Peritoneal Mesothelioma

Primary peritoneal mesothelioma is a rare malignancy that is related to previous exposure to asbestos, with an increased risk proportional to the duration and intensity of exposure. It is a tumor arising from serial surfaces: pleura 70%, peritoneum 25%, pericardium, 10% and testis. Peritoneal localization is associated in about half of cases with effusion. In recent years there has been an increasing number of cases, the highest incidence is between 50 and 70. The lag time is twenty to forty years, depending on time of exposure to asbestos fiber type and concentration and size. He also described a relationship with prior radiation therapy. We present a case of a patient with peritoneal mesothelioma, pleural unaffected, was a man of 66, who had transported asbestos (hydraulic brakes) twenty years earlier. The presenting complaint was abdominal pain and bloating. On ultrasound showed a fluid collection and as cites in small amounts. The suspected diagnosis was made on CT scan and confirmed after aspiration and laparotomy. Before beginning treatment the patient died of renal failure.

66 year old male, carrier, smoking a pack a day
Background: Typhoid fever, lumbar disc hernia, duodenal ulcer, appendectomy, myocardial infarction, twelve years earlier. He reported vague abdominal pain in the previous four months, sometimes more intense in the right par umbilical region under transrectal scar, had been visited in the Emergency sub occlusion being diagnosed by hernia in relation to the ex ante and prescribing painkillers. Goes to the consultation for persistent pain, occasional bloating sensation, hyperemia and loss of 5 kg. On examination a mass was palpable right par umbilical imprecise.
RX: Thin handles rejected. Ultrasound: fluid collected from 6.5 x 3 cm right lower quadrant and another collection tube of 3 cm, low scar, as cites in small amounts.
CT: Lesion of heterogeneous density than the liquid in the anterior abdominal region with a thickness of 50 mm, the density increases with the infusion of contrast, consistent with vascular injury peritoneal as cites encapsulated.
Puncture guided by ultrasound: high cellularity of papillary formation, large nuclei with frequent mitosis and vesicular basophilic PAS negative cytoplasm.
Immunohistochemical techniques: Focal vimentin-positive and B-72.3, Leu Ml and CEA negative, diffuse positivity with CAM5.2. It was decided to perform laparotomy which confirmed the suspected diagnosis of peritoneal mesothelioma, not performing resection. He died within a week for kidney failure.

Peritoneal Mesothelioma usually presents clinically by as cites and occasionally recurrent intestinal obstruction crisis. Although metastasis occurs, is most notable local invasive capacity. The diagnosis is confirmed with ascetic fluid cytology, although not always as it has up to 40% false negatives. Evidence of diagnostic imaging are not usually effective in the accurate diagnosis and are usually not large, obtaining good results with laparoscopy. A pathological examination of the biopsy is to be provided the definitive diagnosis was confirmed with biochemical data, electron microscopy and immunohistochemical (Keratin Vimentin + Leu + MI-). Microscopy allows to observe intracellular hyaluronic acid and PAS diastase negative staining. At present, chemotherapy with cisplatin and adriamycin has improved the prognosis, as the natural evolution does not reach higher survival rates a year, being higher in patients treated with surgery and radiotherapy. To avoid the recurrence of as cites can make a peritoneal-venous shunt or inject intraperitonelamente 5-fluorouracil or interferon beta. Also some cases have been treated with interferon-alpha. In conclusion, this case confirms the difficulty to diagnose peritoneal mesothelioma, particularly when there is pleural involvement, and poor prognosis.