(A) etiology
Etiology and asbestos exposure related to its incidence and exposure to very long intervals, often in more than 30 years. Early in the 20th century, 40 years, foreign scholars found the incidence of mesothelioma and asbestos exposure are closely related. Shipyard workers, pipeline workers, welders and paint, the incidence of construction workers 300 times higher than the average person. Close relationship between mesothelioma and asbestos exposure has been confirmed by the fact that more and more and recognized. At the same time, European and American scholars found that about 60% of patients had peritoneal mesothelioma, occupational history of asbestos exposure or asbestos lung tissue corpuscles, in the use of asbestos-induced pleural mesothelioma in experimental animals, also place a small number of animals peritoneal mesothelioma, indicating the occurrence of peritoneal mesothelioma and asbestos exposure there is a certain relationship. Different types of asbestos fibers disease risk as follows: crocidolite> amosite> chrysotile asbestos. 0.5 ~ 50μm in diameter is generally believed that long before the asbestos dust into the respiratory tract, and then by the diaphragmatic lymph or blood into the abdominal cavity and net deposition in the peritoneum, the formation of asbestos bodies, and sometimes asbestos bodies in the surrounding foreign body giant cell reaction can occur. Asbestos fiber intake by the digestive tract can reach the peritoneum via the intestinal wall. Mesothelioma from exposure to asbestos found that an average of 35 to 40 years, the incidence peaks in 45 years after exposure. The exact mechanism of asbestos-induced mesothelioma is also unclear. But about 30% of the mesothelioma patients no history of exposure to asbestos, asbestos fibers in contact with the quantitative and did not show a large number of asbestos fibers. Reported occurred with mesothelioma and other factors related to radiation therapy, history of exposure to thorium dioxide (often patients have received diagnostic tests related to history.) In addition, patients with a history of Hodgkin increased risk of mesothelioma.
Virus infection: the simian virus (simian virus 40, SV40), which is a DNA tumor virus. According to the literature, the United States about 50% of the mesothelioma patients with biopsy specimens there SV40, which induces telomerase activity in primary mesothelioma, but not fibroblasts. 72h after infection of wild-type SV40 telomerase activity can be measured after 1 week shows a clear DNA ladder. Telomerase activity in cell structure and is proportional to the number of SV40 T antigen, SV40 infected by mesothelial cells, telomerase activity increased, making difficult to apoptosis in mesothelial cells, easily understood form of mesothelioma.
Mesothelioma may also be to the following factors: exposure to fluorspar, tuberculosis scars, chronic inflammation, radioactive substances, such as genetic predisposition.
(B) of the pathogenesis
According to their biological behavior and tumor invasion and scope, can be divided into benign and malignant mesothelioma, localized and diffuse. Reported cases of mesothelioma in bulk, about 57.1% occurred in the pleura, peritoneum occurred in 39.5% and 1% occur in the pericardium, can involve multiple serosal surface, or even in the testis sheath.
1. Mesothelioma tissue that comes from both its early cells, the surface of the peritoneal mesothelial cells and connective tissue cells. Has recently been proved to be from a single cell, that mesothelial cells. Mesothelial cells and fibroblasts to the epithelial cells showed two forms of differentiation. Dardick (1984) found in sarcomatoid mesothelioma in the region does not show the ultrastructural features of fibroblasts, which show different stages of differentiation characteristics of epithelial cells. Blobel proved by immunohistochemistry cytokeratin polypeptide (cytokeratin polypeptide) in the fibrous mesothelioma, and expressed in all epithelial mesothelioma. The wavy fiber protein (fibrin), in the same or the same tumor cells also expressed the two-way display the expression characteristics of mesothelioma.
2. Peritoneal mesothelioma can be divided into low grade cystic mesothelioma, well-differentiated papillary mesothelioma and malignant mesothelioma.
(1) low grade cystic mesothelioma: is common in middle-aged women, often located in the pelvic extraperitoneal and can be invaded. Tumors larger envelope was not obvious, ill-defined, often in the structure of the surrounding pelvic adhesions. Section for multi-cystic, smooth wall, clear liquid or capsule containing thin mucus. Flat to low columnar wall covered mesothelial cells, mild to moderate abnormal, can be presented papillary hyperplasia and metaplasia. Cystic hyperplasia of fibrous stroma, in which no chronic inflammatory cell infiltration.
(2) well-differentiated papillary mesothelioma: not common, even in the operation found that occurs in women of childbearing age. Prognosis is usually good, even to the development of malignant mesothelioma. Visible over the pelvic peritoneum and omentum showed papillary or nodular lesions, solid, white, diameter <2cm. Tumors may also occur in the stomach, intestine and mesenteric peritoneum. Endoscopic papillary tumors of flat to cuboidal single-layer coating the surface of mesothelial cells, nuclear atypia, rare mitotic figures, cytoplasmic axis for the fibrous stroma. Visible tumors formed by the mesothelial cells in a small tube, branch-like cords or solid pieces, occasionally sand body.
(3) malignant mesothelioma: single or multiple tumors were dispersed growth, while involving the visceral and parietal peritoneum can be classified according to shape and limitations of diffuse type. Localized malignant mesothelioma, clear boundary, pedunculated or capsule, hard and tough, low degree of malignancy. Diffuse malignant mesothelioma, diffuse peritoneal thickening involved, the surface was papillary, plaque or nodular, highly malignant. In general see, widely distributed peritoneal surface tumor nodules of varying sizes, isolated, or was beaded cluster mass, from a few millimeters to several centimeters in diameter, yellowish white or gray, hard, like a rubber-like texture . Late thickened peritoneum, peritoneal tumor was covered by dense white, so that organ into a "frozen" (frozen) state. Tumor tissue and abdominal viscera, especially the digestive tract fused with each other sticky and difficult to separate, or organs in the abdominal cavity peritoneal surface showed multiple nodular masses of grape-like, or diffusely distributed in the abdominal peritoneal surface of the diaphragm, peritoneal surface, and after omentum, mesentery, small intestine and colon serosa or the liver, bladder surface. Sometimes multiple nodules fused into lumps.
Peritoneal mesothelial cells pathologic tumor peritoneal mesothelioma outlook general observation is similar to pleural mesothelioma, there are 2 types, namely, diffuse peritoneal mesothelioma and limitations of peritoneal mesothelioma, in general, diffuse 75% of malignant mesothelioma, and limitations of mesothelioma are mostly benign. The former showed a large number of tumor nodules or plaques covered in the parietal or visceral peritoneum with tumor development, the bulk of the thickening of the film was widely covered and in the parietal peritoneum, or abdominal organs on the surface, may be associated with ranging in size tumor or nodule. Mostly off-white tumor tissue, hard and tough, also was jelly, may have hemorrhage and necrosis. Tumor tissue, fibrous tissue hyperplasia, and even a glass-like change. Tumors can invade the liver or intestine, but rarely invade deep organs, omentum can be completely replaced by tumor tissue, intestinal adhesions can occur, there is intra-abdominal effusion, and even bloody ascites. Limitations of peritoneal mesothelial cells in the tumor, tumor tissue showed nodular or plaque in the parietal or visceral peritoneum, are pale, hard, circumscribed, rarely hemorrhage and necrosis (Figure 1).
