Ovarian malignant peritoneal mesothelioma

　　1946年，Wyers首先注意到恶性间皮瘤似乎与接触石棉有关。1960年Wagnert等肯定了间皮瘤的发生和接触石棉粉尘的密切关系。以后各家报道有石棉接触史的病人所占比例迥异，从0％～100％，多数文献为70％～80％。石棉的接触途径包括职业、环境及石棉工人的家庭成员，其中最主要的接触是职业。据统计，船厂工人、纺织工人、管道工人、焊工、油漆匠及建筑工的发生率较一般人群高300倍。在这些厂矿附近的居民及石棉工人家属的发病率，也明显高于普通人。石棉是一种普遍存在的物质，在工业上的用途有3000种。据电镜对尸检的观察，发现几乎100％的都市人口肺组织中都隐藏着石棉纤维。石棉的致癌力与接触的时间、接触的量有关，还与石棉纤维的类型、特性、长度及宿主的敏感性有关。已观察到实验动物吸入或注入石棉纤维后诱发间皮增生、非典型增生到癌变的过程。3种石棉纤维有同样的致癌力。人的间皮瘤主要是由青石棉所引起，其次是铁石棉和透闪石，其物理形状比化学成分更为重要，致癌纤维为0.5～50m长度的细丝。一般先吸入呼吸道，然后通过横膈或血流吸入腹腔。沉积在组织中的石棉细丝，由于含铁蛋白沉积而形成金黄色或棕红色长短、粗细不一的块节状或弯曲小体，称石棉小体，这在组织切片中易辨认，有些小体边缘可出现异物巨细胞反应。曾对84例腹膜间皮瘤进行观察，其中54例有职业石棉接触史，并在肺组织内发现了一定数量的石棉小体。一般认为与石棉接触的量越大和时间越长，发现腹膜间皮瘤的机会越多。从接触石棉到间皮瘤发病，短不到1年，长可达50年以上。多数作者认为有一个比较长的潜伏期，平均33～43年，故发病年龄以50～70岁多见，男性多于女性，约为2∶1，这可能是男性从事职业性石棉接触较多的缘故。
　　The occurrence of mesothelioma may also be related to radioactive substances, viruses, genetics, individual sensitivity, and chronic inflammation. There are also reports of malignant mesothelioma occurring after radiotherapy for pelvic and abdominal malignant tumors, with a long latent period. Therefore, it is very meaningful to follow up on patients who have survived 10 to 20 years after radiotherapy. It can be seen that the occurrence of mesothelioma has multiple factors like other tumors.

　　Ovarian malignant peritoneal mesothelioma can cause severe intestinal obstruction. The vast majority of patients die from the primary lesion's complications, so it is essential to treat the primary disease actively, and high-risk populations need regular screening.

　　The most common symptoms are abdominal distension, abdominal pain, ascites, and abdominal masses. The vast majority of patients (90%) have serous or hemorrhagic ascites that increase rapidly, especially in disseminated mesothelioma. Abdominal pain is diverse, ranging from burning sensation or discomfort without a clear location to severe cramping pain, which may worsen during urination or defecation. It is often accompanied by systemic symptoms such as fatigue, weight loss, and decreased appetite. A few patients may initially present with chronic small bowel obstruction. Some tumors may produce antidiuretic hormone, growth hormone, adrenocorticotropic hormone, or insulin-like substances, leading to symptoms of hypoglycemia, thrombocytosis, and thromboembolism are also common.
　　Metastasis and clinical staging: This tumor mainly proliferates and expands along the serosa and subserosal tissue. Although it can involve intra-abdominal organs, it often remains limited to the surface and rarely invades deep tissue. Occasionally, the tumor can spread directly to the thoracic cavity and mediastinal organs through the diaphragm. It is generally believed that the tendency for distant metastasis is smaller than that of general cancer, but local infiltration and metastasis are also very common in post-mortem examinations. Local infiltration of the gastrointestinal tract can involve the submucosa and even the mucosal layer. Metastasis can occur through lymphatic and hematogenous routes in any organ, with the liver and lungs being common, followed by the adrenal glands, thyroid, kidney, pancreas, and bone.

　　Avoiding exposure to asbestos can effectively prevent the onset of the disease in a portion of the population. However, since the etiology of ovarian malignant peritoneal mesothelioma is not yet fully understood, there are no other effective preventive measures at present.

