Journal of Surgical Oncology 2014;110:372–374
CASE REPORT Fertility Preservation in a Patient with Benign Multicystic Peritoneal Mesothelioma ZAIN A. AL-SAFI, MD,1* BARISH H. EDIL,
2 MD,
AND 1
MIRIAM D. POST, MD,1,3 NATHAN W. PEARLMAN, MD,2 RUBEN ALVERO, MD1
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 2 Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado 3 Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Benign multicystic peritoneal mesothelioma (BMPM) is a rare peritoneal tumor. Surgery is the only effective treatment for BMPM, and affected tissues occasionally must be sacrificed to achieve adequate debulking. A 25‐year‐old female was diagnosed with BMPM. She was counseled on fertility preservation and had oocyte cryopreservation prior to her debulking. Fertility preservation through embryo or oocyte cryopreservation is a valuable option for patients at risk of losing reproductive tissues during extensive surgery and chemotherapy.
J. Surg. Oncol. 2014;110:372–374. ß 2014 Wiley Periodicals, Inc.
KEY WORDS: peritoneal mesothelioma; benign multicystic; fertility; egg banking
INTRODUCTION Benign multicystic peritoneal mesothelioma (BMPM) is a rare localized peritoneal tumor arising from the epithelial and mesenchymal elements of mesothelial cells. It most commonly arises from the pelvic retroperitoneum. It was first described in 1979 by Mennemeyer and Smith, and since then, about 140 cases have been reported in the literature. It has mostly been described in adult women with a median age at presentation of 36 years. Most BMPMs are diagnosed incidentally, some present as a localized mass, and others present with abdominal pain. Patients presenting with pain describe a chronic or intermittent lower abdominal or pelvic pain. The pathogenesis of BMPM is controversial. It has been suggested that BMPM is neoplastic, while others consider it reactive, and some authors consider it developmental [1]. It has been theorized to be a peritoneal response to chronic irritation, leading to mesothelial cell entrapment and reactive proliferation. This is supported by its association with inflammation, a history of prior surgery, endometriosis, and uterine leiomyoma [2]. Given the close relationship of BMPM with pelvic organs pathology and possible deleterious effect on future fertility, we present a case of a young patient with this condition that opted for fertility preservation through egg banking prior to undergoing definitive treatment.
CASE A 25‐year‐old female nulli‐gravida presented to the emergency department with sudden onset of severe epigastric pain associated with dizziness and chest pain. She was in her usual state of health prior to that with no medical problems. Her past surgical history was significant only for lipoma excision from her thigh. She had no family history of malignancies. Vitals signs were within normal limits, and her physical exam was significant for abdominal tenderness in the epigastric region. No pelvic abnormalities were noted on exam. Complete blood count and electrolytes were both normal, and pregnancy test was negative. A scan
ß 2014 Wiley Periodicals, Inc.
was subsequently done showing moderate peritoneal fluid that appeared loculated with septations, displacing the stomach and bowel loops. A vaginal ultrasound revealed a partially visualized multilocular cystic peritoneal mass with normal ovaries and uterus. Sampling of the peritoneal fluid was performed, but did not show significant abnormalities. Tumor markers including CA 15‐3, LDH, CEA, CA 19‐9, AFP, Inhibin B, and hCG were all within normal limits. CA 125 was slightly elevated at 44.7. A diagnostic laparoscopy was done revealing multiple cysts throughout her abdomen. A dominant multiloculated cystic structure emanated from the lesser curvature of the stomach at the antrum. There were also innumerable additional cystic structures located throughout the abdomen, including the pelvis, the greater omentum, and the small bowel mesentery. The ovaries, tubes, the uterus appeared grossly normal. The appendix appeared normal as well. A biopsy taken from a cystic structure near the lesser curvature of the stomach was remarkable for aggregate of intact thin‐walled fluid‐filled cyst and fibromembranous tissue, compatible with multicystic mesothelioma. The patient subsequently presented to our center for further evaluation and treatment since the patient experienced continued severe pain, causing her to be bed‐ridden. She also had concerns regarding future fertility since the disease process or its treatment might result in hysterectomy, and/or oophorectomy as well as planned intra‐ peritoneal chemotherapy. We counseled the patient extensively with regard to available options for fertility preservation, and she opted for
*Correspondence to: Zain A. Al‐Safi, MD, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Denver, 12631 E. 17th Avenue, B198‐3, Aurora, CO 80045. Fax: 720‐848‐1678. E‐mail: zain.al-safi@ucdenver.edu Received 1 April 2014; Accepted 19 April 2014 DOI 10.1002/jso.23653 Published online 26 May 2014 in Wiley Online Library (wileyonlinelibrary.com).
