Benign multicystic peritoneal mesothelioma(BMPM)is a rare tumor originating from peritoneal mesothelial cells.Here,we present a case of an 18-year-old male with right lower abdominal pain.Physical examination revealed...Benign multicystic peritoneal mesothelioma(BMPM)is a rare tumor originating from peritoneal mesothelial cells.Here,we present a case of an 18-year-old male with right lower abdominal pain.Physical examination revealed a palpable mass with unclear boundaries.Laboratory tests showed elevated levels of monocytes and high-sensitivity C-reactive protein.CT scan revealed a cystic mass in the ileocecal region with multiple septations.Laparoscopic surgery confirmed a cystic solid mass resembling beads on the colon’s right side.Immunohistochemistry confirmed BMPM diagnosis.BMPM,especially in the ileocecal region,is uncommon and presents diagnostic challenges.Differential diagnosis includes lymphangioma,peritoneal metastasis,and malignant mesothelioma.CT findings,such as thin cyst walls and septations,aid in diagnosis.Recognition of BMPM’s imaging features improves diagnostic accuracy.Surgical resection remains the primary treatment.This case underscores the importance of considering BMPM in young male patients with abdominal pain and emphasizes the value of imaging modalities in accurate diagnosis and management.展开更多
BACKGROUND Thoracic empyema and malignant pleural mesothelioma(MPM)are distinct medical conditions with similar symptoms,including cough,chest pain,and breathing difficulty.We present a rare MPM case mimicking thoraci...BACKGROUND Thoracic empyema and malignant pleural mesothelioma(MPM)are distinct medical conditions with similar symptoms,including cough,chest pain,and breathing difficulty.We present a rare MPM case mimicking thoracic empyema.Physicians must consider MPM risks for patients exposed to building material who exhibit lobulated pleural effusions,indicating thoracic empyema.CASE SUMMARY A 68-year-old retired male construction worker suffered from shortness of breath and chest tightness over 10 d,particularly during physical activity.A poor appetite and 4 kg weight loss over the past 3 wk were also reported.Chest images and laboratory data concluded a tentative impression of empyema thoracis(right).Video-assisted thoracic surgery with decortication and delobulation(right)was conducted.The pathological report yielded an MPM diagnosis.Refractory pleural bilateral effusions and respiratory failure developed postoperatively,and the patient died three weeks after the operation.CONCLUSION Thoracic empyema and MPM are distinct medical conditions that can present similar symptoms,and video-assisted thoracic surgery facilitates an accurate diagnosis.Empyema-mimicking presentations and postoperative refractory pleural effusion may indicate a poor MPM outcome.展开更多
BACKGROUND Malignant peritoneal mesothelioma(MPeM)is a rare cancer with a poor prognosis at advanced stage,and the standard first-line treatment for inoperable patients is chemotherapy.Although combining programmed ce...BACKGROUND Malignant peritoneal mesothelioma(MPeM)is a rare cancer with a poor prognosis at advanced stage,and the standard first-line treatment for inoperable patients is chemotherapy.Although combining programmed cell death 1(PD-1)inhibitors with chemotherapy is generally considered safe and effective in several malignant solid tumors,there are few reports regarding initial immunochemotherapy in advanced MPeM.CASE SUMMARY Here,to our knowledge,we present the first case of a patient with epithelioid subtype MPeM,who was treatment-naïve and benefited from initial PD-1 inhibitor plus standard chemotherapy with a prolonged progression-free survival(PFS)and good tolerance.A 49-year-old man was admitted to our hospital for a persistent burning sensation in the abdomen.Computed tomography revealed a solid mass in the lower abdomen,which was subsequently diagnosed histologically as epithelioid subtype MPeM by core needle biopsy.The patient received eight cycles of pemetrexed 800 mg(day 1),cisplatin 60/50 mg(day 1–2),and zimberelimab(PD-1 inhibitor)240 mg(day 1)every 3 wk.He achieved significant reduction of peritoneal tumors with remarkable improvement in symptoms.The best tumor response was partial remission with a final PFS of 7 mo.No immunerelated adverse event occurred during the combination treatment.CONCLUSION The outcome of the present case demonstrates the promising anti-tumor activity of immunochemotherapy to treat inoperable MPeM in the future.展开更多
Malignant pleural mesothelioma(MPM) is the most common type of malignant mesothelioma. It is a rare tumor linked to asbestos exposure and is associated with a poor prognosis. Until very recently, patients with advance...Malignant pleural mesothelioma(MPM) is the most common type of malignant mesothelioma. It is a rare tumor linked to asbestos exposure and is associated with a poor prognosis. Until very recently, patients with advanced or unresectable disease had limited treatment options, primarily based on doublet chemotherapy with cisplatin and pemetrexed. In 2020 and 2021, after more than a decade with no major advances or new drugs, two phase Ⅲ clinical trials published results positioning immunotherapy as a promising option for the first-and second-line treatment of MPM. Immunotherapy has revolutionized the treatment of many cancers and is also showing encouraging results in malignant mesothelioma. Both immune checkpoint inhibition and dual cytotoxic T-lymphocyte–associated antigen 4 and programmed death-ligand 1 pathway blockade resulted in significantly improved overall survival in randomized phase Ⅲ trials. In the Check Mate 743 trial, first-line therapy with nivolumab plus ipilimumab outperformed standard chemotherapy, while in the CONFIRM trial, nivolumab outperformed placebo in patients previously treated with chemotherapy. These two trials represent a major milestone in the treatment of MPM and are set to position immunotherapy as a viable alternative for treatment-naive patients and patients with progressive disease after chemotherapy.展开更多
Malignant mesothelioma is a highly aggressive neoplasm.The incidence of malignant mesothelioma is increasing worldwide.Diffuse malignant peritoneal mesothelioma(DMPM) represents one-fourth of all mesotheliomas.Associa...Malignant mesothelioma is a highly aggressive neoplasm.The incidence of malignant mesothelioma is increasing worldwide.Diffuse malignant peritoneal mesothelioma(DMPM) represents one-fourth of all mesotheliomas.Association of asbestos exposure with DMPM has been observed,especially in males.The great majority of patients present with abdominal pain and distension,caused by accumulation of tumors and ascitic ? uid.In the past,DMPM was considered a pre-terminal condition;therefore attracted little attention.Patients invariably died from their disease within a year.Recently,several prospective trials have demonstrated a median survival of 40 to 90 mo and 5-year survival of 30% to 60% after combined treatment using cytoreductive surgery and perioperative intraperitoneal chemotherapy.This remarkable improvement in survival has prompted new search into the medical science related to DMPM,a disease previously ignored as uninteresting.This review article focuses on the key advances in the epidemiology,diagnosis,staging,treatments and prognosis of DMPM that have occurred in the past decade.展开更多
