Devita, Hellman, and Rosenberg's Cancer

LWBK1006-37 LWW-Govindan-Review November 24, 2011 11:29

494 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Answer 37.12. The answer is D.

All of these factors have been associated with increased risks for malignant

peritoneal mesothelioma. Reported associations between asbestos and

malignant mesothelioma range from 50% to 83%, but the link appears

to be less than that seen with pleural mesothelioma.

Answer 37.13. The answer is A.

The epithelial type of malignant peritoneal mesothelioma is the most com-

mon and carries the best prognosis, although significant variability in the

extent of disease at presentation is common.

Answer 37.14. The answer is A.

Distinguishing between adenocarcinoma and malignant mesothelioma by

routine histologic examination may be difficult. Immunohistochemistry

is helpful in such situations. However, there is no single specific marker to

diagnose malignant mesothelioma. A panel of markers is used to differen-

tiate between adenocarcinoma and malignant mesothelioma. Malignant

mesothelioma is usually positive for WT-1, calretinin, and cytokeratin

5/6, whereas a positive CEA is seen in adenocarcinoma. Primary peri-

toneal carcinoma is rarely seen in men.

Answer 37.15. The answer is B.

There is no clear consensus in the treatment of peritoneal malignant

mesothelioma. However, in patients who are otherwise healthy with good

performance status, nonbulky peritoneal disease, and no extraperitoneal

spread, an aggressive surgical approach with cytoreduction followed by

intraperitoneal chemotherapy is feasible. Even though there have been

no randomized studies to evaluate the effectiveness of this approach,

small prospective studies have shown dramatic benefit in carefully selected

patients.

Answer 37.16. The answer is A.

Well-differentiated papillary mesothelioma is an intermediate-grade

benign tumor. The treatment of choice is surgical resection. Treatment

with chemotherapy and radiation therapy does not improve outcomes.

Answer 37.17. The answer is A.

Primary peritoneal carcinoma is a rare group of tumors of unclear ori-

gin arising in the peritoneal cavity. Primary peritoneal carcinoma can be

distinguished from ovarian cancer by the following criteria: Both ovaries

must be normal in size; the amount of extraovarian tumor must be greater

than the involvement on the surface of the ovary; the ovarian component

must be less than 5×5 mm within the ovary and otherwise confined

to the surface of the ovary; and the cytologic characteristics must be of

the serous type. Treatment of primary peritoneal carcinoma follows pro-

grams established for ovarian carcinoma, including operative debulking

and adjuvant chemotherapy.