心膜に原発した悪性中皮腫の1例

A Case of Primary Malignant Mesothelioma of Pericardium

　原発性心膜悪性中皮腫は稀な疾患で，臨床的に診断がつけにくい疾患の一つである．心嚢液細胞診はこの疾患の診断に非常に有用な検査法である一方，時に腺癌と紛らわしい所見を呈することがある．この症例は心嚢液細胞診，その他の検査所見から腺癌の心嚢転移が疑われ，原発巣不明のまま死亡し，剖検の結果，心膜原発の悪性中皮腫と診断された1例である．腺癌との鑑別診断については，細胞診ではBer-EP4などの免疫組織染色法や電子顕微鏡所見を組み合わせ，さらにMRI,CTなどの画像診断やその他の臨床所見を含めて総合判断することが重要である．

55-year-old female was presented with cough and dyspnea caused by massive pericardial effusion. Peri-cardiocentesis yielded hemorrhagic fluid containing adenocarcinoma-like cells. She died from cardiac tamponade mainly resulting from the compression of the heart by the tumor. The diagnosis of pericardial mesothelioma was confirmed at autopsy by histological findings as well as by histochemical and immunohisto-chemical studies. Tumor cells in the pericardial effusion were negative in staining for Ber-EP4, and showed ultrastructural features characteristic of malig-nant mesothelioma.