Malignant peritoneal mesothelioma(PM) is an infrequent disease which has historically been associated with a poor prognosis. Given its long latency period and non-specific symptomatology, a diagnosis of PM can be sugg...Malignant peritoneal mesothelioma(PM) is an infrequent disease which has historically been associated with a poor prognosis. Given its long latency period and non-specific symptomatology, a diagnosis of PM can be suggested by occupational exposure history, but ultimately relies heavily on imaging and diagnostic biopsy. Early treatment options including palliative operative debulking, intraperitoneal chemotherapy, and systemic chemotherapy have marginally improved the natural course of the disease with median survival being approximately one year. The advent of cytoreduction(CRS) with hyperthermic intraperitoneal chemotherapy(HIPEC) has dramatically improved survival outcomes with wide median survival estimates between 2.5 to 9 years; these studies however remain largely heterogeneous, with differing study populations, tumor biology, and specific treatment regimens. More recent investigations have explored extent of cytoreduction, repeated operative intervention, and choice of chemotherapy but have been unable to offer definitive conclusions. CRS and HIPEC remain morbid procedures with complication rates ranging between 30% to 46% in larger series. Ac-cordingly, an increasing interest in identifying molecular targets and developing targeted therapies is emerging. Among such novel targets is sphingosine kinase 1(SphK1) which regulates the production of sphingosine-1-phosphate, a biologically active lipid implicated in various cancers including malignant mesothelioma. The known action of specific SphK inhibitors may warrant further exploration in peritoneal disease.展开更多
Benign multicystic peritoneal mesothelioma(BMPM)is a rare cystic mesothelial lesion that occurs predominantly in reproductive aged women.A 56-year-old Caucasian male was admitted to our surgical department with a chie...Benign multicystic peritoneal mesothelioma(BMPM)is a rare cystic mesothelial lesion that occurs predominantly in reproductive aged women.A 56-year-old Caucasian male was admitted to our surgical department with a chief complaint of a painful mass in his right lower abdomen for almost 2 years.The physical examination revealed a palpable painful mass.Computed tomography demonstrated an irregular,cystic tumor in his right lower abdomen.There was no obvious capsule or internal septations.No enhancement after intravenous administration of contrast was noted.An exploratory laparotomy was performed,and a multicystic tumor and adherent to the caecum was noted.The walls of the cysts were thin and smooth,filled with clear fluid,and very friable.An en bloc resection of the tumor,including appendix and caecum,was performed.Histological examination revealed multiple cysts lined with flattened simple epithelial cells,and the capsule walls of the cysts were composed of fibrous tissue.Immunohistochemical analysis documented positive expression of mesothelial cells and calretinin.The final diagnosis was BMPM.The patient was well at 6-mo follow-up.BMPM is exceedingly rare lesion.A complete resection of the tumor is required.The diagnosis of BMPM is based on pathological analysis.展开更多
Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon and rapidly fatal tumor.Therapeutic options have traditionally been limited and ineffective.The biologic and molecular events correlated with poor respon...Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon and rapidly fatal tumor.Therapeutic options have traditionally been limited and ineffective.The biologic and molecular events correlated with poor responsiveness to therapy are still poorly understood.In recent years,an innovative treatment approach involving aggressive cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy has reportedly resulted in improved outcome,as compared to historical controls.Since 1995,at the National Cancer Institute (NCI) of Milan (Italy),patients with DMPM have been treated with CRS and hyperthermic intraperitoneal chemotherapy (HIPEC).In the present paper,clinical experiences and basic science investigations on DMPM at Milan NCI are reviewed.Perioperative and long-term outcome results with CRS and HIPEC are presented.Clinico-pathological prognostic factors were investigated by multivariate analysis.The pathologic features and immunohistochemical markers related to DMPM biologic behavior were assessed in a large case-series uniformly treated at our institution.The prevalence and prognostic role of telomere maintenance mechanisms,which account for the limitless cell replicative potential of many malignancies,were studied.The dysregulation of the apoptotic pathways may play a role in the relative chemo-resistance of DMPM and a better understanding of apoptosis-related mechanisms could result in novel targeted therapeutic strategies.On this basis,the expression of survivin and other IAP family members (IAP-1,IAP-2,and X-IAP),the pro-apoptotic protein Smac/DIABLO,and antigens associated with cell proliferation (Ki-67) and apoptosis (caspase-cleaved cytokeratin-18) were analyzed.Finally,analyses of EGFR,PDGFRA and PDGFRB were performed to ascertain if deregulation of RTK could offer useful alternative therapeutic targets.展开更多
Malignant peritoneal mesothelioma is a rare aggres-sive tumor of the peritoneum. An increasing number of malignant mesothelioma cases have been reported in recent years. We report here a very rare case of malignant pe...Malignant peritoneal mesothelioma is a rare aggres-sive tumor of the peritoneum. An increasing number of malignant mesothelioma cases have been reported in recent years. We report here a very rare case of malignant peritoneal mesothelioma with both umbilical hernia and umbilical metastasis which is also called Sister Mary Joseph's nodule. We performed laparoscopy which showed specific laparoscopic findings, and the pathological findings of the biopsy specimen led to the diagnosis. This case was associated with umbilical her-nia which could be induced by massive ascites. A newly developed abdominal hernia should be noted as a primary symptom of malignant peritoneal mesothelioma, as shown in the present case.展开更多
