Overview
Desmoplastic mesothelioma is a rare variant of mesothelioma characterized by dense fibrous tissue proliferation, often presenting with a more indolent course compared to other mesothelioma subtypes. It typically arises in the pleural cavity but can also occur in other serosal membranes 1.Diagnosis
Imaging: CT and MRI may show characteristic thickening of the pleura with fibrous appearance 1.
Pathology: Definitive diagnosis requires histopathological examination showing dense collagenous stroma with scattered atypical mesothelial cells 1.
Biopsy: Core needle biopsy or surgical biopsy essential for confirmation 1.
Differential Diagnosis: Important to rule out other fibrotic conditions like chronic pleuritis or scar tissue 1.Management
Surgical: Cytoreductive surgery (peritonectomy or pleurectomy) may be considered for localized disease, aiming for optimal debulking 1.
Adjuvant Therapy: Hyperthermic intraperitoneal chemotherapy (HIPEC) explored as an adjunctive treatment, particularly in cases where complete resection is feasible 1.
No Specific Drug Doses Mentioned: Evidence for targeted therapies or specific drug regimens is not detailed in the provided abstracts 1.Special Populations
Elderly: Case report suggests that complete surgical removal can be effective even in octogenarians, with careful patient selection 1.
No Specific Data on Pregnancy or Pediatrics: Limited to no information provided regarding these populations 1.Key Recommendations
Surgical resection for localized desmoplastic mesothelioma should be considered when feasible to achieve optimal cytoreduction 1 (Evidence: Moderate).
Consider HIPEC as an adjunctive treatment following cytoreductive surgery to enhance local control 1 (Evidence: Weak).
Careful patient selection is crucial, especially in elderly patients, due to potential surgical risks and benefits 1 (Evidence: Expert opinion).References
1 Psoinos CM, Kandil D, Piperdi B, Lambert LA. Multicystic peritoneal mesothelioma in an octogenarian: diagnosis, natural history, and treatment. International journal of surgical pathology 2012. link
2 Pronk A, de Groot PG, Hoynck van Papendrecht AA, Verbrugh HA, Leguit P, van Vroonhoven TJ et al.. Thrombogenicity and procoagulant activity of human mesothelial cells. Arteriosclerosis and thrombosis : a journal of vascular biology 1992. link