腹膜炎症状で発生した腹膜悪性中皮腫の１例

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  • A case of malignant peritoneal mesothelioma presenting as acute petritonitis

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Background: The cytological diagnosis of malignant peritoneal mesothelioma with ascites is often difficult. We report a case in which cytological findings showing evidence of ascites provided an important clue for diagnosis.Case: A-79-year-old woman with acute abdominal pain was discoverd to have ascites. She had received radiation therapy to her pelvic region when she was 41 years old for the treatment of an unspecified disease. A blood test showed an elevated white blood cell count and CRP level. She was examined using ultrasonography, computed tomography, magnetic resonance imaging, and an upper and lower endoscopy, but no abnormal mass was detected. Cytological examination of an ascites sample showed atypical mesothelial cells. The presence of PAS-staining positive granules in the cyto plasm and the results of an immunocytological examination (i.e., anti-calretinin antibody) suggested a malignant mesothelioma. A few months after her first visit to our outpatient clinic, she was diagnosed as having a malignant mesothelioma during an exploratory laparotomy.Conclusion: Careful cytological examination of ascites specimens and immunohistochemical examinations may assist in the diagnosis of malignant mesothelioma.

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