Parasternal Lymph Node Metastasis of Malignant Peritoneal Mesothelioma: Report of a Case
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Parasternal line
Surgical oncology
Palpation
Chrysotile
Etiology
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Survival for mesothelioma has been shown to be poor, with marginal improvement over time. Recent advances in the understanding of pathophysiology and treatment of mesothelioma may impact therapy to improve survival that may not be evident from available clinical trials that are often small and not randomized. Therapies may affect survival differently based on mesothelioma location (pleural vs peritoneal). Data are conflicting regarding the effect of asbestos exposure on mesothelioma location.We examined survival in a large cohort of mesothelioma subjects analyzed by tumor location and presence and mode of asbestos exposure.Data were analyzed from cases (n = 380) diagnosed with mesothelioma from 1992 to 2012. Cases were either drawn from treatment referrals, independent medical evaluation for medical legal purposes, or volunteers who were diagnosed with mesothelioma. Subjects completed an occupational medical questionnaire, personal interview with the examining physician, and physician review of the medical record.This study reports better survival for mesothelioma than historical reports. Survival for peritoneal mesothelioma was longer than that for pleural mesothelioma (hazard ratio = 0.36, 95% confidence interval = 0.24-0.54, P < .001) after adjusting for gender and age at diagnosis. Non-occupational cases were more likely to be 1) diagnosed with peritoneal mesothelioma, 2) female, 3) exposed, and 4) diagnosed at a younger age and to have a 5) shorter latency compared to occupational cases (P < .001).Peritoneal mesothelioma was more likely associated with non-occupational exposure, thus emphasizing the importance of exposure history in enhancing early diagnosis and treatment impact.
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Malignant mesothelioma is a lethal disease. It is rare in the general population; however, workers exposed to asbestos suffer significant burdens of the neoplasm. The survival time of 457 consecutive fatal cases of pleural and peritoneal mesothelioma that occurred among 17,800 asbestos insulation workers observed prospectively from 1 January 1967 to 1 January 1987 was studied. Mean survival time from initial presentation of the disease to death was 11.4 months for the pleural mesothelioma patients compared with 7.4 months for the peritoneal group. This difference was statistically significant. Mean survival time from diagnosis to death was shorter for both groups of patients: 8.4 months for pleural mesothelioma v 5.8 months for the peritoneal cases. In conclusion, survival time in mesothelioma patients is short; most die within a year from the onset of the initial symptoms. No effective therapy is yet available.
Pleural disease
Asbestosis
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At present, there are many treatments for peritoneal mesothelioma, but the treatment of peritoneal mesothelioma is still facing great challenges. Distant metastasis is the main cause of poor prognosis and death of patients with peritoneal mesothelioma. Ki67 is a cell proliferation marker. In recent years, it has been found to be used as a molecular marker for the diagnosis, treatment and prognosis of different tumor cells. Ki67 has been shown to play a crucial role in the occurrence and development of a variety of cancers. However, the clinical significance and biological function of Ki67 in peritoneal mesothelioma remain poorly understood.To clarify the expression of Ki67 in peritoneal mesothelioma (PC), and to explore the relationship between the expression level of Ki67 and the clinicopathological parameters and prognosis of patients with PC, and to explore the potential of Ki67 as a therapeutic target and prognostic biomarker for PC.TIMER database was used to compare the expression levels of Ki67 mRNA and protein in mesothelioma tissues and adjacent tissues. The relationship between the expression level of Ki67 in mesothelioma and clinicopathological characteristics, and the relationship between the expression level of Ki67 and the level of immune infiltration in mesothelioma were analyzed. The prognostic value of Ki67 in mesothelioma patients was predicted, and the overall survival curve was drawn according to the follow-up data. LinkedOmics database and GSEA were used to perform co-expression analysis and enrichment analysis of Ki67, respectively.Bioinformatics analysis showed that Ki67 was highly expressed in peritoneal mesothelioma (P < .01). Immunohistochemistry showed that the positive rate of Ki67 in peritoneal mesothelioma was high, and the number of Ki67 positive cases was 62.0% (31/50 cases). Univariate analysis showed that TNM stage (P = .007), asbestos (P < .001), chemotherapy (P < .001), and Ki67 expression level (P = .029) were associated with prognosis. Multivariate analysis showed that Ki67 expression level (P = .039) and TNM stage (P = .029) were independent risk factors for the prognosis of peritoneal mesothelioma. Peritoneal mesothelioma patients with high Ki67 expression have poor OS. In addition, Ki67 is also associated with the immune infiltration of mesothelioma.Ki67 is highly expressed in peritoneal mesothelioma. Ki67 protein plays an important role in the development of peritoneal mesothelioma and is one of the important factors to evaluate the prognosis of patients with peritoneal mesothelioma.
Mesothelin
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The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading some to suggest that peritoneal mesothelioma occurs only after high levels of exposure to asbestos. To investigate the relationship between asbestos exposure and the development of peritoneal mesothelioma, a case-control study examined 40 cases of primary peritoneal mesothelioma from a single institution. This series differed from previous reports in that 75% of the cases and controls had attended college. Results show an odds ratio of 6.6 for asbestos exposure among this group of primary peritoneal mesothelioma cases with relatively slight asbestos exposures.
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To report the number of malignant pleural and peritoneal mesotheliomas that have occurred in former Wittenoom crocidolite workers to the end of 2008, to compare this with earlier predictions, and to relate the mesothelioma rate to amount of exposure. A group of 6489 men and 419 women who had worked for the company operating the former Wittenoom crocidolite mine and mill at some time between 1943 and 1966 have been followed up throughout Australia and Italy to the end of 2008. The cumulative number of mesotheliomas up to 2008 was 316 in men (268 pleural, 48 peritoneal) and 13 (all pleural) in women. There had been 302 deaths with mesothelioma in men and 13 in women, which was almost 10% of all known deaths. Mesothelioma rate, both pleural and peritoneal, increased with time since first exposure and appeared to reach a plateau after about 40 to 50 years. The mesothelioma rate increased with amount of exposure and the peritoneal mesotheliomas occurred preferentially in the highest exposure group, 37% compared with 15% overall. By the end of 2008, the number of mesothelioma deaths had reached 4.7% for all the male workers and 3.1% for the females. Over the past 8 years the numbers were higher than expected. It is predicted that about another 60 to 70 deaths with mesothelioma may occur in men by 2020.
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Pleural disease
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