Ghabra Shadin, Dinerman Aaron J, Sitler Collin A, Ahn Diane, Joyce Stacy R, Satterwhite Audra, Sullivan Molly A, Blakely Andrew M
Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
J Gastrointest Oncol. 2024 Aug 31;15(4):1939-1947. doi: 10.21037/jgo-24-266. Epub 2024 Aug 20.
Mesothelioma is a rare, aggressive disease originating from mesothelial cells and carries a poor prognosis. Mesothelioma may arise from the pleura, pericardium, or peritoneum. Peritoneal mesothelioma (PM) usually spreads in a diffuse manner; however, a localized unifocal form of PM may occur. Literature on unifocal mesothelioma remains scarce.
Herein, we highlight a case of localized epithelioid PM in an 81-year-old gentleman with the unique challenges faced during management. The pelvic mass was 7 cm, well-circumscribed, and hyper-vascular with fibrous attachments to the abdominal wall. The patient had a peritoneal cancer index (PCI) of 4 on initial diagnostic laparoscopy. Diagnosis was confirmed by histology. Resection of the mass with a partial omentectomy was performed. Months later, the patient developed recurrence detected on follow-up imaging in the peri-splenic region. The patient underwent cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for 60 minutes using mitomycin C and cisplatin followed by an uneventful recovery. Our case report is followed by a review of literature on disease pathophysiology, treatment options, and recently promising immunotherapy approaches.
CRS and HIPEC remains the standard treatment regimen for patients with PM. Nonetheless, a more nuanced approach might be indicated in specific patients with localized unifocal PM. Disease distribution and burden may impact the decision on surgical management in selected patients.
间皮瘤是一种罕见的侵袭性疾病，起源于间皮细胞，预后较差。间皮瘤可起源于胸膜、心包或腹膜。腹膜间皮瘤（PM）通常以弥漫方式扩散；然而，也可能出现局部单灶性的PM。关于单灶性间皮瘤的文献仍然很少。
在此，我们重点介绍一例81岁男性患者的局限性上皮样PM病例，以及治疗过程中面临的独特挑战。盆腔肿块为7厘米，边界清晰，血管丰富，与腹壁有纤维连接。患者在初次诊断性腹腔镜检查时腹膜癌指数（PCI）为4。通过组织学确诊。进行了肿块切除并部分切除网膜。数月后，患者在随访影像检查中发现脾周区域复发。患者接受了细胞减灭术（CRS）和使用丝裂霉素C和顺铂进行60分钟的热腹腔内化疗（HIPEC），随后恢复顺利。我们的病例报告之后是对疾病病理生理学、治疗选择以及最近有前景的免疫治疗方法的文献综述。
CRS和HIPEC仍然是PM患者的标准治疗方案。尽管如此，对于特定的局限性单灶性PM患者，可能需要更细致入微的治疗方法。疾病分布和负担可能会影响特定患者手术治疗的决策。
