Diffuse malignant peritoneal mesothelioma (DMPM) is a rare yet aggressive neoplasm arising from mesothelial cells of the peritoneum. It spreads extensively within the abdominal cavity with substantial associated morbidity and mortality. Expertise in cytoreductive surgery (CRS) and hyperthermic intraoperative peritoneal perfusion chemotherapy (HIPEC) has led to increased overall survival for patients. With improving survival rates and possibility of cure, it is unknown what impact CRS and HIPEC have on the future fertility of reproductive-aged women. We report the case of a successful pregnancy achieved with in-vitro fertilization (IVF) following CRS and HIPEC treatment for epithelioid subtype DMPM.METHODS:
Data collected from Essentris and Altha, Department of Defense Electronic Medical records for outpatient and inpatient care.RESULTS:
A 28 year old female with primary infertility and recurrent ascites was found to have fleshy- appearing peritoneal nodules on laparoscopy with histologic findings of epithelioid subtype DMPM. She elected ovarian suppression with a GnRH-agonist prior to undergoing CRS, HIPEC, and adjuvant chemotherapy. Spontaneous return of menses occurred 18 months after completion of chemotherapy. After two years of remission, she pursued fertility treatment with IVF, and has an ongoing uncomplicated singleton gestation.CONCLUSION:
Median survival for patients with DMPM has improved to approximately 50% at five years with CRS and HIPEC treatment. We report the first known case of a successful pregnancy achieved with IVF following CRS, HIPEC, and adjuvant chemotherapy for DMPM. Of interest, GnRH pre-treatment offered an approach to ovarian suppression. In light of urgency to initiate expeditious treatment, this approach possibly optimized fertility preservation and post-treatment childbearing potential.