　　Tumor presence can be suggested by clinical manifestations, X-rays, ultrasound, and other examinations, but the diagnosis of ovarian malignant peritoneal mesothelioma relies on laparoscopic examination, exploratory laparotomy, and pathological confirmation. When the histology is atypical, especially when the morphological features of epithelial mesothelioma resemble metastatic adenocarcinoma, and EPSPC is dominated by mesothelial cells, it is sometimes difficult to differentiate with traditional light microscopy. It is necessary to combine histochemistry, immunohistochemistry, and electron microscopic ultrastructure observation to make a more accurate diagnosis.
　　1. Laboratory examination:
　　1. Ascites examination:Ascites is hemorrhagic or serofibrinous, with high specific gravity (most > 1.020) and positive Rivalta test. If there are a large number of atypical, atypical mesothelial cells or tumor cells in the ascites cytological examination, it has important diagnostic significance. However, due to their atypical morphology, they are often indistinguishable from hyperplastic mesothelial cells, and it is generally considered that diagnosis based solely on cytological examination is difficult.
　　2. Gastrointestinal radiography:The following signs can be seen during gastrointestinal radiography.
　　(1) Due to the extensive involvement of the peritoneum, changes in intestinal loops occur, such as deformation of small intestinal loops and poor mobility leading to fixation.
　　(2) The lumen of the intestinal tract can be narrowed eccentrically due to external pressure, and even obstruction may occur.
　　(3) Due to the displacement of the tumor tissue due to adhesion, abnormalities in the distribution of intestinal loops often occur.
　　(4) There is no obvious damage to the intestinal mucosa, and no space-occupying lesions can be seen in the gastrointestinal tract.
　　These changes are not characteristic X-ray features of malignant mesothelioma. Conditions such as multiple metastatic tumors in the abdominal cavity and some widespread lesions involving the peritoneum can also produce these changes. Generally, X-ray examination shows extensive compression, deformation, displacement, and abnormal arrangement of the gastrointestinal tract, while the mucosal folds are not obviously destroyed, suggesting the possibility of primary peritoneal mesothelioma. There are also a few tumors that can reach the mucosa of the intestinal wall from the serosal surface, causing mucosal destruction and forming ulcers.
　　3. Ultrasound examination:Ultrasound, in addition to accurately reporting large masses in the ascites and pelvis, can also often show internal intestinal loops adhered and fixed, irregular thickening of the intestinal wall, and abnormal echo waves suggesting intraperitoneal tumor implantation. When the tumor invades the peritoneum, the originally continuous and uniform peritoneal line presents with undulations, and spherical small nodules, localized thickening, or irregular masses may appear.
　　4. CT examination:CT mainly manifests as ascites, irregular thickening and adhesion of the peritoneum, peritoneal nodules, involvement of omentum and mesentery, pelvic masses, pleural involvement (pleural thickening, pleural effusion), and other conditions. It is not easy to find early peritoneal lesions on CT examination; when the peritoneum, omentum, and mesentery are widely thickened and adhered, the findings on CT can suggest the diagnosis of this disease; however, it is not easy to differentiate from ovarian cancer, gastrointestinal tumor metastasis, and chronic peritoneal infection, etc. Regular CT follow-up is often useful for observing the progression of the lesion and the efficacy of treatment.
　　5. Serum CA125 detection:According to Simsek (1996), the serum CA125 levels of all 7 patients with malignant peritoneal mesothelioma were elevated, with an average of 308kU/L (8-1300kU/L). In the follow-up of 3 patients, CA125 decreased to normal in 2 patients sensitive to chemotherapy, and in 1 patient with ineffective chemotherapy, CA125 continued to rise. CA125 can also be used as an indicator for monitoring treatment response.
　　II. Other auxiliary examinations
　　Laparoscopic examination can directly observe the appearance of the abdominal cavity, the location, extent, and condition of the visceral and parietal peritoneum, and take biopsies from multiple sites such as the omentum. It is a relatively reliable preoperative diagnostic method. It is particularly suitable for differential diagnosis with tuberculous peritonitis, liver cirrhosis ascites, etc. The biopsy tissue can be sent for pathological examination to clarify whether the disease is cancerous or non-cancerous. If the biopsy tissue is insufficient, it is often difficult to determine whether it is metastatic cancer or mesothelioma, but both require surgical treatment and do not affect the treatment.

　　Recommend several food therapy recipes suitable for patients with ovarian malignant peritoneal mesothelioma.

　　1. Iron Leaf and Red Date Soup

　　200 grams of iron leaf, 10 red dates.

　　Wash the two ingredients, place them in a pot, add an appropriate amount of water, and decoct to get the juice.

　　Take one dose per day, divide into three servings, and 30 days as one course of treatment.

　　2. Cuttlefish and White-berry

　　60 grams of cuttlefish meat, 10 white-berry fruits, and appropriate amounts of seasonings.

　　Wash the two ingredients, place them in a pot, add an appropriate amount of water, and cook until the meat is tender, then add seasonings.

　　Take once a day, consume the soup as well.

　　3. Dragon Pearl Tea

　　15 grams of solanum nigrum seeds, 30 grams of mica stone, and appropriate amounts of rock sugar.

