恶性腹膜间皮瘤的诊治体会

目的：提高对恶性腹膜间皮瘤的诊断和治疗水平方法：对我院40年来收治的22倒恶性腹膜间皮瘤患者的临床资料结合相关文献进行回顾性分析。结果：22例收治经病理证实的患者，男性9例，女性13倒，年龄18～72岁．13例行减瘤手术＋腹腔或／和全身化疗，1例行手术减瘤＋腹部放疗；4例行剖腹探查＋腹腔及全身化疗；1例未手术．仅行腹腔十全身化疗；3例未手术，仅行全身化疗，经治疗后随访中位生存期18．5月。3例存活超过5年、，结论：恶性腹膜间皮瘤诊断困难．易误诊，预后差，主要依靠剖腹探查、疆水细咆学、B超引导穿刺活检、腹腔镜活检等方法，治疗主要以手术切除减瘤术结合全身化疗的综合治疗为主要手段、     

恶性腹膜间皮瘤41例诊治体会

目的 探讨恶性腹膜问皮瘤的临床诊断与治疗方法。方法 对41例外科治疗并经病理证实的恶性腹膜问皮瘤临床资料进行回顾性分析。结果 41例恶性腹膜间皮瘤中,主要临床表现为持续性腹痛者38例(92．7％),腹泻35例(85．4％)。病理类型为上皮样型21例,梭形细胞型11例,混合型9例。21例行CT检查,13例行腹腔镜检查。手术切除率为70．7％,术后行腹腔局部灌注化疗12例(29．3％),全身化疗23例(56．1％),免疫治疗3例(7．3％);全组2年生存率为36．6％。结论 影像学检查是恶性腹膜间皮瘤的主要诊断方法,但肿瘤的确诊须依据病理诊断;恶性腹膜间皮瘤应采用以手术为主的综合治疗方法。     

女性恶性腹膜间皮瘤17例临床分析

目的提高对恶性腹膜间皮瘤的临床特征、诊断及治疗手段的认识。方法回顾性分析17例女性恶性腹膜间皮瘤的临床资料。结果17例中主要表现为腹胀12例,腹痛10例,体征为腹水征阳性,腹部及盆腔肿块;10例血小板计数升高;13例有石棉接触史;10例行腹腔镜活检,4例剖腹探查,3例术后诊断。病理分型：上皮型8例,肉瘤型5例,混合型4例。9例行肿瘤细胞歼灭术,9例腹腔静脉联合化疗,1例腔内静脉联合化疗加放疗,1例腔内热化疗联合静脉化疗,3例腔内化疗。确诊到死亡时间平均为9月。结论石棉是导致恶性间皮瘤的主要诱因之一。该病临床表现缺乏特异性,诊断应尽早并可能取腹膜病理活检,必要时联合免疫组化鉴别,治疗采取以手术、局部及全身化疗为主。     

腹腔DDP温热灌注化疗联合IL-2治疗恶性腹膜间皮瘤1例

目的:评价腹腔DDP温热灌注化疗联合IL-2对恶性腹膜间皮瘤的治疗效果.方法:DDP稀释后加温快速腹腔内灌注,之后IL-2及地塞米松腹膜腔内灌注,监测每次腹水引出量进行对比.结果:疗效确切,腹腔积液完全消失.结论:目前恶性腹膜间皮瘤的诊断尚无特异方法,腹腔DDP温热灌注化疗联合IL-2治疗恶性腹膜间皮瘤不失为理想选择之一.     

恶性腹膜间皮瘤——附10例报告

 本文报告经病理组织学证实的恶性腹膜间皮瘤10例，并以临床特点、诊断和治疗等方面进行分析讨论．由于腹膜间皮瘤较少见，误诊率高，作者认为对腹部肿块、腹痛、腹胀患者在排除消化道和泌尿生殖系统肿瘤后应考虑此病的可能．10例经剖腹探查均不能切除，其中2例行腹壁下动脉插管化疗，1例行腹腔和全身化疗，取得一定疗效，提示此瘤采用综合治疗仍有一定价值．     

顺铂腹腔灌注治疗恶性腹水5例疗效观察

顺铂腹腔灌注治疗恶性腹水５例疗效观察李明泉四川广元市医院（６２８０００）恶性腹水是指全身各部位恶性肿瘤腹膜转移导致的一种严重并发症。病人一般情况差，各器官代偿能力下降，手术、放疗、全身化疗都失去治疗意义，本文运用顺铂腹腔灌注治疗恶性腹水５例，现报告如...     

