Ishizuka Kosuke, Uehara Takanori, Arai Makoto, Ikeda Junichiro, Hirose Yuta, Ikusaka Masatomi
Department of General Medicine, Chiba University Hospital, Japan.
Department of Gastroenterology, Tokyo Women's Medical University Yachiyo Medical Center, Japan.
Radiol Case Rep. 2021 Dec 16;17(3):540-543. doi: 10.1016/j.radcr.2021.11.064. eCollection 2022 Mar.
In malignant mesotheliomas, cases involving the peritoneum as the primary site are rare, accounting for approximately 10% of all mesothelioma cases. We report a case of medical-type peritoneal mesothelioma leading to death 2 months after the onset of fever of unknown origin, along with a review of the literature. A 76-year-old man presented with a fever of unknown origin over 4 weeks. Thoracoabdominal computed tomography (CT) scan showed increased mesenteric adipose tissue density. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan showed diffuse hyperaccumulation in the mesentery and hyperaccumulation in the intraperitoneal and parasternal lymph nodes. A thoracoscopic biopsy of the parasternal lymph nodes revealed metastatic peritoneal mesothelioma. The treatment plan was discussed with him and his family, and the best supportive care was provided. 2 months later, he died from multiple organ failure. Underlying malignant tumors cause 38% of mesenteric panniculitis cases. Symptoms accompanied by lymphadenopathy within the area of mesenteric panniculitis are highly suggestive of malignancy. Peritoneal mesothelioma can be classified as (1) classical, which is accompanied by abdominal pain, ascites, and abdominal masses; (2) surgical, which is accompanied by hernia incarceration and intestinal occlusion; and (3) medical, wherein systemic symptoms, such as fever and weight loss, are primarily observed. The medical-type peritoneal mesothelioma, wherein systemic symptoms are primarily observed, has a poorer prognosis than the other types. FDG-PET/CT is an effective diagnostic modality for peritoneal mesothelioma and typically shows diffuse hyperaccumulation along the peritoneal surface.
在恶性间皮瘤中，以腹膜为主要发病部位的病例较为罕见，约占所有间皮瘤病例的10%。我们报告一例医源性腹膜间皮瘤病例，该患者在不明原因发热发作2个月后死亡，并对相关文献进行综述。一名76岁男性出现不明原因发热4周。胸腹计算机断层扫描（CT）显示肠系膜脂肪组织密度增加。18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）显示肠系膜弥漫性高摄取以及腹腔和胸骨旁淋巴结高摄取。胸骨旁淋巴结的胸腔镜活检显示为转移性腹膜间皮瘤。与患者及其家属讨论了治疗方案，并给予了最佳支持治疗。2个月后，患者死于多器官功能衰竭。潜在恶性肿瘤导致38%的肠系膜脂膜炎病例。肠系膜脂膜炎区域伴有淋巴结病的症状高度提示恶性肿瘤。腹膜间皮瘤可分为：（1）经典型，伴有腹痛、腹水和腹部肿块；（2）外科型，伴有疝嵌顿和肠梗阻；（3）医源型，主要表现为发热和体重减轻等全身症状。以全身症状为主的医源型腹膜间皮瘤预后比其他类型更差。FDG-PET/CT是腹膜间皮瘤的一种有效诊断方法，通常显示沿腹膜表面弥漫性高摄取。