Malignant pleural mesothelioma(MPM)is a rare tumor with poor prognosis and rising incidence.Palliative care is common in MPM as radical treatment with curative intent is often not possible due to metastasis or extensi...Malignant pleural mesothelioma(MPM)is a rare tumor with poor prognosis and rising incidence.Palliative care is common in MPM as radical treatment with curative intent is often not possible due to metastasis or extensive locoregional involvement.Numerous therapeutic advances have been made in recent years,including the use of less aggressive surgical techniques associated with lower morbidity and mortality(e.g.,pleurectomy/decortication),technological advancements in the field of radiotherapy(intensity-modulated radiotherapy,image-guided radiotherapy,stereotactic body radiotherapy,proton therapy),and developments in systemic therapies(chemotherapy and immunotherapy).These improvements have had as yet only a modest effect on local control and survival.Advances in the management of MPM and standardization of care are hampered by the evidence to date,limited by high heterogeneity among studies and small sample sizes.In this clinical guideline prepared by the oncological group for the study of lung cancer of the Spanish Society of Radiation Oncology,we review clinical,histologic,and therapeutic aspects of MPM,with a particular focus on all aspects relating to radiotherapy,including the current evidence base,associations with chemotherapy and surgery,treatment volumes and planning,technological advances,and reradiation.展开更多
Malignant pleural mesothelioma is a rare primary tumor rising from the pleura and is associated with exposure to asbestos fibers. Mesothelioma is a locally aggressive disease that usually presents at an advanced stage...Malignant pleural mesothelioma is a rare primary tumor rising from the pleura and is associated with exposure to asbestos fibers. Mesothelioma is a locally aggressive disease that usually presents at an advanced stage and has a median overall survival of 1 year. Treatment options rarely result in cure of disease and range from trimodality treatment, including chemotherapy, radiation, and surgery, to supportive care. In patients with limited local disease and good functional status, trimodality treatment with extra-pleural pneumonectomy, chemotherapy, and radiation is frequently employed. Best supportive care should be instituted for patients with metastatic disease and poor functional status. Palliative therapy focuses on control of pleural effusions with drainage techniques and pain with radiation therapy. Novel therapies are showing promise, including photodynamic therapy, immunotherapy, and molecular targeted therapy.展开更多
BACKGROUND Malignant peritoneal mesothelioma(MPM)originates from the mesothelial and subcutaneous cells of the abdominal cavity.Its diagnose is difficult due to its nonspecific and vague symptoms,and it should be diff...BACKGROUND Malignant peritoneal mesothelioma(MPM)originates from the mesothelial and subcutaneous cells of the abdominal cavity.Its diagnose is difficult due to its nonspecific and vague symptoms,and it should be differentiated from alcoholic cirrhosis and liver and pancreatic cancers.Misdiagnosis and missed diagnosis can easily occur when MPM presents with other diseases.To the best of our knowledge,no case of MPM concurrent with alcoholic cirrhosis has been reported.CASE SUMMARY A 63-year-old man presented to our hospital with abdominal distension for 20days.He had a history of alcohol consumption for nearly 30 years and no history of special drug use or toxic exposure.After treatment for alcoholic cirrhosis in a community hospital,his symptoms did not improve significantly.The patient underwent exploratory laparotomy and surgical resection.Pathologic examination showed an epithelioid MPM.He was treated with chemotherapy and intraperitoneal hyperthermic perfusion after surgery.Currently,he is in a stable condition and tumor recurrence has not occurred.CONCLUSION Misdiagnosis and missed diagnosis of MPM can easily occur because of its insidious onset.Therefore,there is a need to understand.MPM in clinical practice,make the correct diagnosis,and provide timely and effective treatment.展开更多
Background: Malignant pleural mesothelioma is a lethal disease and hence the strong need for identifying new prognostic factors. Methods: This is a retrospective study including all eligible patients with advanced mal...Background: Malignant pleural mesothelioma is a lethal disease and hence the strong need for identifying new prognostic factors. Methods: This is a retrospective study including all eligible patients with advanced malignant pleural mesothelioma (MPM) presenting to National Cancer Institute, Cairo University. Neutrophil lymphocyte (N/L) ratio was assessed before second line chemotherapy. 2.5 was used as the cutoff point. Endpoints were the assessment of correlation between N/L ratio and clinical response (CR), progression free survival (PFS) and overall survival (OS). Results: 52 patients (19 stage III and 33 stage IV) MPM were included and followed up during the period from July 2009 till November 2012 with a median follow-up period of 2.6 months. 87.5% of patients with N/L ratio > 2.5 showed progressive disease versus 91.7% in patients with N/L ratio < 2.5 (P-value = 0.66). 6-month PFS was 11% for patients with N/L ratio > 2.5 versus 14% for patients with N/L ratio < 2.5 (P-value = 0.001). 6-month OS was 72% for patients with N/L ratio > 2.5 versus 66% for patients with N/L ratio < 2.5 (P-value = 0.4). Conclusion: N/L ratio is a potential prognostic marker for advanced MPM treated with second line chemotherapy.展开更多
Objective: To investigate the effects of atranorin, a lichen secondary metabolite, on SPC212 malignant mesothelioma cells in vitro. Methods: SPC212 malignant mesothelioma cell line was used. 3-(4,5-dimethylthiazol-2-y...Objective: To investigate the effects of atranorin, a lichen secondary metabolite, on SPC212 malignant mesothelioma cells in vitro. Methods: SPC212 malignant mesothelioma cell line was used. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to evaluate cytotoxic effects of atranorin and cisplatin at 24, 48 and 72 h. Hematoxylin-eosin staining and 4’,6-diamidino-2-phenylindole, dihydrochloride staining were used for determining cell and nucleus morphology, respectively. Wound healing assay was used for investigating cell migration. The xCELLigence real-time cell analysis system was used for determining cell proliferation.Results: Atranorin at 5-450 μM decreased cell viability at 24, 48 and 72 h. IC50 values of atranorin were 300.94, 292.6 and 278.02 μM at 24, 48 and 72 h, respectively;meanwhile, the IC50 values of cisplatin were 128.00, 34.37 and 17.05 μM at 24, 48 and 72 h, respectively. Furthermore, atranorin disrupted cell and nuclear morphology with increasing concentrations. Atranorin significantly reduced cell migration by 38%, 37% and 35% at 300, 250 and 200 μM, respectively(P<0.000). Atranorin at 160-450 μM decreased cell proliferation at 72 h(P<0.000).Conclusions: Atranorin has cytotoxic, antiproliferative, apoptotic and cell migration inhibitory effects on SPC212 malignant mesothelioma cancer cells.展开更多