恶性腹膜间皮瘤在米兰国家癌症中心的治疗进展

弥漫性恶性腹膜间皮瘤（diffuse malignant peritoneal mesothelioma,DMPM）是一种源自腹膜间皮细胞、高度恶性的罕见原发性恶性肿瘤,本文对DMPM的定义、诊断、患者管理流程、米兰国家癌症中心肿瘤细胞减灭术（cytoreductive surgery,CRS）联合腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy,HIPEC）治疗数据、围手术期化疗对患者预后影响、多囊型腹膜间皮瘤治疗建议、乳头状腹膜间皮瘤治疗建议等进行概述。对本中心DMPM认识与治疗经验进行介绍。随着对这类肿瘤疾病的临床特征和生物学特性进行广泛研究,发现可切除性DMPM应接受CRS+HIPEC,可能会改变患者的自然病程。      

恶性腹膜间皮瘤五例临床分析

目的　提高对恶性腹膜间皮瘤的认识。方法　结合文献复习 ,对 5例恶性腹膜间皮瘤的诊断及治疗进行讨论。结果　恶性腹膜间皮瘤术前诊断极为困难 ,常误诊为卵巢癌 ,最终确诊依据病理检查并结合免疫组化。治疗方案为肿瘤细胞减灭术 ,术后辅以化疗和放疗。结论　本病恶性程度高 ,预后差。综合治疗是提高恶性腹膜间皮瘤生存率的有效方法     

恶性腹膜间皮瘤五例临床分析

目的 提高对恶性腹膜间皮瘤的认识。方法 结合文献复习。对5例恶性腹膜间皮瘤的诊断及治疗进行讨论。结果 恶性腹膜间皮瘤术前诊断极为困难，常误诊为卵巢癌，最终确诊依据病理检查并结合免疫组化，治疗方案为肿瘤细胞减灭术，术后辅以化疗和放疗。结论 本病恶性程度高，预后差，综合治疗是提高恶性腹膜间皮瘤生存率的有效方法。     

恶性腹膜间皮瘤15例诊治体会

为了探讨恶性腹膜间皮细胞瘤患者的临床特点、诊治方法以及预后,回顾性分析我院诊治的恶性腹膜间皮瘤患者15例的人口学资料、临床表现、影像学特点、腹腔镜下表现以及治疗后转归.患者主要临床表现为乏力13例(86.7%),腹胀12例(80.0%),腹痛11例(73.3%),腹部不适10例(66.7%),消瘦、贫血6例(40%),腹水13例(86.7%),腹部膨隆13例(86.7%),腹部包块6例(40.0%).腹部超声和CT检查对该病的诊断没有特异性.腹腔镜下表现为粉红色结节、腹膜广泛或局部胼胝样增厚或局部包块.腹膜表面尚存在不同程度充血、水肿及血管扩张.生存期3～18个月,平均9个月.初步研究结果提示,恶性腹膜间皮瘤临床特征性少,恶性程度大,常规检查难以确诊,腹腔镜在诊断方面具有优势,而且安全可行.     

