2019 Volume 52 Issue 12 Pages 728-735
We report a rare case of small intestinal metastasis from malignant pleural mesothelioma. A 78-year-old man, with a history of lobectomy for lung cancer 6 years previously, underwent total gastrectomy with lymphadenectomy for gastric cancer. Two years and 4 months after gastrectomy, a chest CT revealed pleural effusion, which was gradually increasing. Pathological examination of a biopsy specimen of the pleura was diagnosed as malignant pleural mesothelioma, epithelioid type. Although he received the third line chemotherapy and radiation therapy, his disease progressed, therefore he was treated with best supportive care. He had a sudden onset of lower abdominal pain and CT showed massive ascites and free air in the abdominal cavity. An emergency operation was performed under the diagnosis of suspected bowel perforation. We conducted laparotomy, then found purulent ascites and multiple white nodules on the abdominal wall. Circumferential wall thickening with a central perforation of 7 mm was detected in the jejunum, so partial resection of the small intestine was performed. Immunohistochemical examination for the lesion was positive for mesothelial markers, therefore the definitive diagnosis was small intestinal metastasis from malignant pleural mesothelioma.
