A case analysis of the symptoms of peritoneal mesothelioma

Peritoneal mesothelioma originated in the peritoneal epithelium and mesothelial organization whose pathology can be divided into: adenomatoid tumor, cystic mesothelioma, and three kinds of malignant mesothelioma. Peritoneal malignant mesothelioma is a rare malignant tumor, the incidence rate of 1 / 1 million, mostly occurs in middle-aged men and women, incidence of small, its occurrence with exposure to asbestos.
Patients, female, 52 years old, due to "bloating for more than 20 days" on October 21, 2004 into the medicine. Patient for more than 20 days before admission there was no significant incentive to abdominal distention, progressive increase, no fever, night sweats, no abdominal pain, anorexia, no weight loss, no urine, peerless lower extremity edema. Pumping at a local hospital ascites, cancer was not found. Past physical health. Menstruation: 13,7 / 30,48 years of age, color positive, the amount of medium, without dysmenorrhea. Pregnancy history, G2P2L2. Examination: body temperature 36.8 ℃, pulse 84 times / min, breathing 21 times / min, blood pressure 112/80mmHg. Skin and mucosa stained, superficial body lymph nodes are not touched. The normal heart and lung, abdominal bulge, no varicose veins, abdomen soft, no tenderness and rebound tenderness, liver and spleen did not touch, shifting dullness (+). Admission Across gynecological ultrasound examination showed: the uterus and two annexes areas no obvious abnormalities in a large number of ascites. Cancer Series: CA 125> 500u/ml. On October 26, 2004 by Professor gynecological consultations, gynecological examination: development of a normal vulva, vagina smooth, cervix size of the normal, yet smooth. Uterus flat bits, the size of normal activity. After the dome hit small nodules at 1.5cm × 1.0cm. Pairs of non-attachment zone abnormalities, ascites due to some reasons to consider the possibility of Gynecologic Oncology large, in order to confirm the diagnosis, decided to laparoscopic duct exploration, the patient agreed to surgery on October 26, 2004 transferred to gynecology.

Into gynecological after October 28, 2004 in systemic anesthesia laparoscopic duct exploration, intraoperative see the uterus anterior, normal size, bilateral normal-sized ovary, uterus bladder fold milky peritoneal membrane can be seen at large net membrane, intestinal congestion, and other parietal peritoneum. Suck out the yellow ascites 6500ml, in the pelvic parietal peritoneum and the left ovarian biopsy, and membrane-like material will be inspected, the results for the left ovary benign lesions, parietal peritoneum does not rule out malignant mesothelioma, ascites cytology: Cha See cancer (adenocarcinoma). Conditions and their families to talk about tomorrow, is currently not found in patients with intra-abdominal mass in pots and decided to row biopsy and after diagnosis before further treatment. Wash the abdominal cavity, a drainage tube set, a smooth operation, postoperative transfusion and use of antibiotics to prevent infection. Pathological report: malignant peritoneal mesothelioma (The above skin type-based). Immunohistochemistry: MC (+), CK (+), CA125 (-), CA19-9 (-). Postoperative drainage tube patency, a total of 2800ml drain out of ascites, after reviewing routine blood test, liver function, kidney function was normal, after October 18, 2004 ECG monitoring downlink PT regimen, after a smooth, no obvious adverse reaction.

Discussion

Peritoneal mesothelioma originated in the peritoneal epithelium and mesothelial organization whose pathology can be divided into: adenomatoid tumor, cystic mesothelioma, and three kinds of malignant mesothelioma. Peritoneal malignant mesothelioma is a rare malignant tumor, the incidence rate of 1 / 1 million, mostly occurs in middle-aged men and women, incidence of small, its occurrence with exposure to asbestos. It is reported that 60% ~ 80% of patients with asbestos exposure history, a number of cases often without a clear history of asbestos exposure may be related to radiation therapy and chronic peritoneal stimuli. Caused by certain viruses may also cause mesothelioma. Peritoneal mesothelioma clinical manifestations are not specific, the test positive rate is not high, specificity is not strong, clinical diagnosis very difficult. With laparoscopy, ultrasound and CT-guided biopsy technology, as well as pathology, immunohistochemistry and electron microscopy diagnosis of a higher level, more and more cases during his lifetime, or be clearly preoperative pathological diagnosis. Peritoneal mesothelioma should primarily with tuberculous peritonitis, intra-abdominal metastatic carcinoma, other primary in the peritoneum, omentum differentiated from the tumor. To date, peritoneal mesothelioma is still a lack of effects of treatment, the vast majority of scholars, advocates, including surgical resection, postoperative radiotherapy and chemotherapy comprehensive measures. As the case of malignant tumors, where there is unexplained ascites, clinical doctors ruled out ovarian cancer, gastrointestinal cancer of the intra-abdominal metastasis and tuberculosis, peritonitis and other diseases should take into account the possibility of peritoneal malignant mesothelioma should be as soon as possible biopsy or even exploratory laparotomy, a clear diagnosis in order to win treatment time.