Pleural Mesothelioma Histopathology
Online Second Opinion – Peritoneal carcinomatosis Nature Undefined
Second Opinion – Peritoneal carcinomatosis Undefined Nature
This is a summary of 57 years old patient who was interested in getting a second opinion. When the patient was 2 years old, had appendicitis, 9 years – Operation of intussusception impact on the right side and the iliac fossa, followed by curing the scars and the development of asymptomatic mass-scars, scars interpret as a response. When the patient was 38 years old – 50 years and Dupuytren – laparoscopy.
In December 2004, and several months later, the patient suffered from intestinal obstruction under-bowel obstruction. Colonoscopy was performed, which was negative. November 2005 operation was the discovery of mass membership in the right mid-abdomen. 700 cc exudate Brown was exhausted. Right hemi-colectomy was performed.
Sections that were tested was macroscopically adhesive materials, size 8 * 10 * 6 cm revealed that the cecum and terminal compound Ilie in length 18 cm.
Microscopically the cancer were diagnosed (according to the type and cytodiagnosis in hospital laboratory Riun of Trieste) and low cancer differentiation grade. Same findings were found in adipose tissue with glandular aspects of the nickname. Other parts of the intestine have the same look too microscpical papillary aspects. Markers – negative (CEA-2.10-2.5 Ca19., CA125-5.4).
CT: small amount of fluid. Modest evidence of peritonitis and adhesions in the abdominal wall.
Re-examination of surgical instruments 5th January by the National Institute of tumors suggested The diagnosis of Malignant Mesothelioma Monophasic epithelial type.
Conclusion: Patients with Peritoneal Mesothelioma epithelium that experience with its first episode of the sub-intestinal obstruction from 2004.
On 01.10.06, the patient underwent testing for the new Clinical Pharmacology and New medicine division of the European Institute of Oncology, which reported history. In December 2004, an episode of sub-occlusive disease is reported, it affects thin intestine, which healed spontaneously. CAT scan is performed with irrelevant results. In summer 2005, the episode is over and the patient underwent colonoscopy with irrelevant results.
In November 2005, he underwent tests and surgery, which we discussed in the previous report.
In view of the above information, the specialist suggests waiting for the results of histological analysis of new and repeat chest, abdomen and pelvis scan.
If the hypothesis of mesothelioma is confirmed, it is proposed to consult the advice of a colleague who is an expert surgeon in peritonectomy and Intraperitoneal Hyperthermic treatment, because it is considered the most effective approach.
Alternatively, it is proposed to monitor developments over time Clinical (CAT and PET scans after 3 months), but only after presentation of developments, or where the disease is clearly condemned by the scanner, Specialist suggested systemic chemotherapy.
On the other hand, if the histology to be different, is proposed to repeat all the cats and PET scanning in one month, and the absence of clear primitive, it is appropriate that doctors always advise my colleague peritonectomy.
Histopathological tests carried out on the new European Institute of Oncology to 01 .11.2006 message: "the evidence in accordance with infiltrating epithelial malignant mesothelioma wall of the intestine. immunophenotype of the neoplastic population: positive calretinin, cytokeratin 5 / 6 and WT1, negative, depending CDX-2, 5 and desmin CEA. "
Further histological performed at Milan Cancer Institute report on 01/13/2006: "Morphological and immunophenotypic images consistent with epithelial malignant mesothelioma. Immunoreactivity: + calretinin, CK 5 / 6 +, 180 + WT, CD31 -. "
Thoracic-abdominal CAT scan with contrast done on 01/16/2006 Report: "In the area of the chest or parenchymal or pleural changes are reported, or mediastinal lymphadenopathy. In the abdominal region without focal liver lesions are appreciated, nor signs of dilated bile ducts after cholecystectomy. Minimum and perihepatic perisplenic liquid layer is noticeable in every moment, with modest thickening and homogeneous the peritoneal and liver suprasplenic, pancreas, adrenal glands and kidneys in normal conditions (30mm cortical cyst with more in diameter between the middle third and bottom third of the right kidney), granules lymph nodes (with dimensions not exceeding one centimeter) in periaortocaval area and along the iliac femoral axis. Diffuse thickening of a small moon, with handles, appear slightly conglutinated and adhering to the abdominal wall and a smaller reduction in the transparency of mesenteric adipose tissue, in a situation that could also be consistent with the sequence of sub-occlusive episodes of recurrent events and the subsequent operation. The hole basin extended the normal bladder, with regular walls, no abnormal swelling is apparent. "
On 01/20/2006, Finally, the patient visited a doctor was sent a doctor who had examined on 01.10.2006, and the former if the following conclusion:
"Patient epithelial peritoneal mesothelioma that the interpretation of the first sub-occlusive episode in 2004 as a secondary Such diseases, probably because some time ago and seems to be a low degree of biological malignancy. CAT scan suggests the involvement of phrenic syndrome and significant adhesion between the loop and the abdominal wall. To use a clear indication of surgery, an interview with the surgeon, which in November 2005 in a patient, it appears necessary to assess the involvement of visceral peritoneum and especially the small intestine, the latter is cons-true indication for surgery approach.
Cytoreduction chemotherapy and hyperthermia, followed by systemic chemotherapy seems be the best solution (though experimental). Would, on the other hand, doubts about the surgical indication, we could choose chemotherapy system, possibly with neoadjuvant intent.
It is very important for patients to see whether there are other procedures, diagnoses. Assuming the histological diagnosis is Peritoneal mesothelioma, which is the recommended treatment and whether there are experimental protocols, including including immunotherapy.
The case was sent to medical assistance (www.m-opinion.com) for second opinion evaluations. The case was sent to a teacher from Tel Aviv University to discuss the case.
Professor assume that a diagnosis of Mesothelioma, according various pathological reports. It is important to have an immunohistochemical staining of c-Kit, EGFR, VEGFR, PDGFR-alpha for possible targeted therapy.
The best treatment option for mesothelioma is radical surgery: peritonectomy + Hyperthermic intraoperative administration of chemotherapy. However, it is difficult to imagine that the actual involvement of intra-abdominal tumor according to the description provided by radiologists. It is recommended to examine the CT and PET-CT done with all the fog to find the tumor site.
If the tumor is inoperable, it is better to go to chemotherapy: cisplatin + pemetrexed (ALIMTA), or gemcitabine + cisplatin as a palliative therapy or neoadjuvant therapy.