3. Peritoneal mesothelioma peritoneal mesothelial cells were observed generally have three kinds of tumor histological type:
(1) fibrous mesothelioma: fibrous mesothelioma tumor cells composed of spindle cells, fusiform cells, accompanied by varying amounts of collagen fibers, the limitations of this type more common in mesothelioma. In fibrous mesothelioma cancer is sometimes difficult to distinguish with fibrous tissue, tumor cells were spindle-shaped cells of the surrounding collagen may have, or even a weave-like structure, focal calcification or ossification, when there are obvious interstitial fibrosis or hyaline degeneration, some people call it the ligament-like mesothelioma. Recently, some people will come from the subcutaneous connective tissue between the source of the tumor, called the peritoneal fibroma. Mesothelial cells from the surface before said fibrous mesothelioma. However, based solely on morphology, it is sometimes difficult to distinguish between the two (Figure 2).
(2) epithelioid mesothelioma: epithelial mesothelioma tumor cells were cuboidal or polygonal, often tubular or papillary structures clock. Found in most epithelial mesothelioma, diffuse mesothelioma, the tumor cells were different differentiation status, can form well-differentiated tubular or papillary structures, but also showed a massive piece of undifferentiated tumor tissue, tumor cells of different sizes, in solid, surrounded by connective tissue. Tubular form papillary structures adenoid tumor, tubular or cystic, lined by cubic or flat epithelial cells, the same size, vesicular nucleus, showing 1 to 2 nucleoli. Abundant cytoplasm, cell outlines clear. Also showed a fracture or tumor-like formation of cysts of varying sizes, lined by flattened epithelial cells, these fractures are sometimes seen within the papillae. Similar to the papillary adenocarcinoma. Some cases, the tumor cells arranged in solid, cords or nests, without adenoid or papillary structures. But sometimes may have mucus around the tumor material, forming a similar structure of mucus lake. More consistent cell morphology, nuclear sizes, when the cytoplasm vacuolization mucopolysaccharide containing material (Figure 3).
(3) mixed mesothelioma: differentiation of mesothelioma, also known as two-way, in the same fiber and epithelial tumor associated with 2 components. Zllzllki (1980) reported 210 cases of diffuse malignant mesothelioma, the epithelial-like 67%, mixed 26%, 7% fibrosis, the latter most commonly within the limitations of mesothelioma. Mixed mesothelioma tumor cells and epithelioid sarcoma by the kind of composition, morphology similar to synovial sarcoma. Sarcomatoid component composed of spindle cells, it is often a transitional form of epithelial components, which can be displayed, mesothelioma is a cell from a single source, and asbestos-related mesothelioma in common to this form. Mucinous adenocarcinoma and mesothelioma, staining on the identification of a help, but low differentiation adenocarcinoma, mucus staining can also be negative. The tumor cells Alcianblue mesothelioma can also be displayed positive staining, but these are also found in the extracellular mucous stroma. Reticular fiber staining tumor cells is rich in reticular fibers, and help distinguish it from adenocarcinoma. When the tumor was found asbestos bodies (asbestosbody) when there is help in the diagnosis of mesothelioma, especially in pleural mesothelioma. As asbestos and the occurrence of lung cancer have relationships, so that only the reference value of asbestos bodies (Figure 4).
4. Peritoneal mesothelioma ultrastructural electron microscopy, especially transmission electron microscopy, the diagnosis of mesothelial tumors have a high value. Ultrastructural features are: mesothelioma tumor cells have numerous, slender, brush-like microvilli appear on the surface of tumor cells, but can also appear in the cytoplasm. However, in adenocarcinoma of the microvilli, the number of small, short stick. Mesothelioma has a huge nucleus of cells, prominent nucleoli, moderate amount of mitochondria is the rough endoplasmic reticulum surrounding the common glycogen granules, bundles of fiber tension and intracellular vacuoles. Smooth endoplasmic reticulum is not well developed. Cells outside the substrate, but most do not complete. Connections between cells, can also be found desmosomes. These ultrastructural features were mainly observed in epithelial cells of mesothelioma in mesothelioma or mixed. The fibrous mesothelioma, ultrastructure similar to fibroblasts, the tumor cells in the spindle, is rich in rough endoplasmic reticulum, occasional small cavities between cells and microvilli (Fig. 5).
5. Peritoneal mesothelioma immunohistochemistry Immunohistochemical differential diagnosis of mesothelioma and adenocarcinoma have some help. Cytokeratin (cytokeratin) showed positive in mesothelioma, but CEA was negative or weakly positive; adenocarcinoma positive for CEA are mostly strong, and keratin (keratin) often focal positive or negative. However, due to various reasons, the literature in the immunohistochemical identification of mesothelioma and adenocarcinoma of the reports, each with different results. So simple and so can not make a final conclusion, other technologies must be integrated to make an objective diagnosis. Some mesothelioma patients, accompanied by metabolic disorders, such as blood glucose less psychosis. Occasional limitations of peritoneal mesothelioma can be presented multiple cystic, lined with simple cuboidal or flat epithelium, capsule containing a transparent liquid.
Mesothelioma cell electron microscopy and enzyme histochemical characteristics: mainly by epithelioid mesothelioma cells (epithelioid cell, EC), fibroblast-like cells (fibroblast-like cell, FLC), intermediate cells (interim cell, IC) and primitive mesenchymal cells (primary mesenchymal cell, PMC) 4 kinds of cells formed. EC to enrich characterized by microvilli, cell surface microvilli are slender, its length and width and diameter ratio of 10:1 ~ 15:1, which is far greater than the proportion of other cancer, several tumor cells around showed a sinus-like gap, within which there are many intertwined slender microvilli, FLC in the rough endoplasmic reticulum more. EC dehydrogenase and oxidase activity were higher, and lower hydrolytic activity. FLC cell activity and the EC is the opposite. This may be related to two different types of activity related to cell function.
Immunohistochemical Features of mesothelioma: Since the original mesenchymal cells directly or through intermediate cells to epithelial cells, may also be differentiated into fiber-type cells, which immunohistochemical staining of mesothelioma complex types The immunohistochemical characteristics of mesothelioma cells in Table 1.
As can be seen from the table, mesothelioma, a variety of immunohistochemical expression of different, positive expression and negative results were not 100%. Therefore, certain abdominal tumors, particularly ovarian serous cystadenocarcinoma and tubular epithelial mesothelioma, papillary structures difficult to identify. The former only 2% of CEA expression, whereas epithelial membrane antigen and human milk fat globulin expression there is a higher percentage, so the use of the immunohistochemistry is difficult to distinguish between the two. Recent application of Ber-Ep4 antibody can be identified malignant mesothelioma and adenocarcinoma, Ber-Ep4 and retroperitoneal abdominal peritoneal metastatic adenocarcinoma, and adenocarcinoma of the positive rate was 100%, while only 115 cases of mesothelioma expression in 1 case (accounting for 0.87%). Therefore, the use of comprehensive analysis of immunohistochemical staining, can make the correct pathologic diagnosis of mesothelioma, electron microscopy if the conditions are even more perfect.
2010-11-06
Trajtimi i Mesothelioma peritoneal
(A) treatment
The general effect of radiotherapy and chemotherapy are not satisfied with some reports in recent years, ADM has 50% of cases the treatment extended the survival period, but there are also reports that the invalid, it was also advocate the use of immune therapy, needs further observation, usually after diagnosis 1 ~ 2 years of death, so far, peritoneal mesothelioma is still a lack of standardized treatment, most scholars claim, including surgery, radiotherapy and chemotherapy after comprehensive treatment.