Malignant peritoneal mesothelioma

BACKGROUND: The clinical characteristics of malignant peritoneal mesothelioma are not fully known, and it appears as a variable entity with different types of clinical presentation and with a difficult diagnosis. PATIENTS: Fifteen patients with malignant peritoneal mesothelioma were analyzed for asbestos exposure, clinical presentation, thrombocytosis, X-rays and echotomographic findings, peritoneal fluid cytology, surgical investigations, diagnosis in vita, therapy, cause of death, diagnosis time, and survival time. RESULTS: Asbestos exposure was present in 12 men. Abdominal pain, ascites, abdominal mass, weight loss and fever were the most common presentation symptoms. In 5 patients, the disease presented as a surgical emergency. Assembling the presenting symptoms, malignant peritoneal mesothelioma was subdivided in 3 types: classical (6 cases), surgical (5 cases) and medical (4 cases). Thrombocytosis was present in 11 cases. Peritoneal fluid cytology was positive for neoplastic mesothelial cells in 8 of 10 cases. Laparotomy (5 patients) and laparoscopy (7 cases) were diagnostic in all cases. Diagnosis in vita was malignant peritoneal mesothelioma for 13 patients, peritoneal carcinomatosis for 1, with only 1 autopsy diagnosis. Seven patients were treated with chemotherapy, showing a progression of the disease. Mean symptoms-to-diagnosis time was 122 days (4-410), and mean symptoms-to-survival time was 345 days (45-1510). CONCLUSIONS: Malignant peritoneal mesothelioma is a very unusual disease characterized by a difficult diagnosis, a rapid evolution, a poor response to therapy, and a very high prevalence of thrombocytosis. A new clinical classification into three types (classical, surgical and medical) may be useful for a correct diagnosis. The early diagnosis of malignant peritoneal mesothelioma remains an important open question.     

A case of malignant peritoneal mesothelioma showed complete remission with chemotherapy

A 71-year-old woman presented with an abdominal mass and ascites and was subsequently admitted to our hospital in June 1995. Further examination revealed that the mass was malignant and, as a result, surgery was indicated. However, the mass demonstrated widespread peritoneal dissemination, which therefore could not be resected, and pathological findings suggested a malignant peritoneal mesothelioma. The patient showed a remarkable response to combined chemotherapy with an accompanying intraperitoneal injection of cisplatin and etoposide and an intravenous injection of caffeine. However, owing to side effects, this regimen was discontinued. The patient was administered a combination drug of uracil and tegafur (UFT) in addition to intraperitoneal injection of cisplatin as an outpatient. By the 223rd day after surgery, the tumor mass and ascites had completely disappeared according to the CT. Hence chemotherapy was judged to have resulted in complete remission. Such a marked response to chemotherapy is rare in an advanced malignant peritoneal mesothelioma such as the present case. Eight months later, the tumor recurred in the pleura. Another regimen of chemotherapy with cisplatin and CPT-11 was performed. However, this treatment proved ineffective. The patient subsequently died of respiratory failure in January 1997 due to the mesothelioma. This is a case report of complete remission of malignant peritoneal mesothelioma by combined chemotherapy.      

A case of malignant peritoneal mesothelioma successfully treated with carboplatin and paclitaxel

A 71-year-old woman was seen at our hospital because of abdominal fullness and dyspnea. Examinations revealed a tumor in the pelvis with fluid collection and dissemination was seen in the abdomen and chest. Moreover, hyaluronate in ascites rose to 20,000 mg/dl. Finally, by cytology of ascites using immunohistochemistry, the patient was diagnosed as malignant peritoneal mesothelioma with disseminations in the abdomen and chest. After intraperitoneal administration of 25 mg of cisplatin (CDDP), we started carboplatin (CBDCA) plus paclitaxel (PTX) combination chemotherapy (each treatment course consisted of 100 mg of PTX and 400 mg of CBDCA on day 1 and PTX 100 mg on day 8 and day 15 by intravenous administration followed by 2 drug-free weeks). After the sixth course, a complete remission was observed. Malignant mesothelioma is known to have a poor prognosis. However, we successfully treated malignant peritoneal mesothelioma with CBDCA and PTX combined chemotherapy. Our case suggests that we could improve the prognosis of malignant mesothelioma by aggressive chemotherapy.     

