Peritoneal Meso – Peritoneal mesothelioma is a rare pathology that is characterized by diffuse invasion of peritoneal surfaces. The incidence of pleural and Peritoneal Meso has increased universally since 1970.
In industrialized countries, its incidence is now estimated at 0.5 to 3 cases per million inhabitants in humans and 0.2 to 2 cases per million in women. Peritoneal Meso accounts for 1/5 to 1/4 of all clinical forms of mesothelioma.
The average age of onset is 50 years (17 to 76 years) and this pathology affects the two sexes equally. Its prognosis is very limited in the absence of adequate therapeutic management or medical treatment with a median survival estimated at 1 year. On the other hand, the prognosis appears better in women because of less invasive histological forms.
Peritoneal Meso – Clinical presentation and means of diagnosis
The circumstances and symptoms of the discovery of this pathology are mainly the increase in the volume of the abdomen (secondary to the presence of ascites or tumor formation) and nonspecific abdominal pain. The deterioration of the general state is rare and is found only in case of aggressive histological forms.
The appearance of asymptomatic hernia is also reported in 10% of cases. This mode of revelation is more common in humans. Fortuitous discovery during laparoscopy is more common in women.
The morphological reference examination for the diagnosis, extension assessment and monitoring of Peritoneal Meso remains today as for all peritoneal carcinomatosis, the thoracic-abdominopelvic CT scan. But it only detects lesions larger than 5 mm and greatly underestimates the intraperitoneal extension of the disease.
The intervention of radiologists or colonoscopists in the invasive Peritoneal Meso diagnosis must be careful. This tumor has, in fact, an important capacity for dissemination at the level of the puncture pathways, laparoscopic trocar holes or at the level of the abdominal incisions. Whatever the invasive method used, it must go through the median line. The placement of lateral trocars for laparoscopy should be avoided as it often leads to the parietal spread of the disease.
The pathologists of the Washington Cancer Institute identified 7 different histological types of Peritoneal Meso among 68 patients: multicystic mesothelioma, low-grade mesothelioma, well-differentiated papillary, epithelial, biphasic, sarcomatous and deciduous.