Fertility Preservation in a Patient With BMPM
Fig. 1. Intraoperative photograph showing the lesser sac lined with cysts.
oocyte banking. She underwent a controlled ovarian hyperstimulation cycle with exogenous gonadotropins and transvaginal ultrasound guided oocyte retrieval was completed after stimulation was completed. Ten oocytes were retrieved, seven of which were mature and these were cryopreserved. After a brief recovery from the stimulation and retrieval, the patient underwent cytoreductive surgery which included removal of all cystic lesions, with the largest being 4 cm in the lesser sac (Fig. 1), a 3 cm lesion in the pelvis and multiple additional cysts throughout the abdomen. In total there were approximately 20–30 cysts which were removed from multiple areas in the peritoneal cavity. Surgery also included splenectomy, omentectomy, skeletonization, and lymphadenectomy of the peritoneum, celiac, hepatic, hilar, and portocaval regions. In addition, a cholecystectomy, right peritoneal stripping, pelvic and cul‐ de‐sac peritoneal stripping off the uterus, ovaries, and rectum was performed. Finally, 60 min of intraperitoneal doxorubicin and cisplatin heated to 40° was administered. Pathology specimens showed multiple tissues involved by BMPM, consisting of innumerable cysts coating the affected structures. Microscopically, the cysts were lined by a single‐cell layer of bland mesothelial cells (Fig. 2). There was no invasion into pre‐existing structures or nuclear atypia. The patient did well post‐operatively and her pain was controlled medically. She was subsequently followed by a physical therapist, a pelvic pain specialist, and a psychologist.
DISCUSSION Peritoneal mesothelioma is an uncommon lesion that originates from mesothelial cells lining the human body cavities. The incidence is approximately one per 1,000,000 [3]. Of these peritoneal mesotheliomas, BMPM was reported to constitute 3–5% of all cases and only about 140 reports of BMPM have been cited. BMPM is associated with a favorable short‐term prognosis, but there is increased recurrence during long‐term follow‐up with 40–55% recurrence rate in female patients and a 33% recurrence rate in male patients [4]. There are reports of malignant transformation [5]. BPMP has a strong predilection for the surface of the pelvic viscera. When the tumor is found in the peritoneal cavity, lesions are found intimately attached to serosal surfaces of the intestine and omentum or in the retroperitoneal space, spleen, and liver. Journal of Surgical Oncology
373
Fig. 2. Low‐power image of a peritoneal specimen involved by multiple simple cystic structures.
