Early localized peritoneal mesothelioma as an incidental finding at laparoscopy - Report of a case and implications regarding natural history of the disease

BACKGROUND. Peritoneal mesothelioma is regarded as a fatal disease that pre sents with progressive ascites in a relatively late stage of its natural hi story. To the authors' knowledge, prior published articles have not describ ed the early manifestations of this cancer. METHODS. A 30-year-old asymptomatic woman underwent laparoscopy for an infe rtility workup. Nodules noted in the pelvis were biopsied and determined to be mesothelioma. Standard immunohistochemical studies were performed. Cyto reductive surgery and heated intraoperative intraperitoneal chemotherapy we re used for treatment. RESULTS. Multiple (approximately 30) tumor nodules up to 2 mm in dimension and limited to the pelvis were observed and resected. No primary tumor focu s was evident. These tumor nodules stained positive for Calretinin and nega tive for carcinoembryonic antigen immunohistochemically. CONCLUSIONS, In this patient, no incidence for transcoelomic dissemination of mesothelioma from a single primary site was observed. Rather, this patie nt's clinical presentation suggested that mesothelioma may be multifocal in origin within a limited region of the peritoneal cavity. This hypothesis m ay support a rationale for aggressive local-regional management of selected patients in whom peritoneal mesothelioma is of limited distribution and ma ss. (C) 2000 American Cancer Society.