A Case of Sarcomatoid Peritoneal Mesothelioma with Death due to Rapid Aggravation of Ascites

A 70-year-old man with a history of doing wiring work for 30 years was admitted to our hospital because of lower abdominal pain and ascites. Four months before admission he underwent cholecystectomy due to cholelithiasis and cholecystitis.At that time there were no macroscopic abnormal findings in the peritoneum, surface of the gall bladder,liver,stomach or intestine.We suspected peritonitis carcinomatosa,but ascetic fluid was light yellow and clear, and cytology showed no malignant cells. Computed tomography (CT)showed no malignant findings in visceral organs including the liver, pancreas, spleen, kidney and lung, but prominent ascites and thickening of the peritoneum and omentum were observed.After admission the ascites increased significantly and pleural effusion appeared. The patient died due to respiratory insufficiency two weeks from the onset of disease. Autopsy findings revealed sarcomatoid mesothelioma of the peritoneum, omentum and mesentery.Asbestos bodies were found in the lung,and the concentration of hyaluronic acid in ascites was very high. In conclusion, in cases with rapidly progressive and refractory ascites, asbestos-induced mesothelioma should be included in the differential diagnosis.
Article
信州医学雑誌. 58(2): 69-74 (2010)