Peritoneal mesothelioma

Introduction to peritoneal mesothelioma Peritoneal malignant mesothelioma, also known as primary peritoneal mesothelioma, is a tumor originating from the peritoneal epithelium and mesothelial tissue. This disease is less common than pleural mesothelioma, and males are slightly higher than females. Benign mesothelioma is often single, mostly located in the fallopian tube, the peritoneum at the top of the uterus, other parts are rare, malignant mesothelioma is often diffuse, covering all or part of the peritoneum. Because the clinical manifestations of peritoneal mesothelioma are not specific, it is difficult to distinguish from tuberculous peritonitis and intra-abdominal metastatic tumors. Therefore, it is of great significance to diagnose and treat peritoneal mesothelioma correctly. basic knowledge The proportion of illness: 0.0055% Susceptible people: men are slightly higher than women Mode of infection: non-infectious Complications: ascites, hypoglycemia

The cause of peritoneal mesothelioma

(1) Causes of the disease

The cause is related to asbestos exposure, and the interval between onset and exposure is very long, often over 30 years. As early as the 1940s, foreign scholars found that mesothelioma was closely related to asbestos exposure, shipyard workers, plumbers, welders. And paint, the incidence of construction workers is 300 times higher than the average person. The close relationship between mesothelioma and asbestos has been confirmed and recognized by more and more facts. At the same time, European and American scholars found that about 60% of the peritoneum Patients with skin tumors have occupational asbestos exposure history or asbestos bodies in lung tissue. In the experiment of asbestos-induced animal pleural mesothelioma, there are also a few animals with peritoneal mesothelioma, indicating the occurrence of peritoneal mesothelioma and asbestos. Contact also has a certain relationship. The risk of different types of asbestos fibers is: blue asbestos> iron asbestos> chrysotile. Generally, asbestos dust with a diameter of 0.5 to 50 m is first entered into the respiratory tract, and then through the diaphragmatic lymphatic network or blood. Entering the abdominal cavity and depositing in the peritoneum, forming asbestos bodies, sometimes foreign body giant cell reaction can occur around the asbestos body, asbestos fiber ingested through the digestive tract It can also reach the peritoneum through the intestinal wall. From exposure to asbestos to mesothelioma on average, 35 to 40 years. After 45 years of exposure, the exact mechanism of asbestos-induced mesothelioma is still unclear, but about 30% There was no history of asbestos exposure in patients with skin tumors. The quantitative examination of asbestos fibers did not reveal the exposure to a large number of asbestos fibers. Other factors related to the occurrence of mesothelioma in the literature were radiotherapy, history of exposure to cerium oxide (usually accepted by patients). In addition, a history of diagnostic examinations, in addition, patients with a history of Hodgkin have an increased risk of mesothelioma.

Viral infection: Simian virus 40 (SV40), which is a DNA tumor virus. According to reports in the literature, approximately 50% of mesothelioma patients in the United States have SV40 in biopsy specimens, which induces human primary mesothelioma cell end. Granzyme activity, but does not affect fibroblasts. Telomerase activity can be measured 72 h after infection with wild-type SV40. A clear DNA ladder can be seen after 1 week. The telomerase activity is proportional to the number of SV40 T antigens in the cell structure. The mesothelial cells infected by SV40 have increased telomerase activity, making mesothelial cells less prone to apoptosis and easy to form mesothelioma.

Mesothelioma may also be associated with fluorite exposure, tuberculous scarring, chronic inflammatory irritation, radioactive material, and genetic susceptibility.

