Korean J Gastroenterol.  2010 Dec;56(6):377-381. 10.4166/kjg.2010.56.6.377.

A Case of Peritoneal Mesothelioma with Direct Invasion to Gastric Mucosa

• Shin SM
• Park SM
• Hwang BS
• Seol SH
• Seo HE
• Kim SH
• Gu MJ
• Shin JY

• KMID: 1775854
• DOI: http://doi.org/10.4166/kjg.2010.56.6.377

Abstract

Mesothelioma is a rare aggressive tumor arising from the mesothelial cell and regarded as universally fatal disease with average survival around 1 year. The incidence rate is varied from one to forty per million in different countries and increasing by the year. The most common site of tumor origin is the pleura and only 20% to 33% of mesothelioma arise from the peritoneum. There are increasing reports of malignant mesothelioma with forty to fifty fatal cases per year in Korea. Histological studies with immunohistochemical stain is helpful for the diagnosis of peritoneal mesothelioma and imaging modality alone is not sufficient for diagnosis, so it is difficult to confirm diagnosis. A 64-year-old male patient was admitted to the hospital with a palpable mass on abdomen. The 6x6 cm sized huge mass was seen on the body of stomach adjacent to the peritoneum. We report a case of malignant peritoneal mesothelioma without evident exposure to asbestos, of which direct invasion to the gastric mucosa was confirmed by endoscopic biopsy and immunohistochemical stain.

Keyword

Peritoneal neoplasms; Mesothelioma

MeSH Terms

Gastric Mucosa/*pathology
Humans
Male
Mesothelioma/*diagnosis/pathology
Middle Aged
Neoplasm Invasiveness
Peritoneal Neoplasms/*diagnosis/pathology
Stomach Neoplasms/*pathology/secondary
Tomography, X-Ray Computed

Figure

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  Fig. 1. Computed tomography showed a 6×6 cm sized mass arising from the peritoneum and externally compressing the body of the stomach.

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  Fig. 2. Endoscopic finding showed a firm subepithelial mass with irregular surface ulceration in anterior wall of the angle and antrum.

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  Fig. 3. Histologic finding of endoscopic biopsy. The tumor cells were arranged in acinar and tubulopapillary pattern lined by pol-ygonal or cuboidal cells with fibrovascular cores and glandlike tubules (H&E stain, ×200).

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  Fig. 4. Immunohistochemical stain of endoscopic biopsy. (A) Malignant mesothelioma cells showed strong immunoreactivity for calretinin (×200). (B) Mesothelioma cells were negative for CEA (×200).

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  Fig. 5. Computed tomography showed increased size of the mass with loss of fat plane between the left lobe of the liver and a metastatic nodule in the segment 4 of the liver.

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