Objective: To summarize the experience in thediagnosis of mesothelioma. Methods: Analyzing theclinical data of 19 patients with pleural mesothelioina,including age, history of exposure to asbestos, clinicalmanifestati...Objective: To summarize the experience in thediagnosis of mesothelioma. Methods: Analyzing theclinical data of 19 patients with pleural mesothelioina,including age, history of exposure to asbestos, clinicalmanifestations, imaging and laboratory examinationsand metastases. Results: None of the 19 patients had ahistory of exposure to asbestos. Eight cases (42.1 %) hadno obvious thoracodynia, 9 cases (47.4%) had pleuraleffusion limited to the right chest, and in 2 cases (10.5%)the brachialis plexus was involved, and in 1 case (5.3%)malignant mesothelial cells were detected in the pleuraleffusion. Pleural thickening or nodules were found in 13cases on CT and in 9 cases by B ultrasonographicexamination. Conclusion: Exposure to asbestos is notthe only cause of pleural mesothelioma. Chest pain isnot always associated with pleural mesothelioma. CTand B ultrasonography are a help in the diagnosis ofpleural mesothelioma.展开更多
BACKGROUND We report the first case,to the best of our knowledge,of massive ascites due to recurrent malignant pleural mesothelioma that was controlled using KM-cell-free and concentrated ascites reinfusion therapy(KM...BACKGROUND We report the first case,to the best of our knowledge,of massive ascites due to recurrent malignant pleural mesothelioma that was controlled using KM-cell-free and concentrated ascites reinfusion therapy(KM-CART).The tumor cells derived via KM-CART were utilized secondarily in an in vitro cell growth assay using the collagen gel droplet-embedded culture drug sensitivity test(CD-DST)to investigate anticancer drug susceptibility.CASE SUMMARY A 56-year-old man presented with recurrent malignant mesothelioma with massive ascites;more than 4000 mL of ascitic fluid was removed,filtered,and concentrated using KM-CART,and the cell-free ascitic fluid was reinfused into the patient to improve quality of life.Cancer cells isolated secondarily in an in vitro proliferation assay using CD-DST exhibited low sensitivity to pemetrexed and high sensitivity to gemcitabine.Treatment with gemcitabine maintained stable disease for 4 mo.CONCLUSION The combination of KM-CART and CD-DST may be a promising treatment option for malignant ascites associated with malignant mesothelioma.展开更多
Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local r...Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local recurrence 10 mo after initial en bloc surgical resection. Abdominal computed tomography was performed for intractable, vague abdominal pain with episodic vomiting, which showed a "target sign" over the left lower quadrant. Laparotomy revealed several intra-luminal metastatic tumors in the small intestine and colon and a segmental resection of metastatic lesions was performed. Unfortunately, the patient died of sepsis despite successful surgical intervention. Though local recurrence is more frequent in LMPM, the possibility of distant metastasis should not be ignored in patients with non-specifi c abdominal pain.展开更多
Introduction: Mesothelioma is a malignant conditioncaused by exposure to asbestos that has typically a long latency period. The disease is usually found in the later stages when the prognosis is poor despite treatment...Introduction: Mesothelioma is a malignant conditioncaused by exposure to asbestos that has typically a long latency period. The disease is usually found in the later stages when the prognosis is poor despite treatments. Objective: To report a mesothelioma found in a laboratory. Method: We reported here a case of a 60 year-old-man who was exposed to asbestos fibres-first when he studied in a laboratory at high school and then he had exposure over the following years until graduating with a master’s degree, but he did not have exposure after it. He was a smoker as a teenager and he gave up after 23 years. His first symptom was coughing at night which lasted for several months until the pleural fluid was discovered on the right side of thorax. This triggered investigations led to a diagnosis of mesothelioma. According to a systematic literature search, mesothelioma has not been reported previously in relation to asbestos exposure in laboratory work. An operation was carried out, but the patient refused to take chemotherapy due to the limited benefits that could be expected from it. Instead, he opted for a Budwig protocol. The case has had a good quality of life since the surgery, and did not have any medications. He has regular check-ups at the hospital. Conclusion: Our study has shown that mesothelioma is not only a risk to people directly exposed to asbestos, but also indirectly from, for example, laboratory work. People should avoid exposure to asbestos in daily life.展开更多
BACKGROUND Malignant peritoneal mesothelioma(MPM) is an extremely rare tumor with nonspecific clinical manifestations,which is extremely difficult to diagnose.Herein,we reported a case of MPM in the abdominal cavity w...BACKGROUND Malignant peritoneal mesothelioma(MPM) is an extremely rare tumor with nonspecific clinical manifestations,which is extremely difficult to diagnose.Herein,we reported a case of MPM in the abdominal cavity with massive shortterm ascites as the first symptom.CASE SUMMARY A 65-year-old woman presented to the hospital with abdominal pain,distention,and shortness of breath that persisted for 15 d.The serum CA-125 level was 1075 U/m L.The abdominal computed tomography showed massive ascites and no obvious tumor lesions.The pathological examination of the ascitic fluid showed numerous heterotypic cells with some papillary structures.The immunohistochemistry and fluorescence in situ hybridization showed the deletion of CDX2(-),WT-1(-),Ki-67(about 10% +),CEA(-),Glut-1(+++),desmin(-),PD-L1(-),and CDKN2A(P16).The final diagnosis was MPM.The patient refused tumor cytoreductive surgery and received two cycles of cisplatin plus pemetrexed bidirectional chemotherapy.In the second cycle,she received an additional cycle of hyperthermic intraperitoneal chemotherapy and immune checkpoint inhibitor therapy due to massive recalcitrant ascites.She died of disease progression 2 mo after diagnosis.CONCLUSION In case of massive unexplained ascites,the possibility of MPM should not be excluded to avoid misdiagnosis and delay in treatment.展开更多