1. Surgical treatment on stage of disease is in stage Ⅰ, Ⅱ of cases, should the first choice, or for surgical treatment, including surgical resection, palliative resection of the tumor smaller, more limited lesions, should be complete resection of the tumor and organ involved; if more extensive disease should strive for resection of the primary tumor (palliative resection), a wide range of diseases, severe, has resulted in intestinal obstruction, surgical resection can not, palliative surgery can be considered to alleviate the patient's clinical symptoms, biological behavior of benign and low malignant peritoneal mesothelioma, surgery was very good effect, if any, can be re-resection recurrence, Zhu Weiqi and other reports 1 case of recurrence of malignant peritoneal mesothelioma for 20 years, has implemented many 5 second operation resection, reported in the literature, simply the best surgical treatment of a group of cases (7 cases), median survival was 147.2 months, therefore, some cases of peritoneal mesothelioma, surgery is still regarded as an effective treatment.
2. Radiotherapy including external beam radiotherapy and (or) irradiation, the choice of 60Co or 186 kV X-ray as the radiation source, for incomplete resection or unresectable cases, Ke Yi decided to whole abdominal irradiation lesions or local irradiation It is generally believed, peritoneal mesothelioma, pleural mesothelioma, radiation therapy as effective as well, which may be used with pleural mesothelioma radiation dose on the larger, Shanghai Medical University Cancer Hospital data indicate that whole abdominal irradiation, radiation dose per 6 7 weeks 2400cGy, patients with local recurrence rate can be reduced to 11.4%, 66.7% three-year survival rate, indicating that the effect of radiation on peritoneal mesothelioma is yes.
3. Chemotherapy to chemotherapy treatment of peritoneal mesothelioma are many reports now that the peritoneal mesothelioma, is moderately sensitive to chemotherapy, commonly used drugs: doxorubicin (ADM), cisplatin (DDP), vincristine ( VCR), cyclophosphamide (CTX), bleomycin (BLM) and stir-made anti-cancer drugs such as Hong prolactin, in which the efficacy of doxorubicin is most certainly, chemotherapy and systemic chemotherapy into the abdominal cavity chemotherapy.
(1) chemotherapy: systemic give anticancer drugs, drug distribution within the abdominal cavity less foreign data show that both single-agent or combination therapy, systemic chemotherapy was only 11% to 14%, combined chemotherapy, including: DDP ADM ; DDP CTX VCR; CTX VCR BLM, etc., but many scholars combined with chemotherapy did not improve the outcome.
(2) Intraperitoneal chemotherapy: in recent years that intraperitoneal injection of medication may improve the local drug concentration and reduce systemic side effects doxorubicin, intraperitoneal chemotherapy, not only can eliminate residual tumor tissue after surgery to reduce recurrence, but also to partial loss of tumor regression of the surgical patients, ascites reduced condition was under control, abdominal and intravenous dose of a similar amount, or slightly higher than the latter, repeated after 1 week, according to the condition of continuous injection of a few weeks, Ito, etc. to 1 case surgery resection of the patients failed to intraperitoneal injection of DDP, and the joint use of uracil and tegafur, 223 days after the patients had no abdominal mass, ascites completely disappeared, but in the first 8 months after pelvic tumor recurrence, re-awarded to DDP and hi tree base, the result is poor, Ma, etc. are continuous intraperitoneal perfusion with warm (continuous hyperthermic peritoneal perfusion, CHPP), local injection of DDP combined treatment of primary peritoneal mesothelioma, treatment no local adverse reactions, patients are can tolerate CHPP, followed up for 10 months, no treatment of 1 patient died because of CHPP.
Intraperitoneal injection of 33P peritoneal mesothelioma has a certain effect, has been reported with intravitreal injection of 33P, radiotherapy and cyclophosphamide treatment of malignant peritoneal mesothelioma, the patient survived for 17 years, is also useful intraperitoneal injection of radioactive colloid reports .
4. Biological response modifier biological response modifier (biological nesponse modifier, BRM) is the application of the body's own cells and molecules, answering internal and external environment to stimulate the body to participate in maintaining a stable internal environment, BRM through the mobilization of the body inherent ability to resist and eliminate the tumor, the treatment of cancer become the new model.
Cytokine interleukin (IL), interferon (IFN), tumor necrosis factor (TNF), etc. In addition to directly killing tumor cells, and can be activated in vivo anticancer effect of cancer cells or secreted factors, or the maintenance of immune effector cells proliferation, differentiation, can be used as adjuvant therapy for primary peritoneal mesothelioma.
Adoptive transfer of immune cells in the collection, separation, ascites carcinoma cells in the in vitro expansion, and has a killing activity induced lymphokine, activated killer cells (LAK), will be injected into the body, anti-tumor cells, while given IL-2, may improve the outcome.
(B) prognosis
Without treatment of malignant peritoneal mesothelioma, most living in just 1 year after diagnosis, many died of cachexia or small bowel obstruction, the thoroughness of cytoreductive surgery, intraperitoneal chemotherapy and other treatments to improve the prognosis of patients directly affected, there were reports of tumor reduction surgery and intraperitoneal chemotherapy for the treatment of multi methods to peritoneal mesothelioma, the average survival time of 50 to 60 months, women in relatively good prognosis, in addition to In addition, the biological behavior of the tumor itself has important prognostic significance, has been reported Analysis of a set of data shows that 4710 cases of epithelial type, mixed type and fiber type, the median survival was 11 months, 10 months and 5 months.
The general effect of radiotherapy and chemotherapy are not satisfied with some reports in recent years, ADM has 50% of cases the treatment extended the survival period, but there are also reports that the invalid, it was also advocate the use of immune therapy, needs further observation, usually after diagnosis 1 ~ 2 years of death, so far, peritoneal mesothelioma is still a lack of standardized treatment, most scholars claim, including surgery, radiotherapy and chemotherapy after comprehensive treatment.
1. Surgical treatment on stage of disease is in stage Ⅰ, Ⅱ of cases, should the first choice, or for surgical treatment, including surgical resection, palliative resection of the tumor smaller, more limited lesions, should be complete resection of the tumor and organ involved; if more extensive disease should strive for resection of the primary tumor (palliative resection), a wide range of diseases, severe, has resulted in intestinal obstruction, surgical resection can not, palliative surgery can be considered to alleviate the patient's clinical symptoms, biological behavior of benign and low malignant peritoneal mesothelioma, surgery was very good effect, if any, can be re-resection recurrence, Zhu Weiqi and other reports 1 case of recurrence of malignant peritoneal mesothelioma for 20 years, has implemented many 5 second operation resection, reported in the literature, simply the best surgical treatment of a group of cases (7 cases), median survival was 147.2 months, therefore, some cases of peritoneal mesothelioma, surgery is still regarded as an effective treatment.
2. Radiotherapy including external beam radiotherapy and (or) irradiation, the choice of 60Co or 186 kV X-ray as the radiation source, for incomplete resection or unresectable cases, Ke Yi decided to whole abdominal irradiation lesions or local irradiation It is generally believed, peritoneal mesothelioma, pleural mesothelioma, radiation therapy as effective as well, which may be used with pleural mesothelioma radiation dose on the larger, Shanghai Medical University Cancer Hospital data indicate that whole abdominal irradiation, radiation dose per 6 7 weeks 2400cGy, patients with local recurrence rate can be reduced to 11.4%, 66.7% three-year survival rate, indicating that the effect of radiation on peritoneal mesothelioma is yes.
