腹腔鏡下に診断し，pemetrexed（PEM）＋cisplatin（CDDP）療法を行った悪性腹膜中皮腫の1例

Malignant peritoneal mesothelioma diagnosed with laparoscopic biopsy and treated with pemetrexed plus cisplatin : A case report

◆要旨：患者は74歳，男性．腹満感を主訴に当院内科を受診した．腹部造影CTで多量の腹水貯留を認め，種々の精査を行ったが確定診断がつかず，腹腔鏡下生検目的で当科へ転科した．腹腔鏡所見では多量の黄色腹水貯留を認め，大網が塊状になっており，表面に白色結節を多数認めた．また，腹膜，小腸表面にも同様に白色小結節を多数認めた．大網，腹膜を一部切除し，病理検査へ提出，悪性腹膜中皮腫と診断された．術後早期よりpemetrexed（PEM）＋cisplatin（CDDP）による化学療法を開始し，腹水の再貯留も認めず，外来治療中である．悪性腹膜中皮腫は確定診断に難渋する場合があり，腹腔鏡下生検が有用と思われた．

　A 74-year-old man with abdominal distention visited our Department of Internal Medicine. Abdominal computed tomography（CT） showed massive ascites. Because definitive diagnosis could not be made, a diagnostic laparoscopy was performed. Laparoscopy revealed a large volume of ascites and multiple white nodules on the massive greater omentum, peritoneum, and wall of the intestine. The nodules on the greater omentum and peritoneum were resected and diagnosed as malignant peritoneal mesothelioma pathologically. The patient underwent early postoperative induction therapy with pemetrexed plus cisplatin, which resulted in a reduction in ascites. He is doing well, treated as an outpatient. Malignant peritoneal mesothelioma is very difficult to diagnose and laparoscopic biopsy is useful for detecting it.