How to diagnosis and treatment of malignant peritoneal mesothelioma

Malignant peritoneal mesothelioma (Malignant Peritoneal Mesothelioma, MPM) is a rare tumor, since we July 2003 2004 August diagnosis and treatment of a total of three cases, the combination of literature review report are as follows.

Malignant peritoneal mesothelioma (Malignant Peritoneal Mesothelioma, MPM) is a rare tumor, since we July 2003 2004 August diagnosis and treatment of a total of three cases, the combination of literature review report are as follows.

1, information and methods of this group three cases, aged 26-47 years old, the median age of 38-year-old. Occupational distribution: 1 workers, farmers, a bank employee who had no history of direct contact with asbestos. The first symptoms of abdominal distention, abdominal pain, abdominal mass. Supplementary examination: three cases were done B-examination, inspection practices and ascites from falling cytology, a routine peritoneal biopsy. Ascites for the yellow exudate, cytology both see a lot of skin cells and lymphocytes, inflammatory cells. In all three cases laparotomy surgery for pathologically confirmed. Pathological type: E-two cases, one case of fiber types. General types: one case of localized, diffuse type 2 cases. Postoperative to chemotherapy, one case of follow-up, survival for more than 18 months.

2, to discuss MPM is the only primary peritoneal cancer, originated in mesothelial cells and / or to the skin cell differentiation between the mesothelioma cells. Low incidence of the disease, non-specific clinical performance, disease occult, clinical diagnosis difficult, high mortality. MPM is not clear the cause, reported in the literature of its occurrence may be related to asbestos dust exposure, chronic inflammation of stimulation, radioactive substances, viruses, genetic susceptibility. Recently, Teixeira, etc. [1] reported chromosome t (3; 3) (p14; q29) and some malignant peritoneal mesothelioma on the pathogenesis. Three cases of this group had no history of exposure to asbestos, one case of tuberculosis was the exact history of peritonitis, the anti-tuberculosis treatment of mitigation or "cured."

The lack of specific clinical manifestations, when the tumor growth to a certain size or involved gastrointestinal symptoms after. Diagnosis rely mainly on clinical features, imaging examination, inspection ascites exfoliated cells, peritoneal biopsy, laparoscopy and laparotomy.

Clinical characteristics: mainly for abdominal pain, abdominal distention, abdominal mass and ascites. The diverse nature of abdominal pain, intractable is the common characteristics. The patients were abdominal distention, abdominal pain, abdominal mass.

Supplementary examination: blood: platelets often abnormal increase. Tumor-associated antigen: CA125 often abnormal increase. B-: accurate tips ascites, tumor size, intra-abdominal adhesions fixed Enterovirus mix, irregular thickening of the wall and abdominal tumor planting. The Group B-3 routine inspection: both tumor size, ascites, part of a mix of intra-abdominal adhesions fixed Enterovirus, irregular thickening of the wall and the cultivation of intra-abdominal tumor. x-examination: abdominal plain film visible signs of intestinal obstruction; gastrointestinal contrast shows that a broad gastrointestinal pressure, deformation, with displacement and abnormal changes and mucosal surface chop no obvious damage. CT and MRI examination: Tips pots of ascites, lesions, tumors cr value of different levels. Ascites check: ascites Changcheng bloody serous or cellulose, hyaluronic acid increased. Smear see a large number of films and special-shaped mononuclear cells of the skin between the diagnosis has important significance. Laparoscopy: the ability to directly peep abdominal appearance, that peritoneal nodules and surface covered with plaques and desirable living seized, confirmed MPM is a reliable method to one. Peritoneal biopsy: MPM is confirmed one of a reliable method. This method is simple, traumatic small, to improve the diagnosis rate can be repeated many times to take samples, or B-ultrasound, CT-guided conduct. Laparotomy: MPM naked eye often observed that the visceral peritoneum was dense white tumor coverage, the organ into a "frozen" status, abdominal tumor and digestive organs in particular, mutual Nien连成一体the other a rare situation Retroperitoneal tumor in the organ is a nodular surface, sometimes together integration of multiple nodules. The group of three routine laparotomy, in the view of ascites 1000 ~ 3000 m1, pots abdominal peritoneal surface and mesentery, diaphragmatic widely distributed grey, Huihuangzhicui size nodules. Omentum was Bingzhuang, Zhicui, rugged, normal omentum organizations disappear. Most of pots of abdominal organ surface Zhicui nodules organizations covering cultivation, and with the surrounding tissue, organs adhesion.

MPM now called for a comprehensive treatment to surgery, combined with chemotherapy, radiation, immunotherapy and Chinese medicine treatment. MPM is doubtful whether the limitations or diffuse, in the absence of surgery contraindications, should be laparotomy, to the extent possible tumor resection. The group of three routine laparotomy, with the exception of one case of the transfer has been widely planted, small intestine, rectal tumor only full line of switches, while two cases were reduced to eliminate cancer and tumor resection, after supplemented by chemotherapy. MPM reported in the literature on the effective chemotherapy for the 0% to 40% [2]. This group three cases, intravenous chemotherapy and underwent abdominal chemotherapy. Different chemotherapy, doxorubicin and cisplatin, cyclophosphamide combined with chemotherapy, cisplatin or carboplatin, mitogen mycophenolate cable, VCR combined with chemotherapy. One case of follow-up, survival for more than 18 months. In recent years advocated by chemical injection drug peritoneal cavity to enhance the local drug concentration and reduce the toxicity of systemic. Ma [3], and other authors of the reports of continued high temperatures abdominal infusion of cisplatin treatment MPMl0 cases, follow-up of 10 months, the results of seven cases of disappearance of ascites, eight cases of non-recurrence of the inspection, and the local no apparent toxic effects, cisplatin unique Pharmacokinetics in high-temperature continuous infusion of additional anti-tumor effect.

Immunotherapy: adoptive immune cell therapy can mobilize, improve and enhance the host immune function; ascites and quickly dissipated, the recent good effect. We TIL increases based on r-IL2 coordinated anti-tumor and the principle of lifting immunosuppressive role in the application of the former TIL plus r-IL2 in the treatment of MPM with massive ascites in patients with one cases, supplemented by postoperative chemotherapy, the effect of significantly. Tani, etc. [4] reported by chemical substances sensitive choice of chemotherapy with cytotoxic drugs lymphocyte immune to the chemical treatment of MPM, the results were satisfactory.

MPM poor prognosis, diagnosed in more than one or two years after the death. The prognosis and clinical stage at diagnosis, and treatment of pathological type methods. Diffuse peritoneal mesothelioma very poor prognosis, there is no cure reported in the literature. Epithelial mesothelioma than the hybrid fiber-better prognosis. One case of follow-up of this group, survival for more than 18 months, then for the E-.