Peritoneal mesothelioma presented with bilateral hydronephrosis : a case report

43歳女.患者は全身倦怠感および嘔気を主訴に近医を受診, 過敏性腸症候群として加療されていた.しかし症状が悪化し, 血清Crの上昇, 更に腹部超音波で両側水腎症と診断され, 著者らの施設へ紹介となった.検査所見等により腎後性腎不全を疑い, 逆行性腎盂造影を施行したところ, 両側下部尿管に3～4cmにわたる狭窄を認め, 右側はガイドワイヤーも通過しなかった.腹水は認めず, CTならびにMRIではわずかに腫瘤性病変を認めるのみで, 各種検索でも異常所見を認めなかった.後腹膜線維症と診断し, ステロイド療法を開始したところ, 症状は改善せず, 3ヵ月後, 腹痛, 嘔気が増悪した.そこで, 腹部骨盤CTを施行した結果, 左腎尾側に腫瘤, 肝外側, 直腸腹側に腫瘤性病変を認めた.原発巣再検索では異常はなかったが, 腫瘍マーカーは上昇しており, 免疫組織化学染色により腹膜中皮腫線維形成型と診断された.化学療法を施行するも効果がなく, 患者は初診約9ヵ月後に死亡となった
We report a case of peritoneal mesothelioma presenting with bilateral hydronephrosis, which was difficult to be diagnosed. A 43-year-old woman was admitted to our hospital with acute renal failure. Ultrasonography revealed bilateral hydronephrosis. Retrograde pyelography revealed the stenosis of bilateral lower ureter. Pelvic magnetic resonance imaging demonstrated only a small mass lesion around the bilateral ureter. Other examinations showed no findings of malignancy. Under the diagnosis of retroperitoneal fibrosis, steroid therapy was performed. After 3 months, computed tomography (CT) revealed multiple abdominal masses. Percutaneous needle biopsy of tumor was performed. Pathological diagnosis was peritoneal mesothelioma. Chemotherapy based on the pleural mesothelioma was done but not effective, she died 9 months after the first medical examination.