Surgery is the only effective treatment for BMPM. Complete removal of the cystic lesion if possible, remains the mainstay of treatment and the only hope to avoid local recurrence. An aggressive surgical approaches with cytoreductive surgery and extensive peritoneal stripping have shown promise [6]. Cytoreductive surgery aims to completely resect visible tumor. The eradication of microscopic residual tumor is possible by heated intraperitoneal chemotherapy (HIPEC) thus minimizing the risk of recurrence [7]. Modified cytoreductive surgery combined with HIPEC has been safely and effectively used in patients with recurrent multicystic peritoneal mesothelioma [8]. Given the risk of hysterectomy and/or uni‐ or bilateral oophorectomy as well as the negative impact on gametes by chemotherapy with progressive depletion of the ovarian follicle pool, fertility preservation should be discussed with the patient. This discussion should take place prior to the planned definitive surgical procedure, and if the patient elects to have a fertility preservation procedure, it needs to be done in a timely manner so it will not cause a long delay to the surgery. Modern fertility preservation techniques in the form of oocyte or embryo banking can be easily used to protect a patient’s reproductive competence. In this case, appropriate counseling was possible due to prior diagnosis by laparoscopy, laparotomy, and histologic assessment. Exploratory laparoscopy is an acceptable diagnostic method since it allows biopsy of the suspected tissue after imaging suggests the presence of a tumor. Since malignancy was in the differential for this patient’s presentation and findings on imaging, fertility preservation should also be made available whenever there is a possibility of the patient losing her reproductive organs. Indeed, the American Society of Clinical Oncology (ASCO) released recommendations in 2006 detailing the need to address fertility when treating reproductive‐aged cancer patients [9]. These recommendations include assessing the potential gonado‐toxicity of treatment and providing access to fertility preservation providers. The most established and reliable method of fertility preservation for women is embryo banking. The protocol for embryo banking is similar to an in vitro fertilization (IVF) cycle done for patients with infertility with the exception that the embryo transfer is obviated and the embryos instead cryopreserved, most commonly after 5 days of post‐fertilization culture. While there are many years of experience with embryo banking, this option may not be acceptable to all women: a sperm source is needed to fertilize the oocytes. Female cancer patients who do not have a male partner may elect to fertilize their oocytes with anonymous donor sperm.
374
Al‐Safi et al.
This step, however, limits their reproductive options and may introduce ethical dilemmas with future use. Oocyte cryopreservation is an option for fertility preservation for young or adolescent females, unpartnered women, women who are partnered but wish to maintain maximum reproductive flexibility, and those patients who have an ethical or religious concern regarding embryo disposition. Oocyte cryopreservation has advanced greatly over the past 6–7 years, and is no longer considered an experimental procedure by the American Society of Reproductive Medicine. Techniques leading to enhanced gamete survival, potential fertilization and live birth rates allow women a much greater degree of autonomy than was possible even in the past 4 years. The influence of estrogen on BMPM is not well understood. Therapies using gonadotropin‐releasing hormone agonist [10] and the anti‐estrogen agent tamoxifen [11] have been used because of concerns that BMPM might be an estrogen‐dependent condition. The biological rationale for this vulnerability remains in question as immunohistochemical detection of estrogen and progesterone receptors was reported to be uncommon [12]. Moreover, BMPM has been reported even in male patients [13]. In this patient ovarian stimulation with gonadotropins lead to a short‐ term increase in estradiol with a peak level of 1,344 pg/ml prior to oocyte retrieval, which is an order of magnitude greater than in the unstimulated menstrual cycle. This increase beyond physiological range did not appear to affect the disease progression or patient symptoms before her surgery and was apparently safe.
CONCLUSION Fertility preservation through embryo or oocyte cryopreservation is a valuable option for patients with BMPM prior to undergoing extensive surgery and chemotherapy that can affect their reproductive function. Elevated levels of estrogen for a short‐term duration during ovarian stimulation appear to be safe in these patients. This case serves as a model for women undergoing other potentially reproductively ablative steps such as cancer surgery and chemotherapy.
