副腎腫瘍との鑑別が困難であった後腹膜腔原発悪性中皮腫の1例

Abstract

27歳女.男児出産後, 1ヵ月に2～3日続く38℃以上の熱発があり, 感冒薬, 抗生剤を処方されたが, 39℃の熱発のため受診した.腹部造影CTで左腎頭側に腫瘤を認め, 内部は不均一に造影効果を認め, 副腎腫瘍が疑われた.アンギオグラフィーで大動脈から分岐する血管より全体に栄養される腫瘤像を認め, non-functionの副腎腫瘍と診断し, 悪性を強く疑い, 腹腔鏡下腫瘍摘出術を施行した.免疫組織化学染色所見より, 悪性中皮腫と診断した.術後1.5年経過したが, 再発を認めず, 極めて稀な症例と思われた

Malignant mesothelioma is a neoplasm which tends to develop along serosal surfaces, such as the pleura and peritoneum. We report a rare case of malignant retroperitoneal mesothelioma in a 27-year-old woman. The patient was admitted with a chief compliant of intermittent high fever once a month, and left retroperitoneal tumor was detected by dynamic abdominal computed tomography. Since an adrenal tumor was suspected, laparoscopic tumor extirpation was performed. Immunohistochemically tumor cells were positive for calretinin and thrombomodulin, but negative for carcinoembryonic antigen (CEA) and Ber-Ep4. Based on these findings, primary malignant retroperitoneal mesothelioma was diagnosed.