Malignant peritoneal mesothelioma: a multicenter study on 81 cases

BackgroundMalignant peritoneal mesothelioma (MPM) is a rare disease characterized by a difficult diagnosis, different types of presentation, variable course and poor prognosis.Materials and methodsEighty-one patients with MPM observed in 14 Italian oncology institutions from 1982 to 2007 have been examined with the aim of delineating the history of MPM.ResultsPresentation symptoms were ascites, abdominal pain, asthenia, weight loss, anorexia, abdominal mass, fever, diarrhea and vomiting in various associations. Computed tomography scan and echotomography signs were ascites, abdominal mass and peritoneal thickening. Peritoneal fluid cytology (61 cases) was positive for mesothelioma in 31 and for malignancy, not mesothelioma, in 13. Laparoscopy was carried out in 40 cases and laparotomy in 36. Thrombocytosis was present in 59 cases. Associated tumors diagnosed during the lifetime were colorectal cancer in two cases and cheek carcinoma, thyroid carcinoma, tongue carcinoma, bladder carcinoma and testicular seminoma. Thirty patients were treated with surgery and 45 with chemotherapy. The median survival time from diagnosis is 13 months. Ascites, fever and vomiting were significative variables at presentation; only vomiting holds significance in a multivariate analysis.ConclusionsMPM is a disease with various types of presentation, frequently associated with thrombocytosis, sometimes with other tumors. Survival and diagnosis time can differ in various types of MPM. Prognosis is poor.     

良性多囊性腹膜间皮瘤1例及文献复习

目的:探讨良性多囊性腹膜间皮瘤（benign multicystic peritoneal mesothelioma，BMPM）临床病理特征、诊断及治疗，提高对该病的认识。方法:回顾性分析我院2019年1月收治的1例BMPM患者的临床资料并复习相关文献。结果:该例患者女性，48岁，主因“反复右下腹疼痛5个月”入院，在全麻下行腹腔镜检查+中转开腹:肿瘤细胞减灭术+腹腔热灌注化疗（cytoreducrive surgery+hyperthermic intraperitoneal chemotherapy,CRS+HIPEC）。术后病理报告示:良性囊性腹膜间皮瘤，免疫组化结果:Calretinin（+），MC（+），WT-1（+），CK（+），Vimentin（+），CK5/6（+），CEA（-），CK7（+），CK20（-），PAX-8（+），ER（-），PR（-）。结论:BMPM临床发病率较低，无典型临床表现且缺乏特异性检查，术前诊断较困难，确诊依靠术后病理及免疫组化结果。CRS+HIPEC是目前首选有效的治疗方法，预后良好，复发率较高但恶变率低。     

58例晚期卵巢癌患者发生腹腔内转移后的临床特征、疗效及预后影响因素分析

目的 探讨晚期卵巢癌患者发生腹腔转移后的临床特点、疗效,并探讨预后的影响因素。方法 回顾性分析湖北省天门市第一人民医院肿瘤科3个病区2013年1月—2016年1月期间病理诊断明确、初诊且临床资料齐全的65例晚期卵巢癌患者,其中发生腹腔转移的58例,对58例患者预后影响因素进行单因素和多因素生存分析。结果 58例诊断卵巢癌腹腔转移患者的平均年龄为(49.2±6.5)岁,从确诊卵巢癌到发生腹腔转移的平均时间为11个月,卵巢癌腹腔转移患者的中位生存时间为8周,而7例未发生腹腔转移者的中位生存时间为15周。单因素生存曲线比较显示,患者婚姻状况、生育史、哺乳史、恶性腹水、新辅助化疗、综合治疗(化疗+开腹的肿瘤细胞减灭术+腹腔热灌注化疗)、腹腔转移瘤数目、残余病灶大小、患者的生存质量(卡氏评分)、血浆中D-二聚体水平、尿液中微量白蛋白的水平与患者的预后均有关(P＜0.05)。Cox多因素回归模型分析显示,患者生育史、综合治疗、血浆中D-二聚体的水平、尿液中微量白蛋白水平为影响患者预后的独立危险因素(P＜0.05)。结论 晚期卵巢癌腹腔转移患者生存时间短,预后差;新辅助化疗联合肿瘤细胞减灭术及术后腹腔热灌注化疗,短期疗效好,既能提高晚期卵巢癌治疗有效性,又可改善晚期患者的生存质量;治疗前血浆中D-二聚体水平以及尿液中微量白蛋白持续维持在高水平或者不降低的患者,治疗效果差,预后也差,提示二者可以作为一种新的判断预后的指标。     