(two) pathogenesis

According to its biological behavior and tumor invasion range, mesothelioma can be divided into benign and malignant, localized and diffuse. In the case report of large mesothelioma, about 57.1% occurred in the pleura and 39.5% occurred in the peritoneum. 1% occurs in the pericardium, can affect multiple serosal surfaces, and even occurs in the testicular sheath

1. The histopathology of mesothelioma is thought to come from two kinds of cells, mesothelial cells and connective tissue cells on the surface of the peritoneum. Recently, it has been confirmed that it is derived from a single cell, namely mesothelial cells, mesothelial cells, epithelial cells and fibers. The cells differentiated in two forms. Dardick (1984) found a sarcomatoid region in mesothelioma. The ultrastructure did not show the characteristics of fibroblasts, but showed the characteristics of epithelial cells at different stages of differentiation. Blobel used immunohistochemistry. It is proved that cytokeratin polypeptide is expressed in both fibrous mesothelioma and epithelial mesothelioma, while fibrin is expressed simultaneously in the same tumor or the same cell, showing mesothelioma. Bidirectional expression characteristics.

2. Peritoneal mesothelioma can be divided into low-grade cystic mesothelioma, highly differentiated papillary mesothelioma and malignant mesothelioma.

(1) low-grade cystic mesothelioma: common in middle-aged and elderly women, often located in the pelvic cavity and can invade the extraperitoneum, the tumor is large, the capsule is not obvious, the boundary is unclear, and often the surrounding pelvic structure is stuck. The cut surface is polycystic, the inner wall is smooth, the capsule contains clear liquid or thin mucus, the capsule wall is flattened to low columnar mesothelial cells, mild to moderately shaped, can be papillary hyperplasia and metaplasia, fibrous wall interstitial Hyperplasia, in which no obvious chronic inflammatory cell infiltration.

(2) well-differentiated papillary mesothelioma: uncommon, even found in surgery, occurs in women of childbearing age, the prognosis is generally good, can even develop malignant mesothelioma, visible pelvic peritoneum and omentum with multiple nipples Symptoms or nodular lesions, solid, grayish white, <2cm in diameter, tumors can also occur in the peritoneum of the stomach, intestines and mesentery. Microscopically, the surface of the tumorous papilla is covered with a single layer of flattened to cuboid mesothelial cells, and the nucleus has no abnormality. A rare mitotic image, the central axis of the cytoplasm is fibrotic interstitial, small tubules formed by mesothelial cells, branched-like strips or solid patches, occasionally sand granules.

(3) malignant mesothelioma: The tumor is scattered in a single or multiple, and the visceral and parietal peritoneum are involved. According to the morphology, it can be divided into diffuse and localized, localized malignant mesothelioma with clear boundary and pedicle or There is a capsule, the texture is tough, the degree of malignancy is low, diffuse malignant mesothelioma, diffuse thickening of the affected peritoneum, the surface is papillary, plaque or nodular, high degree of malignancy, generally seen, extensive peritoneal surface There are tumor nodules of varying sizes, isolated, beaded or clustered, ranging from a few millimeters to a few centimeters in diameter, yellow-white or gray-white, hard, rubber-like texture, and thickened in the late peritoneum. The peritoneum is covered by dense white tumor tissue, which turns the organ into a "frozen" state. The tumor tissue and the abdominal organs, especially the digestive tract, adhere to each other, are not easy to separate, or have multiple surfaces on the peritoneal surface of the abdominal organs. The nodular mass is grape-like, or diffusely distributed in the peritoneal surface of the abdominal iliac muscle, the posterior peritoneal surface and the omentum, mesentery, small intestine and colon serosal surface or liver, bladder surface, etc., sometimes multiple nodules merge into a mass.

