A CASE OF MALIGNANT PERITONEAL MESOTHELIOMA AND REVIEW OF THE LITERATURE IN JAPAN

A case of peritoneal malignant mesothelioma is reported, with some discussion based on the Japanese literature. A 65-year-old man was admitted to the hospital because of abdominal distention in April 1990. As the patient had ascites and node in the Douglas' pouch, a tentative diganosis of peritoneal dissemination from unknown origin was made and exploratory laparotomy was performed. On laparotomy it was found that the greater omentum was replaced with tumor mass and the peritoneum was extensively scattered with numerous nodi 1cm in diameter. Histopathologically, cubic tumor cells lacking the atypia showed a ductal structure, were PAS-positive, and were able to be digested by hyaluronidase. Accordingly, the diagnosis of epithelial type of mesothelioma was confirmed. One week after laparotomy, continuous hyperthermic peritoneal perfusion using CDDP and Mitomycin C was started. Decrease of the ascitic fluid and the degeneration of tumor cells were observed. Until the end of 1990, 240 cases of peritoneal mesothelioma have been reported in Japan. Their average age was 54 years. The male-to-female ratio was 4:3. The diagnosis is difficult without laparotomy or laparoscopy. CDDPbased intraperitoneal chemotherapy seems to be the best available treatment at present. Nevertheless, peritoneal mesothelioma has still poor prognosis.