　　Boil the two ingredients in water, remove the dregs, and add rock sugar.

　　Take as tea daily.

　　4. Purple Root and Quail Eggs

　　60 grams of purple root, 4 quail eggs. Boil the purple root and quail eggs together with water until the eggs are fully cooked. Remove the purple root.

　　Take one dose per day, eat the eggs, and take for 15 consecutive days.

　　5. Motherwort Boiled Eggs

　　50 grams of motherwort, 2 eggs.

　　Wash the motherwort and cut it into segments, boil it with fresh eggs and water, remove the shell of the eggs after they are cooked, and boil for a moment more.

　　Take one dose per day, eat the egg and drink the soup.

　　6. Fresh Reed Root Soup

　　120 grams of fresh reed root, 30 grams of rock sugar.

　　Boil fresh reed root in about 500 milliliters of water for 20 minutes, then add rock sugar and it is ready.

　　Take once or twice a day, or drink as tea.

　　Function: Clear the stomach and stop vomiting.

　　Indications: During chemotherapy, nausea, dry mouth, etc.

　　7. Fresh Lotus Root and Ginger Juice Porridge

　　500 grams of fresh lotus root (without joints), 10 grams of ginger juice, and 100 grams of glutinous rice.

　　Add 1000 milliliters of clear water, cook the porridge over low heat for about 1 hour, and add ginger juice when it is done.

　　Take once or twice a day.

　　Function: Harmonize the middle and nourish the stomach.

　　Indications: During chemotherapy, loss of appetite, nausea and vomiting, etc.

　　8. Finger Citron Porridge

　　10 grams of dried finger citron, 100 grams of glutinous rice, and appropriate amounts of rock sugar and scallions.

　　Dry finger citron, decoct the juice, add glutinous rice, 1000 milliliters of water, and cook together as porridge. Add rock sugar and scallions for seasoning and consumption.

　　Take once or twice a day.

　　Function: Harmonize the qi and stomach.

　　Indications: During chemotherapy, loss of appetite, abdominal distension, etc.

　　9. Sea Cucumber and Poria Soup

　　20 grams of wolfberry, 20 grams of poria, and 250 grams of sea cucumber (wet).

　　Firstly, decoct the wolfberry and poria in water, then cook the sea cucumber until tender with the water, season with salt, and serve as a soup.

　　Once a day.

　　Effect: Nourishing the spleen and kidney, nourishing yin and generating blood.

　　Indications: Vertigo, shortness of breath, palpitations, leukopenia during chemotherapy.

　　The treatment of ovarian malignant peritoneal mesothelioma is still being explored, and there is no standard treatment method to follow. It is generally believed that the tumor should be resected first, and then adjuvant chemotherapy and radiotherapy may have some effect.
　　1. Surgical Treatment:Whether it is localized or disseminated, if there are no surgical contraindications, surgical exploration should be accepted. According to the extent of the lesion, resection of the lesion, omentectomy, and partial peritoneal resection can be performed, which can reduce the tumor burden, enhance the effect of postoperative chemotherapy or radiotherapy, and also relieve symptoms, temporarily control the disease, and reduce the production of ascites. The therapeutic effect of surgical resection for localized mesothelioma is quite good, and the opportunity for complete resection of the lesion in disseminated mesothelioma is very rare, and some can only play the role of surgical exploration and biopsy.
　　2. Chemotherapy:Malignant peritoneal mesothelioma is relatively rare, it is not easy to accumulate enough cases to explore effective chemotherapy regimens. Preliminary experience suggests that the efficacy of chemotherapy is 0% to 40%. Cisplatin, doxorubicin (adriamycin), mitomycin, fluorouracil (5-fluorouracil), cyclophosphamide, dacarbazine (氮烯咪胺), and ifosfamide have some efficacy against mesothelioma. In recent years, it is generally believed that combination chemotherapy with cisplatin as the main agent is the most effective, especially recommended for intraperitoneal chemotherapy. From the perspective of pharmacokinetics, the effect of intraperitoneal administration is 15 times that of intravenous administration. Markman et al. used 100mg/m2 of cisplatin once for intraperitoneal chemotherapy, with a course of 28 days, and 5-10mg of mitomycin concurrently for 7 days. The average survival time of 19 patients with mesothelioma after treatment was 9 months, 4 patients have survived for more than 3 years, 2 patients have survived for more than 5 years, and there were no signs of clinical recurrence. There are reports in the literature of detoxification with sodium thiosulfate by intravenous administration, and then increasing the dose of cisplatin to 200-270mg/m2 for intraperitoneal administration after that, although there were no obvious toxic reactions, whether it increases efficacy due to the small number of cases used is not yet conclusive.
　　3. Radiotherapy:So far, radiotherapy seems to be the most effective method. Among various treatment methods, the largest number of people have long-term survival.