Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website http://www.gastrores.org

Case Report

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

Malignant Peritoneal Mesothelioma Without Asbestos Exposure

Figure 2. Diffuse malignant mesothelioma of epithelial type comprised of tubulopapillary pattern with papillary structures and branching tubules (H&E, magnification × 100).

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. Calretinin immunostain shows strong positivity of tumor cells for the mesothelial cells (immunostain, magnification × 400).

**Table 1.** Laboratory Test Results
Laboratory	Results
Hemoglobin	11.6 g/dL
Hematocrit	37.0%
MCV (mean corpuscular volume)	71.9 fL
WBC (white blood cells)	6.1 k/µL
Neutrophils %	72.8%
Lymphocyte %	16.7%
Platelet	337 k/µL
PT (prothrombin time)	11.6 s
INR (international normalization ratio)	1.0
APTT (activated partial thromboplastin time)	29.6 s
Ferritin	24 ng/mL
Iron	125 µg/dL
UIBC (unsaturated iron binding capacity)	266 µg/dL
Vitamin B12	247 pg/mL
Folate	8.9 ng/mL
TSH (thyroid stimulating hormone)	0.55 mIU/L
Cholesterol	213 mg/dL
LDL (low density lipoprotein)	106 mg/dL
HDL (high density lipoprotein)	60 mg/dL
Triglycerides	234 mg/dL
Sodium	134 mEq/L
Potassium	4.3 mEq/L
Chloride	98 mEq/L
HCO₃ (bicarbonate)	26 mEq/L
BUN (blood urea nitrogen)	7 mg/dL
Creatinine	0.8 mg/dL
Calcium	8.6 mg/dL
Glucose	76 mg/dL
Protein	6.6 g/dL
Albumin	3.9 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 total	0.3 mg/dL
Lipase	27 U/L
LDH (lactate dehydrogenase)	84 unit/L
HbA1c (hemoglobin A1C)	4.4%
ESR (erythrocyte sedimentation rate)	8.0 mm/h
Hepatitis E Ab IgG	Negative
Hepatitis E Ab IgM	Negative
Hepatitis A total Ab	Negative
Hepatitis B core total Ab	Negative
Hepatitis B surface Ab	Positive
Hepatitis B surface antigen	Negative
Hepatitis C Ab	Negative
ANA (anti nuclear antibody)	Negative
Anti-mitochondrial Ab	Negative
Alpha 1 antitrypsin	207 mg/dL
Ceruloplasmin	26 mg/dL
HIV (human immunodeficiency virus)	Negative
IgA level	188 mg/dL
Liver kidney microsomal assay	< 20.0
Smooth muscle actin Ab screen	Negative
Tissue transglutaminase Ab IgA	1 U/mL
Celiac interpretation	Negative
QuantiFERON® gold	Negative
Urine analysis	Negative

Table 1. Laboratory Test Results

Laboratory

Results

Hemoglobin

11.6 g/dL

Hematocrit

37.0%

MCV (mean corpuscular volume)

71.9 fL

WBC (white blood cells)

6.1 k/µL

Neutrophils %

72.8%

Lymphocyte %

16.7%

Platelet

337 k/µL

PT (prothrombin time)

11.6 s

INR (international normalization ratio)

1.0

APTT (activated partial thromboplastin time)

29.6 s

Ferritin

24 ng/mL

Iron

125 µg/dL

UIBC (unsaturated iron binding capacity)

266 µg/dL

Vitamin B12

247 pg/mL

Folate

8.9 ng/mL

TSH (thyroid stimulating hormone)

0.55 mIU/L

Cholesterol

213 mg/dL

LDL (low density lipoprotein)

106 mg/dL

HDL (high density lipoprotein)

60 mg/dL

Triglycerides

234 mg/dL

Sodium

134 mEq/L

Potassium

4.3 mEq/L

Chloride

98 mEq/L

HCO₃ (bicarbonate)

26 mEq/L

BUN (blood urea nitrogen)

7 mg/dL

Creatinine

0.8 mg/dL

Calcium

8.6 mg/dL

Glucose

76 mg/dL

Protein

6.6 g/dL

Albumin

3.9 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 total

0.3 mg/dL

Lipase

27 U/L

LDH (lactate dehydrogenase)

84 unit/L

HbA1c (hemoglobin A1C)

4.4%

ESR (erythrocyte sedimentation rate)

8.0 mm/h

Hepatitis E Ab IgG

Negative

Hepatitis E Ab IgM

Negative

Hepatitis A total Ab

Negative

Hepatitis B core total Ab

Negative

Hepatitis B surface Ab

Positive

Hepatitis B surface antigen

Negative

Hepatitis C Ab

Negative

ANA (anti nuclear antibody)

Negative

Anti-mitochondrial Ab

Negative

Alpha 1 antitrypsin

207 mg/dL

Ceruloplasmin

26 mg/dL

HIV (human immunodeficiency virus)

Negative

IgA level

188 mg/dL

Liver kidney microsomal assay

< 20.0

Smooth muscle actin Ab screen

Negative

Tissue transglutaminase Ab IgA

1 U/mL

Celiac interpretation

Negative

QuantiFERON® gold

Negative

Urine analysis

Negative

**Table 2.** Ascitic Fluid Analysis
Ascitic fluid	Results
Color	Cloudy
WBC (white blood cell) count	960 cells/mm³
Segmented neutrophils count	25.0%
Lymphocyte count	75.0%
RBC (red blood cell) count	19,500 Mil cells/mm³
Mesothelial cells	Many
Macrophage	Many
Albumin	3.2 g/dL
Amylase	46 unit/L
Adenosine deaminase	36.8 U/L
LDH (lactate dehydrogenase)	278 unit/L
Protein	5.2 g/dL
SAAG (serum ascites albumin gradient)	0.7 g/dL

Table 2. Ascitic Fluid Analysis

Ascitic fluid

Results

Color

Cloudy

WBC (white blood cell) count

960 cells/mm³

Segmented neutrophils count

25.0%

Lymphocyte count

75.0%

RBC (red blood cell) count

19,500 Mil cells/mm³

Mesothelial cells

Many

Macrophage

Many

Albumin

3.2 g/dL

Amylase

46 unit/L

Adenosine deaminase

36.8 U/L

LDH (lactate dehydrogenase)

278 unit/L

Protein

5.2 g/dL

SAAG (serum ascites albumin gradient)

0.7 g/dL