3. Chemotherapy to chemotherapy treatment of peritoneal mesothelioma are many reports now that the peritoneal mesothelioma, is moderately sensitive to chemotherapy, commonly used drugs: doxorubicin (ADM), cisplatin (DDP), vincristine ( VCR), cyclophosphamide (CTX), bleomycin (BLM) and stir-made anti-cancer drugs such as Hong prolactin, in which the efficacy of doxorubicin is most certainly, chemotherapy and systemic chemotherapy into the abdominal cavity chemotherapy.
(1) chemotherapy: systemic give anticancer drugs, drug distribution within the abdominal cavity less foreign data show that both single-agent or combination therapy, systemic chemotherapy was only 11% to 14%, combined chemotherapy, including: DDP ADM ; DDP CTX VCR; CTX VCR BLM, etc., but many scholars combined with chemotherapy did not improve the outcome.
(2) Intraperitoneal chemotherapy: in recent years that intraperitoneal injection of medication may improve the local drug concentration and reduce systemic side effects doxorubicin, intraperitoneal chemotherapy, not only can eliminate residual tumor tissue after surgery to reduce recurrence, but also to partial loss of tumor regression of the surgical patients, ascites reduced condition was under control, abdominal and intravenous dose of a similar amount, or slightly higher than the latter, repeated after 1 week, according to the condition of continuous injection of a few weeks, Ito, etc. to 1 case surgery resection of the patients failed to intraperitoneal injection of DDP, and the joint use of uracil and tegafur, 223 days after the patients had no abdominal mass, ascites completely disappeared, but in the first 8 months after pelvic tumor recurrence, re-awarded to DDP and hi tree base, the result is poor, Ma, etc. are continuous intraperitoneal perfusion with warm (continuous hyperthermic peritoneal perfusion, CHPP), local injection of DDP combined treatment of primary peritoneal mesothelioma, treatment no local adverse reactions, patients are can tolerate CHPP, followed up for 10 months, no treatment of 1 patient died because of CHPP.
Intraperitoneal injection of 33P peritoneal mesothelioma has a certain effect, has been reported with intravitreal injection of 33P, radiotherapy and cyclophosphamide treatment of malignant peritoneal mesothelioma, the patient survived for 17 years, is also useful intraperitoneal injection of radioactive colloid reports .
4. Biological response modifier biological response modifier (biological nesponse modifier, BRM) is the application of the body's own cells and molecules, answering internal and external environment to stimulate the body to participate in maintaining a stable internal environment, BRM through the mobilization of the body inherent ability to resist and eliminate the tumor, the treatment of cancer become the new model.
Cytokine interleukin (IL), interferon (IFN), tumor necrosis factor (TNF), etc. In addition to directly killing tumor cells, and can be activated in vivo anticancer effect of cancer cells or secreted factors, or the maintenance of immune effector cells proliferation, differentiation, can be used as adjuvant therapy for primary peritoneal mesothelioma.
Adoptive transfer of immune cells in the collection, separation, ascites carcinoma cells in the in vitro expansion, and has a killing activity induced lymphokine, activated killer cells (LAK), will be injected into the body, anti-tumor cells, while given IL-2, may improve the outcome.
(B) prognosis
Without treatment of malignant peritoneal mesothelioma, most living in just 1 year after diagnosis, many died of cachexia or small bowel obstruction, the thoroughness of cytoreductive surgery, intraperitoneal chemotherapy and other treatments to improve the prognosis of patients directly affected, there were reports of tumor reduction surgery and intraperitoneal chemotherapy for the treatment of multi methods to peritoneal mesothelioma, the average survival time of 50 to 60 months, women in relatively good prognosis, in addition to In addition, the biological behavior of the tumor itself has important prognostic significance, has been reported Analysis of a set of data shows that 4710 cases of epithelial type, mixed type and fiber type, the median survival was 11 months, 10 months and 5 months.
Symptoms of peritoneal mesothelioma
Peritoneal mesothelioma can occur in from 2 to 92 years, the average diagnosis of foreign literature age of 54 years, of which about 63% of cases in the 45 to 64 years old, the sick children, a rare tumor of mesothelial cells was no early obvious symptoms, and only to a certain size and growth of tumor involving the stomach, intestines and other abdominal organs before clinical symptoms, mainly abdominal pain, abdominal distension, ascites, abdominal mass, gastrointestinal symptoms, and systemic change.
1. Peritoneal mesothelioma, abdominal pain, abdominal pain is the most common symptoms in persistent pain, tenderness, but also for cramps or sudden paroxysmal pain, pain is usually located on the abdomen and right upper quadrant, but also abdominal pain in the next the abdomen caused by clinically misdiagnosed as ectopic pregnancy or pelvic tumors reported the occurrence of abdominal pain and violations of parietal peritoneum, cancer and gastrointestinal tract obstruction caused by adhesions and pelvic organs, organ torsion and massive ascites, abdominal mass produce placeholder effect of other factors, the nature and location of the course of abdominal pain can be changed.
2. Bloating as ascites, intra-abdominal mass and secondary dyspepsia, intestinal obstruction and other factors, patients can have varying degrees of abdominal distention, severe symptoms can affect eating, even breathing difficulties.
3. Ascites about 90% of patients with peritoneal mesothelioma absence of ascites, and the rapid growth of a considerable number of patients with ascites, ascites can be as thick yellow drainage or bloody fluid, the tumor cells with active secretion of hyaluronic acid function.
4. Peritoneal mesothelioma, abdominal mass is a common clinical manifestations, some patients while the doctor because of abdominal mass, and peritoneal mesothelioma, abdominal mass can be single, but also for multiple, texture, or more rigid hard, nodular surface, located in the greater omentum, mesenteric serosal surface of the mass can move in the physical examination, abdominal mass may have tenderness in the pelvic mass could triple by digital rectal examination or consultation found that the merger a large number of drainage of ascites in patients with ascites after abdominal mass more clearly understand the situation, detailed physical examination for abdominal mass in a preliminary understanding of the abdominal wall, substantial organ, the first visit to the clinic to provide information.
5. Other minority patients may also have loss of appetite, nausea, vomiting, diarrhea or constipation, urinary tract irritation, menstrual changes and fatigue, fever, weight loss, anemia, individual patients have low blood sugar, diffuse abdominal ossification and other clinical manifestations, When combined with other parts of the patient or peritoneal mesothelioma, mesothelioma metastasis to other organs or complications, the clinical manifestations may appear appropriate.
Very few reported patients with pleural mesothelioma, peritoneal, or exist in other parts of mesothelioma, peritoneal mesothelioma, mesothelioma and other parts or for multicentric occurrence or metastases of primary tumor and the relationship, it is not too clear.
A large number of autopsy material showed that the peritoneal mesothelioma can only dip and abdominal pelvic organs, can also cause distant metastasis, direct invasion of peritoneal mesothelioma and gastrointestinal tract, some patients can be tumor cells directly to a depth of mucosal invasion lower, or even mucous layer, peritoneal mesothelioma can also invade to the abdominal wall, liver, gallbladder, pancreas and bladder, prostate and other organs, tumor metastasis to the lymph nodes and can also be the liver, lungs, heart, kidney, adrenal gland, bone marrow and other tissues and organs .
Squeeze the gastrointestinal tract tumor, adhesion and invasion of gastrointestinal and gastrointestinal wall, peritoneal mesothelioma can cause intestinal obstruction.
