[Peritoneal mesothelioma and abdominal hernias]

In a review of 720 cases of peritoneal mesothelioma described in Medical Literature, there have been 361 patients for whom the diagnosis has been confirmed by necropsy, 294 by bioptic laparotomy and another 65, where there is no precise information on the method of histopathological diagnosis. Exposure to asbestos can be observed in 55% of the cases studied from the 1960's onwards. As for pathogenesis, amongst other irritant stimuli, it is noteworthy that abdominal hernias provoke mild but chronic reactions on peritoneal serosa. These hernias are to be found in at least 40 of the subjects affected by peritoneal mesothelioma. Reported sites: Inguinal in 28 cases; umbilical in 3 cases; diaphragmatic hiatus in 5 cases; in one case, the site has not been stated. In many cases, hernias may occur as the result of an increase in the endoabdominal pressure caused by ascites or they can be symptomatic of a metastasis of a peritoneal mesothelioma which has spread in a pre-established hernial sac; there are, however, clear examples of primitive, malignant, mesothelial neoplasia of the hernial sac, which can spread throughout the peritoneal cavity months or even years later.