Diffuse malignant peritoneal mesothelioma (DMPM) is a rare cancer that is ultimately fatal in all afflicted individuals. DMPM represents only 15% to 20% of all mesothelioma diagnoses, with most being the pleural variant. Approximately 400 new cases of DMPM are diagnosed annually in the United States, with men and women having an equal incidence of the disease.1,2 Several risk factors have been implicated in the development of DMPM. Data indicating a strong association between asbestos exposure and the development of disease have been available for decades.3 Although the risk of peritoneal mesothelioma attributed to asbestos exposure may differ between the sexes, these differences may be from misclassification of exposure in women.4 Other factors found to be associated with peritoneal mesothelioma development are previous abdominal radiation and the mineral erionite.5,6 Less substantiated and more controversial putative risk factors include a diet low in vegetable consumption, and simian virus 40 infection from contaminated polio vaccines.7,8
The first convincing description of DMPM as a distinct clinical entity representing a diffuse primary malignant process of the peritoneal serosa was provided more than 100 years ago. In 1908, Miller and Wynn9 published what is widely believed to be the first documented case of DMPM. In their report, a 32-year-old male miller who presented with abdominal pain and ascites was noted to have an extensive and diffuse intraperitoneal neoplastic process that was not amenable to resection at surgical exploration. He was treated palliatively and succumbed to disease 1 year later. A review of the literature 50 years later found only 13 pathologically confirmed cases of DMPM.10 However, after that detailed description of the tumor's pathologic features, a marked increase occurred in the number of documented cases in the medical literature, accompanied by an initial understanding of the risk factors and clinical features of the condition. From 1960 until the publication of Moertel's widely acclaimed review of the subject in 1972, at least 169 cases were documented in the literature.11 Despite the initial description of DMPM in the early 20th century, results of clinical trials and treatment strategies specifically for patients with DMPM were not reported until the end of the century.
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