The onset of occult peritoneal mesothelioma, clinical manifestations do not have specific, positive rate of the supplementary examination is not high, specificity is not strong, so its very difficult clinical diagnosis, early cases reported in the literature or even more by the laparotomy for other diseases surgery (eg hernia repair) when the biopsy was confirmed, with laparoscopy, B ultrasound and CT guided biopsy technology, carry out and pathology, immunohistochemistry and electron microscopic diagnosis level, more and more cases and even in his lifetime clearly preoperative pathological diagnosis.
Clinically unexplained abdominal pain, abdominal distension, ascites and abdominal mass in patients, especially when the patient with asbestos exposure history, should consider the diagnosis of peritoneal mesothelioma and peritoneal cytology examination and repeated the inspection, such as abdominal CT examination revealed the typical changes, the examination and failed to find other parts of the evidence of a primary tumor, should be highly suspected diagnosis of peritoneal mesothelioma may be related to pathology by laparoscopy and diagnosed, if necessary, consider laparotomy diagnosis and surgical treatment for the same time.
Exfoliated cells in the ascites and biopsy less ordinary light microscope staining sometimes difficult pathological diagnosis, immunohistochemistry, electron microscopy can help confirm the diagnosis.
Made in the diagnosis of peritoneal mesothelioma at the same time, should understand their stage of disease, disease of the morning and evening on the choice of treatment, the prognosis significance of the decision, made in 1976, Butchart and other changes to the mesothelioma program divided into 4 stages period, Ⅰ period: tumor confined to ipsilateral pleura, lung, pericardium, or peritoneum; Ⅱ of: tumor invading the chest wall, mediastinum, and (or) chest or abdominal lymph nodes within the corresponding structure; Ⅲ of: penetrating the diaphragm, chest , extraperitoneal lymph node involvement; Ⅳ period: distant metastasis, and some scholars have differences of opinion still exist in the program, it needs to be further improved.
1. Peritoneal mesothelioma, abdominal pain, abdominal pain is the most common symptoms in persistent pain, tenderness, but also for cramps or sudden paroxysmal pain, pain is usually located on the abdomen and right upper quadrant, but also abdominal pain in the next the abdomen caused by clinically misdiagnosed as ectopic pregnancy or pelvic tumors reported the occurrence of abdominal pain and violations of parietal peritoneum, cancer and gastrointestinal tract obstruction caused by adhesions and pelvic organs, organ torsion and massive ascites, abdominal mass produce placeholder effect of other factors, the nature and location of the course of abdominal pain can be changed.
2. Bloating as ascites, intra-abdominal mass and secondary dyspepsia, intestinal obstruction and other factors, patients can have varying degrees of abdominal distention, severe symptoms can affect eating, even breathing difficulties.
3. Ascites about 90% of patients with peritoneal mesothelioma absence of ascites, and the rapid growth of a considerable number of patients with ascites, ascites can be as thick yellow drainage or bloody fluid, the tumor cells with active secretion of hyaluronic acid function.
4. Peritoneal mesothelioma, abdominal mass is a common clinical manifestations, some patients while the doctor because of abdominal mass, and peritoneal mesothelioma, abdominal mass can be single, but also for multiple, texture, or more rigid hard, nodular surface, located in the greater omentum, mesenteric serosal surface of the mass can move in the physical examination, abdominal mass may have tenderness in the pelvic mass could triple by digital rectal examination or consultation found that the merger a large number of drainage of ascites in patients with ascites after abdominal mass more clearly understand the situation, detailed physical examination for abdominal mass in a preliminary understanding of the abdominal wall, substantial organ, the first visit to the clinic to provide information.
5. Other minority patients may also have loss of appetite, nausea, vomiting, diarrhea or constipation, urinary tract irritation, menstrual changes and fatigue, fever, weight loss, anemia, individual patients have low blood sugar, diffuse abdominal ossification and other clinical manifestations, When combined with other parts of the patient or peritoneal mesothelioma, mesothelioma metastasis to other organs or complications, the clinical manifestations may appear appropriate.
Very few reported patients with pleural mesothelioma, peritoneal, or exist in other parts of mesothelioma, peritoneal mesothelioma, mesothelioma and other parts or for multicentric occurrence or metastases of primary tumor and the relationship, it is not too clear.
A large number of autopsy material showed that the peritoneal mesothelioma can only dip and abdominal pelvic organs, can also cause distant metastasis, direct invasion of peritoneal mesothelioma and gastrointestinal tract, some patients can be tumor cells directly to a depth of mucosal invasion lower, or even mucous layer, peritoneal mesothelioma can also invade to the abdominal wall, liver, gallbladder, pancreas and bladder, prostate and other organs, tumor metastasis to the lymph nodes and can also be the liver, lungs, heart, kidney, adrenal gland, bone marrow and other tissues and organs .
Squeeze the gastrointestinal tract tumor, adhesion and invasion of gastrointestinal and gastrointestinal wall, peritoneal mesothelioma can cause intestinal obstruction.
The onset of occult peritoneal mesothelioma, clinical manifestations do not have specific, positive rate of the supplementary examination is not high, specificity is not strong, so its very difficult clinical diagnosis, early cases reported in the literature or even more by the laparotomy for other diseases surgery (eg hernia repair) when the biopsy was confirmed, with laparoscopy, B ultrasound and CT guided biopsy technology, carry out and pathology, immunohistochemistry and electron microscopic diagnosis level, more and more cases and even in his lifetime clearly preoperative pathological diagnosis.
Clinically unexplained abdominal pain, abdominal distension, ascites and abdominal mass in patients, especially when the patient with asbestos exposure history, should consider the diagnosis of peritoneal mesothelioma and peritoneal cytology examination and repeated the inspection, such as abdominal CT examination revealed the typical changes, the examination and failed to find other parts of the evidence of a primary tumor, should be highly suspected diagnosis of peritoneal mesothelioma may be related to pathology by laparoscopy and diagnosed, if necessary, consider laparotomy diagnosis and surgical treatment for the same time.
Exfoliated cells in the ascites and biopsy less ordinary light microscope staining sometimes difficult pathological diagnosis, immunohistochemistry, electron microscopy can help confirm the diagnosis.
Made in the diagnosis of peritoneal mesothelioma at the same time, should understand their stage of disease, disease of the morning and evening on the choice of treatment, the prognosis significance of the decision, made in 1976, Butchart and other changes to the mesothelioma program divided into 4 stages period, Ⅰ period: tumor confined to ipsilateral pleura, lung, pericardium, or peritoneum; Ⅱ of: tumor invading the chest wall, mediastinum, and (or) chest or abdominal lymph nodes within the corresponding structure; Ⅲ of: penetrating the diaphragm, chest , extraperitoneal lymph node involvement; Ⅳ period: distant metastasis, and some scholars have differences of opinion still exist in the program, it needs to be further improved.
Peritoneal malignant mesothelioma
【Overview】
Peritoneal malignant mesothelioma (malignant peritoneal mesothelioma), also known as primary peritoneal mesothelioma, is originated in the peritoneal epithelium and mesothelial tissue tumors. Is a rare disease, but the reported cases has increased in recent years. Such tumors can occur in the pleura, peritoneum and pericardium: about 65% occurred in pleura, 25% occur in the peritoneum, 10% occurred in the pericardium.