Gross pathology of peritoneal mesothelioma. Peritoneal mesothelioma is similar to pleural mesothelioma. There are two types, diffuse peritoneal mesothelioma and localized peritoneal mesothelioma. Generally speaking, diffuse Sexual mesothelioma is 75% malignant, and localized mesothelioma is mostly benign. The former tumor tissue is covered with numerous small nodules or plaques covering the peritoneal wall or visceral layer. As the tumor develops, it is a piece. The thickening of the shape, widely spread on the surface of the peritoneal or abdominal organs of the parietal layer, may be accompanied by tumors or nodules of different sizes, the tumor tissue is mostly grayish white, the texture is tough, and may also be jelly-like, may have bleeding and Necrosis, tumor tissue, fibrous tissue hyperplasia, and even glassy changes, tumor tissue can invade the liver or intestine, but rarely invade the deep part of the organ, the omentum can be completely replaced by tumor tissue, the intestine can be adhered, abdominal cavity There is exudate, even bloody ascites, in the localized peritoneal mesothelioma, the tumor tissue is nodular or plaque in the peritoneal wall layer or visceral layer, grayish white, hard texture, clear boundaries, rarely bleeding And necrosis.

3. Peritoneal mesothelioma observation

There are generally three histological types of peritoneal mesothelioma:

(1) Fibrous mesothelioma: Fibrous mesothelioma cells are composed of spindle cells, which are long fusiform, with varying amounts of collagen fibers. This type is more common in localized mesothelioma. Sexual mesothelioma is sometimes difficult to distinguish from fibrous tissue tumors. The tumor cells are fusiform, collagenous around the cells, and even woven structures, focal calcification or ossification, when the interstitial has obvious fibrosis Or glass-like changes, some people call it ligament-like mesothelioma, recently also from the subcutaneous subcutaneous tissue-derived tumor called peritoneal fibroma, from the surface mesothelial cells called fibrous mesothelioma, However, depending on the organizational form, it is sometimes difficult to distinguish the two.

(2) Epithelioid mesothelioma: Epithelioid mesothelioma cells are cuboidal or polygonal, often with tubular or papillary structures. Epithelial mesothelioma is most common in diffuse mesothelioma, and tumor cells are different. The differentiated state can form a highly differentiated tubular or papillary structure, or it can be an undifferentiated patchy tumor tissue. The tumor cells are of different sizes and are solid, surrounded by connective tissue and tubular papillary structure. It consists of adenoid, tubular or cystic, lining with cubic or flat epithelioid cells, uniform cell size, vacuolar nucleus, visible 1-2 nucleoli, abundant cytoplasm, clear cell contour, and tumor can also be fissure Shaped or formed into sacs of different sizes, lined with flat epithelial cells, papillary protrusions sometimes appear in these fissures, similar to papillary adenocarcinoma, and in some cases, tumor cells are arranged in solid, strip-like or nested, There is no adenoid or papillary structure, but sometimes there may be mucus material around the tumor tissue, forming a structure similar to a mucus lake. The cell morphology is relatively uniform, the size of the nucleus is different, and vacuoles are formed in the cytoplasm, containing mucopolysaccharides. .

(3) mixed mesothelioma: also known as bidirectionally differentiated mesothelioma, with the same tumor with fiber and epithelial components, Zllzllki (1980) reported 210 cases of diffuse malignant mesothelioma, epithelioid 67%, mixed 26%, fibrosis 7%, the latter most commonly within the localized mesothelioma, mixed mesothelioma tissue consists of epithelioid cells and sarcomatoid components, similar to synovial sarcoma The sarcomatoid component consists of spindle cells, which often have a transitional form with the epithelial component. It can be shown that mesothelioma is derived from a single cell, which is common in asbestos-associated mesothelioma, mucus staining. It is helpful for the identification of adenocarcinoma and mesothelioma, but mucin staining can also be negative when adenocarcinoma is low, and Alcianblue staining of mesothelioma tumor cells can also be positive, and such mucus can also be seen outside the cell. In the interstitial, reticular fiber staining shows that there are abundant reticular fibers between the tumor cells, which is helpful for distinguishing from adenocarcinoma. When asbestos body is found in the tumor, it is helpful for the diagnosis of mesothelioma, especially the pleura. Mesothelioma due to asbestos and Relationship also occurs adenocarcinoma, it is found that asbestos bodies only reference value.