Journal of Surgical Oncology
REFERENCES 1. Scucchi L, Mingazzini P, Di Stefano D, et al.: Two cases of “multicystic peritoneal mesothelioma”: Description and critical review of the literature. Anticancer Res 1994;14:715–720. 2. Safioleas MC, Constantinos K, Michael S, et al.: Benign multicystic peritoneal mesothelioma: A case report and review of the literature. World J Gastroenterol 2006;12:5739–5742. 3. Sugarbaker PH, Acherman YI, Gonzalez‐Moreno S, et al.: Diagnosis and treatment of peritoneal mesothelioma: The Washington Cancer Institute experience. Semin Oncol 2002;29:51–61. 4. Allam M, Seywright M, Robins JB: The uncertain problem of peritoneal bubblewrap. Br J Obstet Gynaecol 1998;105:1332–1334. 5. Gonzalez‐Moreno S, Yan H, Alcorn KW, et al.: Malignant transformation of “benign” cystic mesothelioma of the peritoneum. J Surg Oncol 2002;79:243–251. 6. Sethna K, Mohamed F, Sugarbaker PH, et al.: Peritoneal cystic mesothelioma: A case series. Tumori 2003;89:31–35. 7. Sugarbaker PH: New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol 2006;7:69–76. 8. Baratti D, Kusamura S, Sironi A, et al.: Multicystic peritoneal mesothelioma treated by surgical cytoreduction and hyperthermic intra‐peritoneal chemotherapy (HIPEC). In Vivo 2008;22:153–157. 9. Lee SJ, Schover LR, Partridge AH, et al.: American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 2006;24:2917–2931. 10. Letterie GS, Yon JL: Use of a long‐acting GnRH agonist for benign cystic mesothelioma. Obstet Gynecol 1995;85:901–903. 11. Letterie GS, Yon JL: The antiestrogen tamoxifen in the treatment of recurrent benign cystic mesothelioma. Gynecol Oncol 1998;70: 131–133. 12. Sawh RN, Malpica A, Deavers MT, et al.: Benign cystic mesothelioma of the peritoneum: A clinicopathologic study of 17 cases and immunohistochemical analysis of estrogen and progesterone receptor status. Hum Pathol 2003;34:369–374. 13. Sienkowski IK, Russell AJ, Dilly SA, et al.: Peritoneal cystic mesothelioma: An electron microscopic and immunohistochemical study of two male patients. J Clin Pathol 1986;39:440–445.
CASE REPORT Fertility Preservation in a Patient with Benign Multicystic Peritoneal Mesothelioma ZAIN A. AL-SAFI, MD,1* BARISH H. EDIL,
2 MD,
AND 1
MIRIAM D. POST, MD,1,3 NATHAN W. PEARLMAN, MD,2 RUBEN ALVERO, MD1
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 2 Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado 3 Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
Benign multicystic peritoneal mesothelioma (BMPM) is a rare peritoneal tumor. Surgery is the only effective treatment for BMPM, and affected tissues occasionally must be sacrificed to achieve adequate debulking. A 25‐year‐old female was diagnosed with BMPM. She was counseled on fertility preservation and had oocyte cryopreservation prior to her debulking. Fertility preservation through embryo or oocyte cryopreservation is a valuable option for patients at risk of losing reproductive tissues during extensive surgery and chemotherapy.
J. Surg. Oncol. 2014;110:372–374. ß 2014 Wiley Periodicals, Inc.
KEY WORDS: peritoneal mesothelioma; benign multicystic; fertility; egg banking
INTRODUCTION Benign multicystic peritoneal mesothelioma (BMPM) is a rare localized peritoneal tumor arising from the epithelial and mesenchymal elements of mesothelial cells. It most commonly arises from the pelvic retroperitoneum. It was first described in 1979 by Mennemeyer and Smith, and since then, about 140 cases have been reported in the literature. It has mostly been described in adult women with a median age at presentation of 36 years. Most BMPMs are diagnosed incidentally, some present as a localized mass, and others present with abdominal pain. Patients presenting with pain describe a chronic or intermittent lower abdominal or pelvic pain. The pathogenesis of BMPM is controversial. It has been suggested that BMPM is neoplastic, while others consider it reactive, and some authors consider it developmental [1]. It has been theorized to be a peritoneal response to chronic irritation, leading to mesothelial cell entrapment and reactive proliferation. This is supported by its association with inflammation, a history of prior surgery, endometriosis, and uterine leiomyoma [2]. Given the close relationship of BMPM with pelvic organs pathology and possible deleterious effect on future fertility, we present a case of a young patient with this condition that opted for fertility preservation through egg banking prior to undergoing definitive treatment.