【Etiology and pathogenesis 】
Asbestos dust for the pathogenic substances to the pathogenicity of crocidolite strong, followed by amosite and chrysotile asbestos. The disease mostly occurs in asbestos workers exposed to asbestos dust in the environment may also sick. Average time from exposure to onset of 35 to 40 years, sometimes only a few months and the incidence of exposure to the report, the incidence peak after 45 years in contact with.
Asbestos fibers enter the body through the respiratory tract, the peritoneal diaphragmatic lymphatic network reach can also enter the body through the intestine, but not fed to animals caused by asbestos disease.
The patient's respiratory system could be detected asbestos lung, including pulmonary fibrosis, pleural plaques and asbestos bodies transparent protein. 1 / 3 of patients with peritoneal mesothelioma peritoneal asbestos fibers can be detected. Animal experiments into the pleural or peritoneal mesothelioma, asbestos can produce.
30% of the cases no history of exposure to asbestos, so that there may be other than asbestos outside factor. Experimental study found that asbestos fibers can produce a similar nature mesothelioma. In the case of non-occupational exposure history, genetic factors may also be one of the causes of morbidity.
【Pathology】
See generally difficult to distinguish from metastasis. Often invaded the parietal and visceral peritoneum, but also invasion and local lymph nodes. 50% had visceral metastasis, but no clinical symptoms.
Diversity of histological lesions, but little more individual cells or degeneration of mitosis. Epithelial component accounted for 70%, epithelial type: tubular, papillary, flakes, flake or crack like solid nests; fibrous and sarcomatoid mesothelioma: stroma was fibrous tumor-like and spindle cell-like; mixed sex: Many mesothelioma simultaneously in a tumor epithelial and stromal components. If PAS staining and hyaluronic acid staining, but also proved to be mesothelioma.
【Diagnostic points】
Clinical manifestations
More common in men, and occupation, more than 60 years after the onset, juvenile onset who has also been reported. Abdominal pain, abdominal distension, ascites and abdominal mass are common symptoms and signs.
(1) abdominal pain: is the most common symptoms of peritoneal mesothelioma, the performance of persistent pain, pain, cramps can also paroxysmal or sudden pain, pain is usually located on the abdomen and right upper quadrant, can be abdominal symptoms caused by the following clinically misdiagnosed as ectopic pregnancy or pelvic tumors reported. The occurrence and parietal peritoneum and abdominal pain are violated, cancer and gastrointestinal tract obstruction caused by adhesions and pelvic organs, organ torsion and massive ascites, abdominal mass produce mass effect and other factors. The course of nature and the location of abdominal pain can be changed.
(2) abdominal distension: the ascites, abdominal mass, and secondary dyspepsia, intestinal obstruction and other factors, patients can have varying degrees of abdominal distention. Severe symptoms can affect eating, even breathing difficulties.
(3) ascites: approximately 90% of patients with peritoneal mesothelioma absence of ascites, and the rapid growth of a considerable number of patients with ascites and ascites drainage or bloody for the yellow viscous liquid, the tumor cells and the secretion of hyaluronic acid with the active function related.
(4) abdominal mass: a common peritoneal mesothelioma, one of the clinical manifestations, some patients is due to the treatment of abdominal mass. Peritoneal mesothelioma abdominal mass for single, also for the multiple, the largest are up to 20 cm × 30 cm, the texture more rigid or hard, nodular surface, located in the greater omentum, mesenteric serosal surface mass can move in the physical examination, abdominal mass may have tenderness. Mass in the pelvic or rectal examination can be found in triple diagnosis, associated with massive ascites drainage of ascites in patients after abdominal blocks a clearer understanding of the situation. Detailed physical examination can be a preliminary understanding of abdominal mass in the abdominal wall, substantial organ, the first visit to the clinic to provide information.
A small number of patients may also have loss of appetite, nausea, vomiting, diarrhea or constipation, urinary tract irritation, menstrual changes and fatigue, fever, weight loss, anemia, individual patients have low blood sugar, diffuse abdominal ossification and other clinical manifestations. When combined with other parts of the patient or peritoneal mesothelioma, mesothelioma metastasis to other organs or complications, can occur associated with clinical manifestations.
Laboratory
The general examination no special laboratory findings. Check for leaking ascites fluid, can also bloody, hyaluronic acid increased significantly, the diagnosis of help. But many at the middle level, and difficult to identify metastases.
Imaging
1. X-ray examination 50% of patients under X-ray signs of asbestosis. Bowel gastrointestinal imaging often show was over, or narrow, or even the performance of intestinal obstruction.
2. Ultrasound and CT examination can be found in ultrasound and CT examination of thin sheet mass, typical of those seen extensive irregular thickening of the peritoneal omentum involvement, adhesion formation pie abdominal mass, mesenteric density increased, adhesion formation mass star, may have varying degrees of ascites. B ultrasound-guided biopsy, obtain tissue cytology.
Other tests
1. Laparoscopy Laparoscopic peritoneal surface covered with visible nodules and plaques. Biopsy and pathological confirm the diagnosis.
2. Laparotomy desirable living tissue, can also detect whether the metastatic tumor, whether the primary tumor.
Differential Diagnosis
1. Malignant mesothelioma of tuberculous peritonitis and tuberculous peritonitis in the differential diagnosis difficult. In general, the majority of tuberculous peritonitis in middle-aged, clinically addition to abdominal pain, abdominal distension, ascites and other abdominal mass, fever is a common clinical manifestations. PPD-positive, ESR faster support the diagnosis of tuberculous peritonitis. Ascites with effusion as much, mainly monocytes, ascites culture that has a diagnosis of Mycobacterium tuberculosis. Highly suspected cases of tuberculous peritonitis down in close observation of effective anti-TB treatment, ineffective treatment difficult to identify cases, should seek early laparoscopy or surgical exploration, is not difficult to distinguish between pathological.
2. Peritoneal metastatic peritoneal metastatic tumors often from cancer, ovarian cancer, pancreatic cancer, liver cancer and colon cancer. When the primary clinical manifestations of occult cancer, the identification more difficult. Fecal occult blood and the need to repeatedly check the help of digestive endoscopy, gastrointestinal imaging, abdominal pelvic ultrasound and CT scan, blood sugar, AFP and other tumor antigens, and even laparoscopy to find the primary tumor. Difficult to distinguish when the desirability of pathology, in particular, immunohistochemistry or electron microscope.
3. Other primary malignant tumors in the peritoneal peritoneal serous borderline tumors, have called primary peritoneal papillary tumors and low grade peritoneal serous malignant small papillomatosis is a rare primary peritoneal lesions. Often in women, more than 40 years of age, the main symptoms are abdominal or pelvic pain. Symptoms of chronic inflammation, intestinal adhesion, or even amenorrhea. Pathology can identify with peritoneal mesothelioma, the disease prognosis is good.
Other primary tumors in the peritoneal adenocarcinoma, fibrosarcoma, liposarcoma, etc., is very rare. Can not be clinically distinguished from peritoneal mesothelioma. If the comprehensive examination has not found other parts of the primary tumor lesions, pathological examination also supported it as cancer, sarcoma, the diagnosis was established, many of these cases was confirmed in the autopsy.