Advanced malignant mesothelioma (MM) is among the most aggressive and difficult-to-treat diseases. Industrialization and exposure to asbestos is the main causative factor for the dramatic increase in the incidence of ...Advanced malignant mesothelioma (MM) is among the most aggressive and difficult-to-treat diseases. Industrialization and exposure to asbestos is the main causative factor for the dramatic increase in the incidence of MM, which carries a poor prognosis and a median survival of less than 12 months. Combination chemotherapy offers only palliative results;however, targeted therapy carries more promise for future successful treatment. This paper presents preliminary findings of improved overall survival (OS) using a combination of sodium phenylbutyrate (PB) with various chemotherapeutic and targeted agents in advanced MM. The data suggest using a strategy of simultaneous interruption of signal transduction involving RAS-MEK-ERK, PI3K-AKT, mTOR, Merlin, and angiogenesis pathways and interference in cell cycle and epigenetic processes. Complete response was determined in 15.4% and stable disease in 46.2% in the group of 13 evaluable patients. Median OS for MM was higher compared to other treatments (17 months compared to between 6 and 12.1 months). The longest surviving patient continues to be in complete response and in excellent condition for over 12.5 years from the treatment start. These findings are only preliminary and validation of the results using a well-designed phase I/II trial in advanced MM is proposed.展开更多
文摘Benign multicystic peritoneal mesothelioma(BMPM)is a rare tumor originating from peritoneal mesothelial cells.Here,we present a case of an 18-year-old male with right lower abdominal pain.Physical examination revealed a palpable mass with unclear boundaries.Laboratory tests showed elevated levels of monocytes and high-sensitivity C-reactive protein.CT scan revealed a cystic mass in the ileocecal region with multiple septations.Laparoscopic surgery confirmed a cystic solid mass resembling beads on the colon’s right side.Immunohistochemistry confirmed BMPM diagnosis.BMPM,especially in the ileocecal region,is uncommon and presents diagnostic challenges.Differential diagnosis includes lymphangioma,peritoneal metastasis,and malignant mesothelioma.CT findings,such as thin cyst walls and septations,aid in diagnosis.Recognition of BMPM’s imaging features improves diagnostic accuracy.Surgical resection remains the primary treatment.This case underscores the importance of considering BMPM in young male patients with abdominal pain and emphasizes the value of imaging modalities in accurate diagnosis and management.
文摘BACKGROUND Thoracic empyema and malignant pleural mesothelioma(MPM)are distinct medical conditions with similar symptoms,including cough,chest pain,and breathing difficulty.We present a rare MPM case mimicking thoracic empyema.Physicians must consider MPM risks for patients exposed to building material who exhibit lobulated pleural effusions,indicating thoracic empyema.CASE SUMMARY A 68-year-old retired male construction worker suffered from shortness of breath and chest tightness over 10 d,particularly during physical activity.A poor appetite and 4 kg weight loss over the past 3 wk were also reported.Chest images and laboratory data concluded a tentative impression of empyema thoracis(right).Video-assisted thoracic surgery with decortication and delobulation(right)was conducted.The pathological report yielded an MPM diagnosis.Refractory pleural bilateral effusions and respiratory failure developed postoperatively,and the patient died three weeks after the operation.CONCLUSION Thoracic empyema and MPM are distinct medical conditions that can present similar symptoms,and video-assisted thoracic surgery facilitates an accurate diagnosis.Empyema-mimicking presentations and postoperative refractory pleural effusion may indicate a poor MPM outcome.
文摘BACKGROUND Malignant peritoneal mesothelioma(MPeM)is a rare cancer with a poor prognosis at advanced stage,and the standard first-line treatment for inoperable patients is chemotherapy.Although combining programmed cell death 1(PD-1)inhibitors with chemotherapy is generally considered safe and effective in several malignant solid tumors,there are few reports regarding initial immunochemotherapy in advanced MPeM.CASE SUMMARY Here,to our knowledge,we present the first case of a patient with epithelioid subtype MPeM,who was treatment-naïve and benefited from initial PD-1 inhibitor plus standard chemotherapy with a prolonged progression-free survival(PFS)and good tolerance.A 49-year-old man was admitted to our hospital for a persistent burning sensation in the abdomen.Computed tomography revealed a solid mass in the lower abdomen,which was subsequently diagnosed histologically as epithelioid subtype MPeM by core needle biopsy.The patient received eight cycles of pemetrexed 800 mg(day 1),cisplatin 60/50 mg(day 1–2),and zimberelimab(PD-1 inhibitor)240 mg(day 1)every 3 wk.He achieved significant reduction of peritoneal tumors with remarkable improvement in symptoms.The best tumor response was partial remission with a final PFS of 7 mo.No immunerelated adverse event occurred during the combination treatment.CONCLUSION The outcome of the present case demonstrates the promising anti-tumor activity of immunochemotherapy to treat inoperable MPeM in the future.
文摘Malignant pleural mesothelioma(MPM) is the most common type of malignant mesothelioma. It is a rare tumor linked to asbestos exposure and is associated with a poor prognosis. Until very recently, patients with advanced or unresectable disease had limited treatment options, primarily based on doublet chemotherapy with cisplatin and pemetrexed. In 2020 and 2021, after more than a decade with no major advances or new drugs, two phase Ⅲ clinical trials published results positioning immunotherapy as a promising option for the first-and second-line treatment of MPM. Immunotherapy has revolutionized the treatment of many cancers and is also showing encouraging results in malignant mesothelioma. Both immune checkpoint inhibition and dual cytotoxic T-lymphocyte–associated antigen 4 and programmed death-ligand 1 pathway blockade resulted in significantly improved overall survival in randomized phase Ⅲ trials. In the Check Mate 743 trial, first-line therapy with nivolumab plus ipilimumab outperformed standard chemotherapy, while in the CONFIRM trial, nivolumab outperformed placebo in patients previously treated with chemotherapy. These two trials represent a major milestone in the treatment of MPM and are set to position immunotherapy as a viable alternative for treatment-naive patients and patients with progressive disease after chemotherapy.
