Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
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Case Report

Volume 12, Number 1, February 2019, pages 48-51

Malignant Peritoneal Mesothelioma Without Asbestos Exposure


Figure 1.
Figure 1. CT scan of the abdomen showing complex ascites and omental caking.
Figure 2.
Figure 2. Diffuse malignant mesothelioma of epithelial type comprised of tubulopapillary pattern with papillary structures and branching tubules (H&E, magnification × 100).
Figure 3.
Figure 3. Diffuse malignant mesothelioma of epithelial type with predominantly papillary configuration lined by rather cuboidal to flattened epithelial-like cells with vesicular nuclei (H&E, magnification × 100).
Figure 4.
Figure 4. Calretinin immunostain shows strong positivity of tumor cells for the mesothelial cells (immunostain, magnification × 400).


Table 1. Laboratory Test Results
Hemoglobin11.6 g/dL
MCV (mean corpuscular volume)71.9 fL
WBC (white blood cells)6.1 k/µL
Neutrophils %72.8%
Lymphocyte %16.7%
Platelet337 k/µL
PT (prothrombin time)11.6 s
INR (international normalization ratio)1.0
APTT (activated partial thromboplastin time)29.6 s
Ferritin24 ng/mL
Iron125 µg/dL
UIBC (unsaturated iron binding capacity)266 µg/dL
Vitamin B12247 pg/mL
Folate8.9 ng/mL
TSH (thyroid stimulating hormone)0.55 mIU/L
Cholesterol213 mg/dL
LDL (low density lipoprotein)106 mg/dL
HDL (high density lipoprotein)60 mg/dL
Triglycerides234 mg/dL
Sodium134 mEq/L
Potassium4.3 mEq/L
Chloride98 mEq/L
HCO3 (bicarbonate)26 mEq/L
BUN (blood urea nitrogen)7 mg/dL
Creatinine0.8 mg/dL
Calcium8.6 mg/dL
Glucose76 mg/dL
Protein6.6 g/dL
Albumin3.9 g/dL
ALT (alanine aminotransferase)15 U/L
AST (aspartate transaminase)22 unit/L
GTT (gamma glutamyl transferase)8.0 unit/L
APL (alkaline phosphatase)57 unit/L
Bilirubin total0.3 mg/dL
Lipase27 U/L
LDH (lactate dehydrogenase)84 unit/L
HbA1c (hemoglobin A1C)4.4%
ESR (erythrocyte sedimentation rate)8.0 mm/h
Hepatitis E Ab IgGNegative
Hepatitis E Ab IgMNegative
Hepatitis A total AbNegative
Hepatitis B core total AbNegative
Hepatitis B surface AbPositive
Hepatitis B surface antigenNegative
Hepatitis C AbNegative
ANA (anti nuclear antibody)Negative
Anti-mitochondrial AbNegative
Alpha 1 antitrypsin207 mg/dL
Ceruloplasmin26 mg/dL
HIV (human immunodeficiency virus)Negative
IgA level188 mg/dL
Liver kidney microsomal assay< 20.0
Smooth muscle actin Ab screenNegative
Tissue transglutaminase Ab IgA1 U/mL
Celiac interpretationNegative
QuantiFERON® goldNegative
Urine analysisNegative


Table 2. Ascitic Fluid Analysis
Ascitic fluidResults
WBC (white blood cell) count960 cells/mm3
Segmented neutrophils count25.0%
Lymphocyte count75.0%
RBC (red blood cell) count19,500 Mil cells/mm3
Mesothelial cellsMany
Albumin3.2 g/dL
Amylase46 unit/L
Adenosine deaminase36.8 U/L
LDH (lactate dehydrogenase)278 unit/L
Protein5.2 g/dL
SAAG (serum ascites albumin gradient)0.7 g/dL