CASE A 25‐year‐old female nulli‐gravida presented to the emergency department with sudden onset of severe epigastric pain associated with dizziness and chest pain. She was in her usual state of health prior to that with no medical problems. Her past surgical history was significant only for lipoma excision from her thigh. She had no family history of malignancies. Vitals signs were within normal limits, and her physical exam was significant for abdominal tenderness in the epigastric region. No pelvic abnormalities were noted on exam. Complete blood count and electrolytes were both normal, and pregnancy test was negative. A scan
ß 2014 Wiley Periodicals, Inc.
was subsequently done showing moderate peritoneal fluid that appeared loculated with septations, displacing the stomach and bowel loops. A vaginal ultrasound revealed a partially visualized multilocular cystic peritoneal mass with normal ovaries and uterus. Sampling of the peritoneal fluid was performed, but did not show significant abnormalities. Tumor markers including CA 15‐3, LDH, CEA, CA 19‐9, AFP, Inhibin B, and hCG were all within normal limits. CA 125 was slightly elevated at 44.7. A diagnostic laparoscopy was done revealing multiple cysts throughout her abdomen. A dominant multiloculated cystic structure emanated from the lesser curvature of the stomach at the antrum. There were also innumerable additional cystic structures located throughout the abdomen, including the pelvis, the greater omentum, and the small bowel mesentery. The ovaries, tubes, the uterus appeared grossly normal. The appendix appeared normal as well. A biopsy taken from a cystic structure near the lesser curvature of the stomach was remarkable for aggregate of intact thin‐walled fluid‐filled cyst and fibromembranous tissue, compatible with multicystic mesothelioma. The patient subsequently presented to our center for further evaluation and treatment since the patient experienced continued severe pain, causing her to be bed‐ridden. She also had concerns regarding future fertility since the disease process or its treatment might result in hysterectomy, and/or oophorectomy as well as planned intra‐ peritoneal chemotherapy. We counseled the patient extensively with regard to available options for fertility preservation, and she opted for
*Correspondence to: Zain A. Al‐Safi, MD, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Denver, 12631 E. 17th Avenue, B198‐3, Aurora, CO 80045. Fax: 720‐848‐1678. E‐mail: zain.al-safi@ucdenver.edu Received 1 April 2014; Accepted 19 April 2014 DOI 10.1002/jso.23653 Published online 26 May 2014 in Wiley Online Library (wileyonlinelibrary.com).
Fertility Preservation in a Patient With BMPM
Fig. 1. Intraoperative photograph showing the lesser sac lined with cysts.
oocyte banking. She underwent a controlled ovarian hyperstimulation cycle with exogenous gonadotropins and transvaginal ultrasound guided oocyte retrieval was completed after stimulation was completed. Ten oocytes were retrieved, seven of which were mature and these were cryopreserved. After a brief recovery from the stimulation and retrieval, the patient underwent cytoreductive surgery which included removal of all cystic lesions, with the largest being 4 cm in the lesser sac (Fig. 1), a 3 cm lesion in the pelvis and multiple additional cysts throughout the abdomen. In total there were approximately 20–30 cysts which were removed from multiple areas in the peritoneal cavity. Surgery also included splenectomy, omentectomy, skeletonization, and lymphadenectomy of the peritoneum, celiac, hepatic, hilar, and portocaval regions. In addition, a cholecystectomy, right peritoneal stripping, pelvic and cul‐ de‐sac peritoneal stripping off the uterus, ovaries, and rectum was performed. Finally, 60 min of intraperitoneal doxorubicin and cisplatin heated to 40° was administered. Pathology specimens showed multiple tissues involved by BMPM, consisting of innumerable cysts coating the affected structures. Microscopically, the cysts were lined by a single‐cell layer of bland mesothelial cells (Fig. 2). There was no invasion into pre‐existing structures or nuclear atypia. The patient did well post‐operatively and her pain was controlled medically. She was subsequently followed by a physical therapist, a pelvic pain specialist, and a psychologist.
