卵管癌による癌性腹膜炎が疑われたが審査腹腔鏡によりクラミジア性骨盤腹膜炎と診断し得た1例

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  Chlamydial pelvic peritonitis presents with high levels of CA125, massive ascites and inflammatory changes in the peritoneum, and is sometimes difficult to differentiate from carcinomatous peritonitis. We report a case of chlamydial pelvic peritonitis, diagnosed by laparoscopy, mimicking carcinomatous peritonitis due to fallopian tube cancer. A 22-year-old primipara woman with a history of artificial abortion five months before was referred for a massive ascites effusion. Her CA125 was elevated at 532 U/ml, and pelvic MRI showed a left fallopian tube edema with wall thickening and nodules, and suspected peritoneal and great omentum thickening. A CT scan revealed some enlarged lymph nodes around the pararenal aorta. Cervical chlamydia real-time PCR was positive, and chlamydial pelvic peritonitis was suspected, but carcinomatous peritonitis could not be ruled out, so a laparoscopy was performed. The pelvis was filled with bloody ascites, and fibrous adhesions were found around the uterine adnexa and on the surface of the liver. A mass was found in the left fallopian tube. Rapid ascetic fluid cytology revealed atypical cells that were highly suggestive of malignancy, so a left salpingectomy, bilateral ovarian cyst enucleation, peritoneal biopsy and adhesiolysis were performed. Postoperative pathological examination indicated an atypical oviductal epithelium, but there was no destructive proliferation or invasion indicative of inflammatory changes. After surgery, azithromycin was administered. The ascites disappeared, peritoneal thickening and lymph node enlargement improved, and CA125 became negative. Laparoscopy is a minimally invasive and reliable method of tissue sampling, and is useful in differentiating carcinomatous peritonitis from other type of peritonitis.