Peritoneal Mesothelioma: A Review

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

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Outcome and Prognosis

Mesotheliomas are almost universally considered a fatal neoplasm, and until recently the treatment options were very limited and ineffective. The overall median survival was only 1 year. Nevertheless, a few cases of long-term survivors have been reported (longest survival reported is 19 years[23]).

After the introduction of cytoreductive surgery followed by intraperitoneal hyperthermic perfusion, a significant prolongation in the median survival has been achieved, with approximately half the patients alive at 5 years.[48,62] Tumor histopathology, previous surgical score, lesion size, gender, distribution (assessed with Gilly classification and peritoneal cancer index), and completeness of cytoreduction score[45,62] represent the main prognostic index.

Multicystic mesothelioma and well-differentiated peritoneal mesothelioma typically occur in the peritoneum of women without a history of asbestos exposure and show low malignant potential. Multicystic mesothelioma predominantly affects the pelvic peritoneum of young women, has a high tendency to recur locally, but no tendency to metastasis, and consequently requires only surgical treatment.[63,64] Some theories link this type of mesothelioma to fibromatoses, suggesting a reactive hyperplastic process more than a neoplastic one.[65] A familial form of multicystic mesothelioma has also been described.[66] Sarcomatoid mesothelioma, although rare, is the most aggressive histotype, with a median survival reported of only 3.8 months.[67,68]

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