文摘Malignant mesothelioma is a highly aggressive neoplasm.The incidence of malignant mesothelioma is increasing worldwide.Diffuse malignant peritoneal mesothelioma(DMPM) represents one-fourth of all mesotheliomas.Association of asbestos exposure with DMPM has been observed,especially in males.The great majority of patients present with abdominal pain and distension,caused by accumulation of tumors and ascitic ? uid.In the past,DMPM was considered a pre-terminal condition;therefore attracted little attention.Patients invariably died from their disease within a year.Recently,several prospective trials have demonstrated a median survival of 40 to 90 mo and 5-year survival of 30% to 60% after combined treatment using cytoreductive surgery and perioperative intraperitoneal chemotherapy.This remarkable improvement in survival has prompted new search into the medical science related to DMPM,a disease previously ignored as uninteresting.This review article focuses on the key advances in the epidemiology,diagnosis,staging,treatments and prognosis of DMPM that have occurred in the past decade.
基金Supported by United States National Institute of Health(to Kazuaki Takabe),No.R01CA160688Investigator Initiated Research Grant(to Susan G Komen),No.IIR12222224
文摘Malignant peritoneal mesothelioma(PM) is an infrequent disease which has historically been associated with a poor prognosis. Given its long latency period and non-specific symptomatology, a diagnosis of PM can be suggested by occupational exposure history, but ultimately relies heavily on imaging and diagnostic biopsy. Early treatment options including palliative operative debulking, intraperitoneal chemotherapy, and systemic chemotherapy have marginally improved the natural course of the disease with median survival being approximately one year. The advent of cytoreduction(CRS) with hyperthermic intraperitoneal chemotherapy(HIPEC) has dramatically improved survival outcomes with wide median survival estimates between 2.5 to 9 years; these studies however remain largely heterogeneous, with differing study populations, tumor biology, and specific treatment regimens. More recent investigations have explored extent of cytoreduction, repeated operative intervention, and choice of chemotherapy but have been unable to offer definitive conclusions. CRS and HIPEC remain morbid procedures with complication rates ranging between 30% to 46% in larger series. Ac-cordingly, an increasing interest in identifying molecular targets and developing targeted therapies is emerging. Among such novel targets is sphingosine kinase 1(SphK1) which regulates the production of sphingosine-1-phosphate, a biologically active lipid implicated in various cancers including malignant mesothelioma. The known action of specific SphK inhibitors may warrant further exploration in peritoneal disease.
文摘Benign multicystic peritoneal mesothelioma(BMPM)is a rare cystic mesothelial lesion that occurs predominantly in reproductive aged women.A 56-year-old Caucasian male was admitted to our surgical department with a chief complaint of a painful mass in his right lower abdomen for almost 2 years.The physical examination revealed a palpable painful mass.Computed tomography demonstrated an irregular,cystic tumor in his right lower abdomen.There was no obvious capsule or internal septations.No enhancement after intravenous administration of contrast was noted.An exploratory laparotomy was performed,and a multicystic tumor and adherent to the caecum was noted.The walls of the cysts were thin and smooth,filled with clear fluid,and very friable.An en bloc resection of the tumor,including appendix and caecum,was performed.Histological examination revealed multiple cysts lined with flattened simple epithelial cells,and the capsule walls of the cysts were composed of fibrous tissue.Immunohistochemical analysis documented positive expression of mesothelial cells and calretinin.The final diagnosis was BMPM.The patient was well at 6-mo follow-up.BMPM is exceedingly rare lesion.A complete resection of the tumor is required.The diagnosis of BMPM is based on pathological analysis.
文摘Diffuse malignant peritoneal mesothelioma (DMPM) is an uncommon and rapidly fatal tumor.Therapeutic options have traditionally been limited and ineffective.The biologic and molecular events correlated with poor responsiveness to therapy are still poorly understood.In recent years,an innovative treatment approach involving aggressive cytoreductive surgery (CRS) and perioperative intraperitoneal chemotherapy has reportedly resulted in improved outcome,as compared to historical controls.Since 1995,at the National Cancer Institute (NCI) of Milan (Italy),patients with DMPM have been treated with CRS and hyperthermic intraperitoneal chemotherapy (HIPEC).In the present paper,clinical experiences and basic science investigations on DMPM at Milan NCI are reviewed.Perioperative and long-term outcome results with CRS and HIPEC are presented.Clinico-pathological prognostic factors were investigated by multivariate analysis.The pathologic features and immunohistochemical markers related to DMPM biologic behavior were assessed in a large case-series uniformly treated at our institution.The prevalence and prognostic role of telomere maintenance mechanisms,which account for the limitless cell replicative potential of many malignancies,were studied.The dysregulation of the apoptotic pathways may play a role in the relative chemo-resistance of DMPM and a better understanding of apoptosis-related mechanisms could result in novel targeted therapeutic strategies.On this basis,the expression of survivin and other IAP family members (IAP-1,IAP-2,and X-IAP),the pro-apoptotic protein Smac/DIABLO,and antigens associated with cell proliferation (Ki-67) and apoptosis (caspase-cleaved cytokeratin-18) were analyzed.Finally,analyses of EGFR,PDGFRA and PDGFRB were performed to ascertain if deregulation of RTK could offer useful alternative therapeutic targets.
文摘Malignant peritoneal mesothelioma is a rare aggres-sive tumor of the peritoneum. An increasing number of malignant mesothelioma cases have been reported in recent years. We report here a very rare case of malignant peritoneal mesothelioma with both umbilical hernia and umbilical metastasis which is also called Sister Mary Joseph's nodule. We performed laparoscopy which showed specific laparoscopic findings, and the pathological findings of the biopsy specimen led to the diagnosis. This case was associated with umbilical her-nia which could be induced by massive ascites. A newly developed abdominal hernia should be noted as a primary symptom of malignant peritoneal mesothelioma, as shown in the present case.