Combination chemotherapy with cisplatin and gemcitabine in malignant peritoneal mesothelioma

Malignant peritoneal mesothelioma is a rare neoplasm with a rapidly fatal course. The response of this disease to treatment is poor because it tends to be advanced at diagnosis and tends to have inherent resistance to chemotherapeutic treatment. We describe three patients with malignant peritoneal mesothelioma who received combination chemotherapy with cisplatin and gemcitabine. After a histopathological diagnosis of epithelial-type malignant peritoneal mesothelioma, all patients underwent systemic chemotherapy because of the advanced disease stage. Moreover, one patient would have been at high risk of cardiac events, because of congenital heart malformation if complete surgical resection had been performed. This chemotherapy achieved a partial response in two patients, but had no effect in one. Combination chemotherapy with cisplatin and gemcitabine may prove to be one of the recommended treatments for patients with malignant peritoneal mesothelioma in the near future.     

Malignant peritoneal mesothelioma

Opinion statement This paper summarizes the author’s thoughts about the use of cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy (CS-IPHC) for treatment of peritoneal malignant mesothelioma. Pleural malignant mesotheliomas are by far more common (about ten-to thirty-fold) than the peritoneal variants (2.2 cases per 1 million in the US) [1]. Other locations (pericardium, tunica vaginalis) are very rare. It is well known that chemotherapy for mesothelioma is largely unsatisfactory, and measurement of treatment responses can be difficult. Single agent responses are all less than 20% with currently available agents for systemically administered drugs. Multiple drug combinations are typically more toxic, and have yielded little consistent demonstrable benefit with major studies reporting median survivals consistently under a year. There is currently more attention being paid to the response category of “stable” or absence of disease progression in concert with quality of life measurements; all regimens show poor durability. With peritoneal malignant mesothelioma, malignant ascites is a common presentation and a major factor in disease-related morbidity and mortality. Interperitoneal administration of agents is attractive, but drug distribution is an issue, as are response rates and durability. Multiple treatments are required; further, all neoplasms with peritoneal dissemination are typically understaged by current radiologic tests (CT, MRI), and the variable uptake of sugar by the small bowel limits the use of positron-emission tomography (PET) imaging for peritoneal malignant mesothelioma. Also, symptoms of bowel obstruction are not uncommon, and any mechanical component of obstruction will not improve with any form of chemotherapy. The author’s approach relies on surgery to achieve the following: 1) accurate staging; 2) tumor debulking, as possible, and treatment of mechanical obstruction as well as prevention of impending obstruction by resection or bypass; and 3) preparation for the use of intra-operative hyperthermic chemotherapy perfusion. This approach has been associated with rapid clinical symptom improvement, as well as a reliable and durable resolution of ascites with a single therapy. Morbidity and mortality have been acceptable with about 27-month median survival. The inability to provide effective systemic therapy to maintain or consolidate these gains is problematic.     

A case of diffuse peritoneal malignant mesothelioma--intraabdominal administration of cisplatin is useful for diminishing ascites

A 59-year-old man with a history of exposure to asbestos suffered from abdominal distension and visited our hospital. Abdominal CT revealed vast ascites but there was no obvious primary lesion. Serum tumor markers and hyaluronate were within the normal range. Abdominal puncture was carried out, and cytology of ascites was negative. We suspected diffuse malignant peritoneal mesothelioma because hyaluronate in ascites rose to 10×10? ng/mL. Ga-scintigraphy and FDG-PET were negative. We performed laparoscopic observation for definite diagnosis and found fine white particles at the peritoneum. The result of biopsy was malignant mesothelioma. The patient underwent intraperitoneal administration of cisplatin and his ascites was diminished. He lived for a year with no recurrence but died 23 months after diagnosis because of progression of pleural mesothelioma and liver metastases. Relapse of ascites was not found in the entire clinical course. Cisplatin administration in the peritoneal cavity is thus very effective in preventing progression of ascites.