【Overview】 Treatment
Drug treatment
Peritoneal mesothelioma, chemotherapy is currently considered moderately sensitive to chemotherapy is commonly used drugs are: doxorubicin, cisplatin, vincristine, thiotepa, fluorouracil, cyclophosphamide, mitomycin, of which doxorubicin the efficacy of the most positive elements. Articular injection of chemotherapy drugs in recent years advocated that the injection cavity has a high local drug concentration, systemic adverse reactions and so on. Surgical resection for patients who can not be taken as surgical tumor reduction surgery to remove the tumor, plus radiation therapy and intravitreal injection of doxorubicin and cisplatin achieved a certain effect, but more needs to be seen.
Surgery
Surgery, including tumor resection, palliative resection. Of the tumor smaller, more limited lesions, should be complete resection of the tumor and the affected organs; if the lesion is more extensive for resection of the primary tumor should be. A wide range of diseases, severe, has resulted in intestinal obstruction, surgical resection can not, palliative surgery can be considered to alleviate the patient's clinical symptoms.
Therapy
Radiation therapy including external radiation and internal radiation, can be used as 60Co or 186kV X ray radiation source, for incomplete resection or unresectable cases, Ke Yi decided to whole abdominal irradiation lesions or local irradiation.
Peritoneal malignant mesothelioma (malignant peritoneal mesothelioma), also known as primary peritoneal mesothelioma, is originated in the peritoneal epithelium and mesothelial tissue tumors. Is a rare disease, but the reported cases has increased in recent years. Such tumors can occur in the pleura, peritoneum and pericardium: about 65% occurred in pleura, 25% occur in the peritoneum, 10% occurred in the pericardium.
【Etiology and pathogenesis 】
Asbestos dust for the pathogenic substances to the pathogenicity of crocidolite strong, followed by amosite and chrysotile asbestos. The disease mostly occurs in asbestos workers exposed to asbestos dust in the environment may also sick. Average time from exposure to onset of 35 to 40 years, sometimes only a few months and the incidence of exposure to the report, the incidence peak after 45 years in contact with.
Asbestos fibers enter the body through the respiratory tract, the peritoneal diaphragmatic lymphatic network reach can also enter the body through the intestine, but not fed to animals caused by asbestos disease.
The patient's respiratory system could be detected asbestos lung, including pulmonary fibrosis, pleural plaques and asbestos bodies transparent protein. 1 / 3 of patients with peritoneal mesothelioma peritoneal asbestos fibers can be detected. Animal experiments into the pleural or peritoneal mesothelioma, asbestos can produce.
30% of the cases no history of exposure to asbestos, so that there may be other than asbestos outside factor. Experimental study found that asbestos fibers can produce a similar nature mesothelioma. In the case of non-occupational exposure history, genetic factors may also be one of the causes of morbidity.
【Pathology】
See generally difficult to distinguish from metastasis. Often invaded the parietal and visceral peritoneum, but also invasion and local lymph nodes. 50% had visceral metastasis, but no clinical symptoms.
Diversity of histological lesions, but little more individual cells or degeneration of mitosis. Epithelial component accounted for 70%, epithelial type: tubular, papillary, flakes, flake or crack like solid nests; fibrous and sarcomatoid mesothelioma: stroma was fibrous tumor-like and spindle cell-like; mixed sex: Many mesothelioma simultaneously in a tumor epithelial and stromal components. If PAS staining and hyaluronic acid staining, but also proved to be mesothelioma.
【Diagnostic points】
Clinical manifestations
More common in men, and occupation, more than 60 years after the onset, juvenile onset who has also been reported. Abdominal pain, abdominal distension, ascites and abdominal mass are common symptoms and signs.
(1) abdominal pain: is the most common symptoms of peritoneal mesothelioma, the performance of persistent pain, pain, cramps can also paroxysmal or sudden pain, pain is usually located on the abdomen and right upper quadrant, can be abdominal symptoms caused by the following clinically misdiagnosed as ectopic pregnancy or pelvic tumors reported. The occurrence and parietal peritoneum and abdominal pain are violated, cancer and gastrointestinal tract obstruction caused by adhesions and pelvic organs, organ torsion and massive ascites, abdominal mass produce mass effect and other factors. The course of nature and the location of abdominal pain can be changed.
(2) abdominal distension: the ascites, abdominal mass, and secondary dyspepsia, intestinal obstruction and other factors, patients can have varying degrees of abdominal distention. Severe symptoms can affect eating, even breathing difficulties.
(3) ascites: approximately 90% of patients with peritoneal mesothelioma absence of ascites, and the rapid growth of a considerable number of patients with ascites and ascites drainage or bloody for the yellow viscous liquid, the tumor cells and the secretion of hyaluronic acid with the active function related.
(4) abdominal mass: a common peritoneal mesothelioma, one of the clinical manifestations, some patients is due to the treatment of abdominal mass. Peritoneal mesothelioma abdominal mass for single, also for the multiple, the largest are up to 20 cm × 30 cm, the texture more rigid or hard, nodular surface, located in the greater omentum, mesenteric serosal surface mass can move in the physical examination, abdominal mass may have tenderness. Mass in the pelvic or rectal examination can be found in triple diagnosis, associated with massive ascites drainage of ascites in patients after abdominal blocks a clearer understanding of the situation. Detailed physical examination can be a preliminary understanding of abdominal mass in the abdominal wall, substantial organ, the first visit to the clinic to provide information.
A small number of patients may also have loss of appetite, nausea, vomiting, diarrhea or constipation, urinary tract irritation, menstrual changes and fatigue, fever, weight loss, anemia, individual patients have low blood sugar, diffuse abdominal ossification and other clinical manifestations. When combined with other parts of the patient or peritoneal mesothelioma, mesothelioma metastasis to other organs or complications, can occur associated with clinical manifestations.
Laboratory
The general examination no special laboratory findings. Check for leaking ascites fluid, can also bloody, hyaluronic acid increased significantly, the diagnosis of help. But many at the middle level, and difficult to identify metastases.
Imaging
1. X-ray examination 50% of patients under X-ray signs of asbestosis. Bowel gastrointestinal imaging often show was over, or narrow, or even the performance of intestinal obstruction.
2. Ultrasound and CT examination can be found in ultrasound and CT examination of thin sheet mass, typical of those seen extensive irregular thickening of the peritoneal omentum involvement, adhesion formation pie abdominal mass, mesenteric density increased, adhesion formation mass star, may have varying degrees of ascites. B ultrasound-guided biopsy, obtain tissue cytology.
Other tests
1. Laparoscopy Laparoscopic peritoneal surface covered with visible nodules and plaques. Biopsy and pathological confirm the diagnosis.
2. Laparotomy desirable living tissue, can also detect whether the metastatic tumor, whether the primary tumor.
Differential Diagnosis
1. Malignant mesothelioma of tuberculous peritonitis and tuberculous peritonitis in the differential diagnosis difficult. In general, the majority of tuberculous peritonitis in middle-aged, clinically addition to abdominal pain, abdominal distension, ascites and other abdominal mass, fever is a common clinical manifestations. PPD-positive, ESR faster support the diagnosis of tuberculous peritonitis. Ascites with effusion as much, mainly monocytes, ascites culture that has a diagnosis of Mycobacterium tuberculosis. Highly suspected cases of tuberculous peritonitis down in close observation of effective anti-TB treatment, ineffective treatment difficult to identify cases, should seek early laparoscopy or surgical exploration, is not difficult to distinguish between pathological.
