title: [A case of malignant mesothelioma of the pleura and the peritoneum detected by sudden onset of back pain and pleural effusion and ascites].
abstract: A case of malignant mesothelioma of the pleura and the peritoneum is reported. In April 1996, a 40-year-old men noticed sudden onset of back pain. Radiographic examinations and MRI revealed pleural effusions, ascites, ringed enhanced tumorous lesions in the right posterior diaphragm along the abdominal aorta, and marked thickening of the right diaphragm with moderate signal intensity. On thoracoscopic surgery, there were white small nodules on the intercostal parietal pleura. Tumor cells of a tubulopapillary pattern had large rounded nuclei and eosinophilic cytoplasms in a partially glandlike arrangement. Cytoplasms of tumor cells stained for alcian blue disappeared after hyaluronidase digestion. Immunohistochemical examinations showed positive staining for keratin but negative for CEA. Electron micrographs showed numerous long thin microvilli, desmosomes and intermediate tonofilaments. From these findings, malignant mesothelioma was diagnosed. The malignant mesothelioma cells of the pleura in this case were considered to disseminate the peritoneum directly through the diaphragm or its lymphatic canals. MRI and thoracoscopic surgery were useful for the demonstration of the pleural disseminations and abdominal invasions.
authors.affiliation: Department of Internal Medicine, Hyogo Prefectural Amagasaki Hospital, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: S
authors.initials: S
authors.lastname: Naitoh
authors.forename: S
authors.initials: S
authors.lastname: Nomura
mesh_terms: D000328:Adult; D001202:Ascitic Fluid / Q000209:etiology*; D001416:Back Pain / Q000209:etiology*; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000150:complications / Q000473:pathology*; D010534:Peritoneal Neoplasms / Q000150:complications / Q000473:pathology*; D016066:Pleural Effusion, Malignant / Q000209:etiology*; D010997:Pleural Neoplasms / Q000150:complications / Q000473:pathology*