DISCUSSION Peritoneal mesothelioma is an uncommon lesion that originates from mesothelial cells lining the human body cavities. The incidence is approximately one per 1,000,000 [3]. Of these peritoneal mesotheliomas, BMPM was reported to constitute 3–5% of all cases and only about 140 reports of BMPM have been cited. BMPM is associated with a favorable short‐term prognosis, but there is increased recurrence during long‐term follow‐up with 40–55% recurrence rate in female patients and a 33% recurrence rate in male patients [4]. There are reports of malignant transformation [5]. BPMP has a strong predilection for the surface of the pelvic viscera. When the tumor is found in the peritoneal cavity, lesions are found intimately attached to serosal surfaces of the intestine and omentum or in the retroperitoneal space, spleen, and liver. Journal of Surgical Oncology
373
Fig. 2. Low‐power image of a peritoneal specimen involved by multiple simple cystic structures.
Surgery is the only effective treatment for BMPM. Complete removal of the cystic lesion if possible, remains the mainstay of treatment and the only hope to avoid local recurrence. An aggressive surgical approaches with cytoreductive surgery and extensive peritoneal stripping have shown promise [6]. Cytoreductive surgery aims to completely resect visible tumor. The eradication of microscopic residual tumor is possible by heated intraperitoneal chemotherapy (HIPEC) thus minimizing the risk of recurrence [7]. Modified cytoreductive surgery combined with HIPEC has been safely and effectively used in patients with recurrent multicystic peritoneal mesothelioma [8]. Given the risk of hysterectomy and/or uni‐ or bilateral oophorectomy as well as the negative impact on gametes by chemotherapy with progressive depletion of the ovarian follicle pool, fertility preservation should be discussed with the patient. This discussion should take place prior to the planned definitive surgical procedure, and if the patient elects to have a fertility preservation procedure, it needs to be done in a timely manner so it will not cause a long delay to the surgery. Modern fertility preservation techniques in the form of oocyte or embryo banking can be easily used to protect a patient’s reproductive competence. In this case, appropriate counseling was possible due to prior diagnosis by laparoscopy, laparotomy, and histologic assessment. Exploratory laparoscopy is an acceptable diagnostic method since it allows biopsy of the suspected tissue after imaging suggests the presence of a tumor. Since malignancy was in the differential for this patient’s presentation and findings on imaging, fertility preservation should also be made available whenever there is a possibility of the patient losing her reproductive organs. Indeed, the American Society of Clinical Oncology (ASCO) released recommendations in 2006 detailing the need to address fertility when treating reproductive‐aged cancer patients [9]. These recommendations include assessing the potential gonado‐toxicity of treatment and providing access to fertility preservation providers. The most established and reliable method of fertility preservation for women is embryo banking. The protocol for embryo banking is similar to an in vitro fertilization (IVF) cycle done for patients with infertility with the exception that the embryo transfer is obviated and the embryos instead cryopreserved, most commonly after 5 days of post‐fertilization culture. While there are many years of experience with embryo banking, this option may not be acceptable to all women: a sperm source is needed to fertilize the oocytes. Female cancer patients who do not have a male partner may elect to fertilize their oocytes with anonymous donor sperm.
374
Al‐Safi et al.