文摘Malignant pleural mesothelioma(MPM)is a rare tumor with poor prognosis and rising incidence.Palliative care is common in MPM as radical treatment with curative intent is often not possible due to metastasis or extensive locoregional involvement.Numerous therapeutic advances have been made in recent years,including the use of less aggressive surgical techniques associated with lower morbidity and mortality(e.g.,pleurectomy/decortication),technological advancements in the field of radiotherapy(intensity-modulated radiotherapy,image-guided radiotherapy,stereotactic body radiotherapy,proton therapy),and developments in systemic therapies(chemotherapy and immunotherapy).These improvements have had as yet only a modest effect on local control and survival.Advances in the management of MPM and standardization of care are hampered by the evidence to date,limited by high heterogeneity among studies and small sample sizes.In this clinical guideline prepared by the oncological group for the study of lung cancer of the Spanish Society of Radiation Oncology,we review clinical,histologic,and therapeutic aspects of MPM,with a particular focus on all aspects relating to radiotherapy,including the current evidence base,associations with chemotherapy and surgery,treatment volumes and planning,technological advances,and reradiation.
文摘Malignant pleural mesothelioma is a rare primary tumor rising from the pleura and is associated with exposure to asbestos fibers. Mesothelioma is a locally aggressive disease that usually presents at an advanced stage and has a median overall survival of 1 year. Treatment options rarely result in cure of disease and range from trimodality treatment, including chemotherapy, radiation, and surgery, to supportive care. In patients with limited local disease and good functional status, trimodality treatment with extra-pleural pneumonectomy, chemotherapy, and radiation is frequently employed. Best supportive care should be instituted for patients with metastatic disease and poor functional status. Palliative therapy focuses on control of pleural effusions with drainage techniques and pain with radiation therapy. Novel therapies are showing promise, including photodynamic therapy, immunotherapy, and molecular targeted therapy.
基金Shandong Province Medical and Health Science and Technology Development Plan,No.202003030878.
文摘BACKGROUND Malignant peritoneal mesothelioma(MPM)originates from the mesothelial and subcutaneous cells of the abdominal cavity.Its diagnose is difficult due to its nonspecific and vague symptoms,and it should be differentiated from alcoholic cirrhosis and liver and pancreatic cancers.Misdiagnosis and missed diagnosis can easily occur when MPM presents with other diseases.To the best of our knowledge,no case of MPM concurrent with alcoholic cirrhosis has been reported.CASE SUMMARY A 63-year-old man presented to our hospital with abdominal distension for 20days.He had a history of alcohol consumption for nearly 30 years and no history of special drug use or toxic exposure.After treatment for alcoholic cirrhosis in a community hospital,his symptoms did not improve significantly.The patient underwent exploratory laparotomy and surgical resection.Pathologic examination showed an epithelioid MPM.He was treated with chemotherapy and intraperitoneal hyperthermic perfusion after surgery.Currently,he is in a stable condition and tumor recurrence has not occurred.CONCLUSION Misdiagnosis and missed diagnosis of MPM can easily occur because of its insidious onset.Therefore,there is a need to understand.MPM in clinical practice,make the correct diagnosis,and provide timely and effective treatment.
文摘Background: Malignant pleural mesothelioma is a lethal disease and hence the strong need for identifying new prognostic factors. Methods: This is a retrospective study including all eligible patients with advanced malignant pleural mesothelioma (MPM) presenting to National Cancer Institute, Cairo University. Neutrophil lymphocyte (N/L) ratio was assessed before second line chemotherapy. 2.5 was used as the cutoff point. Endpoints were the assessment of correlation between N/L ratio and clinical response (CR), progression free survival (PFS) and overall survival (OS). Results: 52 patients (19 stage III and 33 stage IV) MPM were included and followed up during the period from July 2009 till November 2012 with a median follow-up period of 2.6 months. 87.5% of patients with N/L ratio > 2.5 showed progressive disease versus 91.7% in patients with N/L ratio < 2.5 (P-value = 0.66). 6-month PFS was 11% for patients with N/L ratio > 2.5 versus 14% for patients with N/L ratio < 2.5 (P-value = 0.001). 6-month OS was 72% for patients with N/L ratio > 2.5 versus 66% for patients with N/L ratio < 2.5 (P-value = 0.4). Conclusion: N/L ratio is a potential prognostic marker for advanced MPM treated with second line chemotherapy.
文摘Objective: To investigate the effects of atranorin, a lichen secondary metabolite, on SPC212 malignant mesothelioma cells in vitro. Methods: SPC212 malignant mesothelioma cell line was used. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to evaluate cytotoxic effects of atranorin and cisplatin at 24, 48 and 72 h. Hematoxylin-eosin staining and 4’,6-diamidino-2-phenylindole, dihydrochloride staining were used for determining cell and nucleus morphology, respectively. Wound healing assay was used for investigating cell migration. The xCELLigence real-time cell analysis system was used for determining cell proliferation.Results: Atranorin at 5-450 μM decreased cell viability at 24, 48 and 72 h. IC50 values of atranorin were 300.94, 292.6 and 278.02 μM at 24, 48 and 72 h, respectively;meanwhile, the IC50 values of cisplatin were 128.00, 34.37 and 17.05 μM at 24, 48 and 72 h, respectively. Furthermore, atranorin disrupted cell and nuclear morphology with increasing concentrations. Atranorin significantly reduced cell migration by 38%, 37% and 35% at 300, 250 and 200 μM, respectively(P<0.000). Atranorin at 160-450 μM decreased cell proliferation at 72 h(P<0.000).Conclusions: Atranorin has cytotoxic, antiproliferative, apoptotic and cell migration inhibitory effects on SPC212 malignant mesothelioma cancer cells.
