Malignant peritoneal Mesothelioma: prolonged unexplained CRP" – A case series

Background:

Malignant peritoneal mesothelioma (MPM) is a rare tumor, which accounts for about 30% of all mesothelioma tumors.

1. It is established that asbestose exposure is the primary risk factor for the development of MPM, but only 1/3 of patients with this disease report a history of prior contact with the mineral.

2. However, without aggressive treatment, MPM is a lethal disease with a median overall survival ranging from 6 to 12 months.

3. depending of the subgroup of the histology. (epithelia, biphasic or sarcomatoid). New data report a median survival of 60 – 90 month.

4. At this time, there is no established biomarker.

Methode:

We report of a series of three cases at our department, diagnosed 2016, 2017 and 2018 which were originally presented with prolonged unexplained elevated C-reactive protein (CRP). All patients had a CT – scan and two of them also a PET – scan. Afterwards, all patients, after confirmed history, were treated multimodal with surgery, also including HIPEC in one case, and douplet – chemotherapy. After a short period, all three patients had a progress of the disease, confirmed by CT -scan.

Result:

We experienced in these cases right at the beginning elevated CRP. After surgery, the CRP was in normal range. When patients had a progression of the disease the first sign was again elevated CRP. We started palliative treatment by monitoring the CRP

Conclusion:

MPM should be considered in the differential diagnosis of prolonged elevated CRP. In our cases CRP was useful in monitoring the disease and was used as a biomarker. Further studies are necessary to find out if elevated CRP can be used as a biomarker in MPM.