2. Peritoneal metastatic peritoneal metastatic tumors often from cancer, ovarian cancer, pancreatic cancer, liver cancer and colon cancer. When the primary clinical manifestations of occult cancer, the identification more difficult. Fecal occult blood and the need to repeatedly check the help of digestive endoscopy, gastrointestinal imaging, abdominal pelvic ultrasound and CT scan, blood sugar, AFP and other tumor antigens, and even laparoscopy to find the primary tumor. Difficult to distinguish when the desirability of pathology, in particular, immunohistochemistry or electron microscope.
3. Other primary malignant tumors in the peritoneal peritoneal serous borderline tumors, have called primary peritoneal papillary tumors and low grade peritoneal serous malignant small papillomatosis is a rare primary peritoneal lesions. Often in women, more than 40 years of age, the main symptoms are abdominal or pelvic pain. Symptoms of chronic inflammation, intestinal adhesion, or even amenorrhea. Pathology can identify with peritoneal mesothelioma, the disease prognosis is good.
Other primary tumors in the peritoneal adenocarcinoma, fibrosarcoma, liposarcoma, etc., is very rare. Can not be clinically distinguished from peritoneal mesothelioma. If the comprehensive examination has not found other parts of the primary tumor lesions, pathological examination also supported it as cancer, sarcoma, the diagnosis was established, many of these cases was confirmed in the autopsy.
【Overview】 Treatment
Drug treatment
Peritoneal mesothelioma, chemotherapy is currently considered moderately sensitive to chemotherapy is commonly used drugs are: doxorubicin, cisplatin, vincristine, thiotepa, fluorouracil, cyclophosphamide, mitomycin, of which doxorubicin the efficacy of the most positive elements. Articular injection of chemotherapy drugs in recent years advocated that the injection cavity has a high local drug concentration, systemic adverse reactions and so on. Surgical resection for patients who can not be taken as surgical tumor reduction surgery to remove the tumor, plus radiation therapy and intravitreal injection of doxorubicin and cisplatin achieved a certain effect, but more needs to be seen.
Surgery
Surgery, including tumor resection, palliative resection. Of the tumor smaller, more limited lesions, should be complete resection of the tumor and the affected organs; if the lesion is more extensive for resection of the primary tumor should be. A wide range of diseases, severe, has resulted in intestinal obstruction, surgical resection can not, palliative surgery can be considered to alleviate the patient's clinical symptoms.
Therapy
Radiation therapy including external radiation and internal radiation, can be used as 60Co or 186kV X ray radiation source, for incomplete resection or unresectable cases, Ke Yi decided to whole abdominal irradiation lesions or local irradiation.
How the treatment of advanced malignant mesothelioma of the abdomen?
Question: in patients with severe abdominal pain, in the number of hospital, and finally diagnosed with advanced malignant mesothelioma of the abdomen, and now patients with adhesions, intestinal obstruction serious, ask how the treatment of advanced malignant mesothelioma of the abdomen?
Expert response: clinical late for abdominal mesothelioma is generally chemotherapy combined with Chinese medicine treatment, but patients with adhesions, intestinal obstruction serious risks of chemotherapy are more difficult and the results may not be ideal. Proposed to consider traditional Chinese medicine to extend survival of patients, improve patient quality of life. Chinese medicine treatment of malignant tumors in our hospital to obtain a relatively good clinical results, if needed hospital treatment recommendations oncology experts, can come to the phone consultation or to clear the patient's condition described by the experts, based on disease status in patients with syndrome differentiation in detail.
Expert response: clinical late for abdominal mesothelioma is generally chemotherapy combined with Chinese medicine treatment, but patients with adhesions, intestinal obstruction serious risks of chemotherapy are more difficult and the results may not be ideal. Proposed to consider traditional Chinese medicine to extend survival of patients, improve patient quality of life. Chinese medicine treatment of malignant tumors in our hospital to obtain a relatively good clinical results, if needed hospital treatment recommendations oncology experts, can come to the phone consultation or to clear the patient's condition described by the experts, based on disease status in patients with syndrome differentiation in detail.
Experts explain the abdominal mesothelioma
Moderator: There is a net friend asked, her husband was in November 2002 had a lower left abdominal surgery, chemotherapy has now been done, the treatment effect is said to use a good power Bi Taijia cisplatin, after 4 courses of treatment, have been discharged, the discharge general physical examination, did not find any foreign body, the body properly, then asked two experts, that the extent of recurrent disease?
Wang million: What place?
Host: lower left abdomen
Wang million: First of all mesothelioma surgery done after that, which means to be radical, if it is relatively widespread, such surgery is difficult to cure, the recurrence rate is relatively high, if these patients are relatively more limited, they do so in the stomach after the treatment, of course, has done a ALINTA, that is multi-target anti-folate drugs. United States ratified the mesothelial sarcoma him as a preferred treatment, which together with cisplatin, before effective treatment of mesothelioma little, so I feel that such a course of four Ye Hao, we call cycle , so that is enough.
How he like? Later to be followed up regularly to do the appropriate checks to see if he has not relapsed, and he could relapse, we should look at his disease before surgery or not, look at his situation in the differentiation of lesions. If a relatively clean operation, and after doing the treatment, he is likely to be cured, or do the review. For early detection and early treatment.
Moderator: This friends long after it usually relapse? That there is no statistical data?
Wang Wan: Because of different tumors (thematic interview advice) form of its biology is not the same, some a few months after tumor recurrence, and some relatively slow tumor growth, or even ten years after her operation, she before relapse, some are relatively easy to relapse, such as a high degree of recurrence of lymphoma.
Mesothelioma to somewhere in between, generally easier to recurrent tumors are two to five years, more than five years if it is, then lower the chance of recurrence, and should be said that the high chance of recurrence is two to three years.
Moderator: If the program or the relapse of his same?
Wang Wan: If a relapse or mesothelioma based mainly on surgery, then this is to periodically review, can be removed if the surgery is to choose resection, surgical resection can not we choose local radiation therapy, there is Select irradiation, there is relatively late, that is, chemotherapy.
Wang million: What place?
Host: lower left abdomen
Wang million: First of all mesothelioma surgery done after that, which means to be radical, if it is relatively widespread, such surgery is difficult to cure, the recurrence rate is relatively high, if these patients are relatively more limited, they do so in the stomach after the treatment, of course, has done a ALINTA, that is multi-target anti-folate drugs. United States ratified the mesothelial sarcoma him as a preferred treatment, which together with cisplatin, before effective treatment of mesothelioma little, so I feel that such a course of four Ye Hao, we call cycle , so that is enough.
How he like? Later to be followed up regularly to do the appropriate checks to see if he has not relapsed, and he could relapse, we should look at his disease before surgery or not, look at his situation in the differentiation of lesions. If a relatively clean operation, and after doing the treatment, he is likely to be cured, or do the review. For early detection and early treatment.
Moderator: This friends long after it usually relapse? That there is no statistical data?
Wang Wan: Because of different tumors (thematic interview advice) form of its biology is not the same, some a few months after tumor recurrence, and some relatively slow tumor growth, or even ten years after her operation, she before relapse, some are relatively easy to relapse, such as a high degree of recurrence of lymphoma.
Mesothelioma to somewhere in between, generally easier to recurrent tumors are two to five years, more than five years if it is, then lower the chance of recurrence, and should be said that the high chance of recurrence is two to three years.
Moderator: If the program or the relapse of his same?
Wang Wan: If a relapse or mesothelioma based mainly on surgery, then this is to periodically review, can be removed if the surgery is to choose resection, surgical resection can not we choose local radiation therapy, there is Select irradiation, there is relatively late, that is, chemotherapy.
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