4. Peritoneal mesothelioma ultrastructure

Electron microscopy, especially TEM, is of great value in the diagnosis of mesothelioma. Its ultrastructural features are: mesothelioma tumor cells have numerous, slender, brush-like microvilli appearing in tumor cells. The surface, but can also appear in the cytoplasm, but in the microvilli of adenocarcinoma, the number is small, short rod, mesothelioma cells have huge nuclei, prominent nucleoli, moderate amount of mitochondria are in the rough surface The texture network is surrounded by common glycogen particles, bundled tension fibrils and intracellular vacuoles. The smooth endoplasmic reticulum is not well developed, and there are substrates outside the cells, but most of them are not complete, and there are connections between cells. Desmosomes, these ultrastructural features, mainly found in epithelial cell mesothelioma or mixed mesothelioma, while fibrous mesothelioma, ultrastructure resembles fibroblasts, abundant in fusiform tumor cells The rough endoplasmic reticulum, occasionally tiny interstitial spaces between cells and microvilli.

5. Peritoneal mesothelioma immunohistochemistry

Immunohistochemistry is helpful in the identification of mesothelioma and adenocarcinoma. Cytokeratin is positive in mesothelioma, while CEA is negative or weakly positive; adenocarcinoma CEA is strongly positive, and keratin Often focally positive or negative, but for various reasons, the literature has different results for the identification of mesothelioma and adenocarcinoma in immunohistochemistry. Therefore, it is not possible to make a final conclusion based on this and must be comprehensive. Other techniques make an objective diagnosis, some mesothelioma patients, with metabolic disorders, such as hypoglycemia, occasionally, localized peritoneal mesothelioma can be polycystic, lined with a single layer of cubic or Flat epithelium with a clear liquid inside the capsule.

Electron microscopy and enzymogenization of mesothelioma cells: mesothelioma mainly consists of epithelioid cells (EC), fibroblast-like cells (FLC), intermediate cells (interim cells, IC) and The primary mesenchymal cell (PMC) is composed of four kinds of cells. The EC is characterized by abundant microvilli. The cell surface has slender microvilli, and its ratio of long diameter to width is 10:1 to 15:1. This is far greater than the proportion of other adenocarcinomas. Several tumor cells surround the sinusoidal sinus. There are many slender microvilli interlaced in them. There are more rough-type endoplasmic reticulum in FLC, EC dehydrogenase and The oxidase activity is higher, and the hydrolase activity is lower. The enzymatic activity of FLC cells is opposite to that of EC, which may be related to the different functional activities of the two types of cells.

It can be seen from the table that mesothelioma has different expressions of various immunohistochemical reactions, and its positive expression and negative result are not 100%, so for some abdominal tumors, especially ovarian serous papillary glands The ductal structure of cancer and epithelial mesothelioma is difficult to distinguish. The former has only 2% expression of carcinoembryonic antigen, but has a higher expression percentage of epithelial membrane antigen and human milk globulin. Immunohistochemical staining is difficult to distinguish between the two. The recent application of Ber-Ep4 antibody can identify malignant mesothelioma and adenocarcinoma. The positive expression rate of Ber-Ep4 in abdominal and retroperitoneal adenocarcinoma and peritoneal metastatic adenocarcinoma 100%, and only 115 cases of mesothelioma in 115 cases (0.87%), therefore, using immunohistochemical staining comprehensive analysis, can make a correct pathological diagnosis of mesothelioma, if conditions are subject to electron microscopy more perfect.

Peritoneal mesothelioma prevention

Peritoneal mesothelioma originates from the epithelial and mesothelium of the peritoneum. Asbestos dust is a pathogenic substance. Some viruses may also cause mesothelioma. Active prevention of occupational diseases (such as textiles and construction) is the key to preventing this disease. In response to the cause, strengthen protection, improve the working environment, and prevent the occurrence of the disease from the source.

