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Sunday, 13 January 2013

CASE 164: ASCITES due to MALIGNANT MESOTHELIOMA, Dr PHAN THANH HẢI,MEDIC MEDICAL CENTER, HCMC. VIETNAM


Man 64 yo, for a long time abusing of alcohool, he himself detected abdomen distention.

At MEDIC,  ultrasound of abdomen and MSCT were done for him.



Blood tests:  normal liver function test, normal renal function, protide total 6,08 g/L; CEA =195 UI/mL. Other cancer markers: CA 19-9, PSA, AFP, beta2 MICROGLOBULINE =1651 (N=2000). ANA negative.
ASCITES FLUID  removed by punction is in cloudy yellow color.


Ascites fluid analysis: cytology no malignant cell, 75%  lymphocyte, protid 30,6g/L, sugar 5,3 g/dL, amylase not elevated.
CEA=   650 UI/L;   CA-125 =550 UI/L
ADA = NEGATIVE , PCR TB = NEGATIVE.
Summary =   With blood test and ascites fluid test results , we try to find out cancer by gastroscopy, colonoscopy.
MDCT TOTAL BODY and  MRI abdomen also no detected cancer.


LAPAROSCOPY DETECTED  MANY INTRAPERITONEAL AND PARIETAL SEEDINGS, AND ALSO ON GREAT OMENTUM. THE  COECUM AND  JEJUNUM WERE WALL-OFF AND  ADHERANT  TO THE  ABDOMINAL WALL. LIVER  SUSPECTED NORMAL.  

3 BIOPSIES RESULT  PERITONEAL  CARCINOMATOSIS.

Microscopic report is  mucineous adenocarcinoma  metastasizing to peritoneum.



Discussion: why the diagnosis of  this case  delayed for one month after onset of ascites.
Where is the primary cancer and what is the choice of treatment for for him from now on?

STAINING IMMUNOHISTOLOGICAL RESULT IS A MESOTHELIOMA.

AFTER  SPECIAL EXAMINATION  BY HISTOIMMUNO, THIS  REPORT IS INTRAPERITONEAL MALIGNANT  MESOTHELIOMA.


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