk factor is asbestos exposure, primarily the crocidolite variety, although some tumors have arisen in ports of prior radiation,[8] or after thorium, talc, erionite or mica exposure,[7,9,10] as well as in patients affected by familial Mediterranean fever[10,11,12] and diffuse lymphocytic lymphoma.[10] Only 50% of patients with a peritoneal origin of MPM have a history of asbestos exposure.[13,14] This association increases to 80% in mesotheliomas with the more common pleural origin. A reported association with simian virus (SV) 40 remains controversial.[8]

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