文摘Objective: To summarize the experience in thediagnosis of mesothelioma. Methods: Analyzing theclinical data of 19 patients with pleural mesothelioina,including age, history of exposure to asbestos, clinicalmanifestations, imaging and laboratory examinationsand metastases. Results: None of the 19 patients had ahistory of exposure to asbestos. Eight cases (42.1 %) hadno obvious thoracodynia, 9 cases (47.4%) had pleuraleffusion limited to the right chest, and in 2 cases (10.5%)the brachialis plexus was involved, and in 1 case (5.3%)malignant mesothelial cells were detected in the pleuraleffusion. Pleural thickening or nodules were found in 13cases on CT and in 9 cases by B ultrasonographicexamination. Conclusion: Exposure to asbestos is notthe only cause of pleural mesothelioma. Chest pain isnot always associated with pleural mesothelioma. CTand B ultrasonography are a help in the diagnosis ofpleural mesothelioma.
文摘BACKGROUND We report the first case,to the best of our knowledge,of massive ascites due to recurrent malignant pleural mesothelioma that was controlled using KM-cell-free and concentrated ascites reinfusion therapy(KM-CART).The tumor cells derived via KM-CART were utilized secondarily in an in vitro cell growth assay using the collagen gel droplet-embedded culture drug sensitivity test(CD-DST)to investigate anticancer drug susceptibility.CASE SUMMARY A 56-year-old man presented with recurrent malignant mesothelioma with massive ascites;more than 4000 mL of ascitic fluid was removed,filtered,and concentrated using KM-CART,and the cell-free ascitic fluid was reinfused into the patient to improve quality of life.Cancer cells isolated secondarily in an in vitro proliferation assay using CD-DST exhibited low sensitivity to pemetrexed and high sensitivity to gemcitabine.Treatment with gemcitabine maintained stable disease for 4 mo.CONCLUSION The combination of KM-CART and CD-DST may be a promising treatment option for malignant ascites associated with malignant mesothelioma.
文摘Localized malignant pleural mesothelioma (LMPM) is a rare occurrence, and gastrointestinal intra-luminal metastases have not previously been reported. Herein, we report a patient with LMPM who presented with a local recurrence 10 mo after initial en bloc surgical resection. Abdominal computed tomography was performed for intractable, vague abdominal pain with episodic vomiting, which showed a "target sign" over the left lower quadrant. Laparotomy revealed several intra-luminal metastatic tumors in the small intestine and colon and a segmental resection of metastatic lesions was performed. Unfortunately, the patient died of sepsis despite successful surgical intervention. Though local recurrence is more frequent in LMPM, the possibility of distant metastasis should not be ignored in patients with non-specifi c abdominal pain.
文摘Introduction: Mesothelioma is a malignant conditioncaused by exposure to asbestos that has typically a long latency period. The disease is usually found in the later stages when the prognosis is poor despite treatments. Objective: To report a mesothelioma found in a laboratory. Method: We reported here a case of a 60 year-old-man who was exposed to asbestos fibres-first when he studied in a laboratory at high school and then he had exposure over the following years until graduating with a master’s degree, but he did not have exposure after it. He was a smoker as a teenager and he gave up after 23 years. His first symptom was coughing at night which lasted for several months until the pleural fluid was discovered on the right side of thorax. This triggered investigations led to a diagnosis of mesothelioma. According to a systematic literature search, mesothelioma has not been reported previously in relation to asbestos exposure in laboratory work. An operation was carried out, but the patient refused to take chemotherapy due to the limited benefits that could be expected from it. Instead, he opted for a Budwig protocol. The case has had a good quality of life since the surgery, and did not have any medications. He has regular check-ups at the hospital. Conclusion: Our study has shown that mesothelioma is not only a risk to people directly exposed to asbestos, but also indirectly from, for example, laboratory work. People should avoid exposure to asbestos in daily life.
基金Supported by the National Traditional Chinese Medicine Clinical Research Base,No.2018131the Guangzhou Science and Technology Program Key Projects,No.202206080015。
文摘BACKGROUND Malignant peritoneal mesothelioma(MPM) is an extremely rare tumor with nonspecific clinical manifestations,which is extremely difficult to diagnose.Herein,we reported a case of MPM in the abdominal cavity with massive shortterm ascites as the first symptom.CASE SUMMARY A 65-year-old woman presented to the hospital with abdominal pain,distention,and shortness of breath that persisted for 15 d.The serum CA-125 level was 1075 U/m L.The abdominal computed tomography showed massive ascites and no obvious tumor lesions.The pathological examination of the ascitic fluid showed numerous heterotypic cells with some papillary structures.The immunohistochemistry and fluorescence in situ hybridization showed the deletion of CDX2(-),WT-1(-),Ki-67(about 10% +),CEA(-),Glut-1(+++),desmin(-),PD-L1(-),and CDKN2A(P16).The final diagnosis was MPM.The patient refused tumor cytoreductive surgery and received two cycles of cisplatin plus pemetrexed bidirectional chemotherapy.In the second cycle,she received an additional cycle of hyperthermic intraperitoneal chemotherapy and immune checkpoint inhibitor therapy due to massive recalcitrant ascites.She died of disease progression 2 mo after diagnosis.CONCLUSION In case of massive unexplained ascites,the possibility of MPM should not be excluded to avoid misdiagnosis and delay in treatment.
文摘Advanced malignant mesothelioma (MM) is among the most aggressive and difficult-to-treat diseases. Industrialization and exposure to asbestos is the main causative factor for the dramatic increase in the incidence of MM, which carries a poor prognosis and a median survival of less than 12 months. Combination chemotherapy offers only palliative results;however, targeted therapy carries more promise for future successful treatment. This paper presents preliminary findings of improved overall survival (OS) using a combination of sodium phenylbutyrate (PB) with various chemotherapeutic and targeted agents in advanced MM. The data suggest using a strategy of simultaneous interruption of signal transduction involving RAS-MEK-ERK, PI3K-AKT, mTOR, Merlin, and angiogenesis pathways and interference in cell cycle and epigenetic processes. Complete response was determined in 15.4% and stable disease in 46.2% in the group of 13 evaluable patients. Median OS for MM was higher compared to other treatments (17 months compared to between 6 and 12.1 months). The longest surviving patient continues to be in complete response and in excellent condition for over 12.5 years from the treatment start. These findings are only preliminary and validation of the results using a well-designed phase I/II trial in advanced MM is proposed.
