卵巣癌との鑑別に審査腹腔鏡が有用であった腹膜中皮腫の一例

抄録

　Malignant peritoneal mesothelioma is a malignant tumor that develops in peritoneal mesothelial cells. More than 80% of malignant mesotheliomas are caused by asbestos exposure and develop over a period of approximately 30-40 years. Preoperative diagnosis is difficult. Most cases are confirmed with postoperative histopathological examination. We describe a case of malignant peritoneal mesothelioma diagnosed via diagnostic laparoscopy surgery.

　The patient was a 51-year-old woman who presented to our emergency department with a chief complaint of abdominal pain. She was found to have localized peritonitis and peritoneal nodules. The peritonitis resolved with antibiotics. The patient was discharged from the hospital; she continued to visit the hospital annually for follow-up of the peritoneal nodule.

　Three years later, computed tomography (CT) showed aggravation of the peritoneal nodules. The patient was referred to our department for a close examination. Transvaginal ultrasonography showed bilateral ovarian enlargement. CT and pelvic MRI showed a strong likelihood of ovarian cancer and peritoneal dissemination. Thus, experimental laparoscopic surgery was performed. Postoperative histopathological examination led to a diagnosis of malignant peritoneal mesothelioma.

　It is important to perform experimental laparoscopic surgery and confirm the postoperative histopathological diagnosis before starting chemotherapy, even in cases where preoperative chemotherapy is considered to be indicated for patients referred to the gynecology department for ovarian cancer or primary peritoneal cancer.