This step, however, limits their reproductive options and may introduce ethical dilemmas with future use. Oocyte cryopreservation is an option for fertility preservation for young or adolescent females, unpartnered women, women who are partnered but wish to maintain maximum reproductive flexibility, and those patients who have an ethical or religious concern regarding embryo disposition. Oocyte cryopreservation has advanced greatly over the past 6–7 years, and is no longer considered an experimental procedure by the American Society of Reproductive Medicine. Techniques leading to enhanced gamete survival, potential fertilization and live birth rates allow women a much greater degree of autonomy than was possible even in the past 4 years. The influence of estrogen on BMPM is not well understood. Therapies using gonadotropin‐releasing hormone agonist [10] and the anti‐estrogen agent tamoxifen [11] have been used because of concerns that BMPM might be an estrogen‐dependent condition. The biological rationale for this vulnerability remains in question as immunohistochemical detection of estrogen and progesterone receptors was reported to be uncommon [12]. Moreover, BMPM has been reported even in male patients [13]. In this patient ovarian stimulation with gonadotropins lead to a short‐ term increase in estradiol with a peak level of 1,344 pg/ml prior to oocyte retrieval, which is an order of magnitude greater than in the unstimulated menstrual cycle. This increase beyond physiological range did not appear to affect the disease progression or patient symptoms before her surgery and was apparently safe.
CONCLUSION Fertility preservation through embryo or oocyte cryopreservation is a valuable option for patients with BMPM prior to undergoing extensive surgery and chemotherapy that can affect their reproductive function. Elevated levels of estrogen for a short‐term duration during ovarian stimulation appear to be safe in these patients. This case serves as a model for women undergoing other potentially reproductively ablative steps such as cancer surgery and chemotherapy.
Journal of Surgical Oncology
REFERENCES 1. Scucchi L, Mingazzini P, Di Stefano D, et al.: Two cases of “multicystic peritoneal mesothelioma”: Description and critical review of the literature. Anticancer Res 1994;14:715–720. 2. Safioleas MC, Constantinos K, Michael S, et al.: Benign multicystic peritoneal mesothelioma: A case report and review of the literature. World J Gastroenterol 2006;12:5739–5742. 3. Sugarbaker PH, Acherman YI, Gonzalez‐Moreno S, et al.: Diagnosis and treatment of peritoneal mesothelioma: The Washington Cancer Institute experience. Semin Oncol 2002;29:51–61. 4. Allam M, Seywright M, Robins JB: The uncertain problem of peritoneal bubblewrap. Br J Obstet Gynaecol 1998;105:1332–1334. 5. Gonzalez‐Moreno S, Yan H, Alcorn KW, et al.: Malignant transformation of “benign” cystic mesothelioma of the peritoneum. J Surg Oncol 2002;79:243–251. 6. Sethna K, Mohamed F, Sugarbaker PH, et al.: Peritoneal cystic mesothelioma: A case series. Tumori 2003;89:31–35. 7. Sugarbaker PH: New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol 2006;7:69–76. 8. Baratti D, Kusamura S, Sironi A, et al.: Multicystic peritoneal mesothelioma treated by surgical cytoreduction and hyperthermic intra‐peritoneal chemotherapy (HIPEC). In Vivo 2008;22:153–157. 9. Lee SJ, Schover LR, Partridge AH, et al.: American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. J Clin Oncol 2006;24:2917–2931. 10. Letterie GS, Yon JL: Use of a long‐acting GnRH agonist for benign cystic mesothelioma. Obstet Gynecol 1995;85:901–903. 11. Letterie GS, Yon JL: The antiestrogen tamoxifen in the treatment of recurrent benign cystic mesothelioma. Gynecol Oncol 1998;70: 131–133. 12. Sawh RN, Malpica A, Deavers MT, et al.: Benign cystic mesothelioma of the peritoneum: A clinicopathologic study of 17 cases and immunohistochemical analysis of estrogen and progesterone receptor status. Hum Pathol 2003;34:369–374. 13. Sienkowski IK, Russell AJ, Dilly SA, et al.: Peritoneal cystic mesothelioma: An electron microscopic and immunohistochemical study of two male patients. J Clin Pathol 1986;39:440–445.
