Well Differentiated papillary Mesothelioma

Well-differentiated papillary mesothelioma (WDPM) remains uncommon tumors of the peritoneal regarded as a tumor with low-grade malignant potential but with high rates of recurrence. Cases of unusual WDPM the ovary and the tunica vaginalis of the testis were also reported. The diagnosis with other malignant peritoneal tumors remains difficult and generally primary or recurrence disease is treated by surgery. We report here 12 cases of WDPM, eight of which originated in the peritoneum, two in the tunica vaginalis of the testis and two in the ovary. WDPM occurred in five males aged 21 to 65 years ; one had a mesothelial hyperplasia of the peritoneum and the others a WDPM. Among them, one patient had both WDPM involving in the peritoneal and in the tunica vaginalis. Two out of the five had a history of exposure to asbestos. All patients underwent surgery, followed for four of them by a 2-hour closed low-volume IPHC perfusion using cisplatin. With complete follow-up more than 6 years, all the male patients are still alive and with no recurrence disease. For the remaining seven women patients aged to 21 to 54 years, one had a multilocular peritoneal inclusion cyst of the peritoneum and the others had a WDPM, two of which involving in the ovary. None of them had a history of asbestos exposure. All underwent primary surgery; one was treated by IPHC while peritoneal recurrence disease and an another one twice by local electro-coagulation while recurrence disease. All these female patients are still alive; two pursued residual indolent disease. For all 12 patients, CA125 levels were at good rates during all the follow-up. These findings seems to indicate that WDPM are rare tumors, with probably an etiology related to asbestos exposure, with a slow evolution; cytoreductive surgery combined with IPHC perfusion may be an encouraging therapy