Peritoneal mesothelioma complications Complications, ascites, hypoglycemia

Pleural mesothelioma, digestive tract dysfunction, ascites, spontaneous hypoglycemia, advanced patients may experience systemic symptoms such as fatigue and weight loss, some large abdominal masses and large amounts of ascites may have compression symptoms, such as breathing difficulties or difficulties, lower limbs Symptoms such as edema and poor urination.

Peritoneal mesothelioma symptoms Common symptoms Diffuse abdominal ossification diarrhea nausea fatigue abdominal distension abdominal muscles peritoneal fibrosis abdominal pain constipation

Peritoneal mesothelioma can occur between 2 and 92 years old. The average age of diagnosis is 54 years old, and about 63% of cases are between 45 and 64 years old. Children are rare, and there is no early peritoneal mesothelioma. Obvious symptoms, only the tumor grows to a certain size and affects the stomach, intestinal and other abdominal organs begin to appear clinical symptoms, mainly manifested as abdominal pain, abdominal distension, ascites, abdominal mass, gastrointestinal symptoms and systemic changes.

Abdominal pain

Abdominal pain is the most common symptom of peritoneal mesothelioma. It is characterized by persistent dull pain, pain, paroxysmal cramps or sudden severe pain. The pain is often located in the upper abdomen and upper right abdomen, and abdominal pain is also caused in the lower abdomen. Clinically misdiagnosed as ectopic pregnancy or pelvic tumor, abdominal pain and wall peritoneal invasion, tumor and gastrointestinal tract and pelvic adhesions caused by intestinal obstruction, organ torsion and a large amount of ascites, abdominal masses have a mass effect and other factors Related to, the nature and location of abdominal pain can change during the course of the disease.

2. Bloating

Due to ascites, intra-abdominal masses and secondary dyspepsia, intestinal obstruction and other factors, patients may have varying degrees of bloating, severe symptoms may affect eating, and even breathing difficulties.

3. Ascites

About 90% of patients with peritoneal mesothelioma have ascites, and a considerable part of patients have rapid ascites. The ascites can be yellow exudate or bloody viscous fluid, which is related to the active secretion of hyaluronic acid by tumor cells.

4. Abdominal mass

It is one of the common clinical manifestations of peritoneal mesothelioma. Some patients are treated for abdominal mass. The abdominal mass of peritoneal mesothelioma can be single or multiple, the texture is hard or hard, and the surface is knotted. Knot-like, located in the greater omentum, the mass of the mesenteric serosal surface can be moved during physical examination, the abdominal mass can be tender, and the mass located in the pelvic cavity can be found by rectal examination or triad diagnosis, and patients with a large amount of ascites After the ascites is pumped, the abdominal mass can be more clearly understood. The detailed physical examination can initially understand that the abdominal mass is located outside the abdominal wall and outside the organs, so as to provide clinical information for the clinic.

5. Other

A small number of patients may also have loss of appetite, nausea, vomiting, diarrhea or constipation, urinary tract irritation, menstrual changes and fatigue, fever, weight loss, anemia, individual patients with hypoglycemia, diffuse abdominal ossification and other clinical manifestations, when patients merge When other parts of mesothelioma or peritoneal mesothelioma metastasize to other organs or complications occur, the corresponding clinical manifestations may occur.

Examination of peritoneal mesothelioma

Laboratory inspection

Hematological examination

Patients with peritoneal mesothelioma may have thrombocytosis, hypoglycemia, increased fibrin degradation products and high immunoglobulinemia. About 25% of patients with peritoneal mesothelioma have elevated CA125, Duan et al believe that part of the mesothelium Cell-derived tumors have the ability to secrete CA125. If the patient has intrahepatic metastasis of peritoneal mesothelioma and the liver can reduce the clearance of CA125 caused by chronic liver disease, the blood CA125 level can be significantly increased, but the increase of CA125 is more common in ovarian cancer. Can also be found in pancreatic cancer, gastric cancer, colon cancer and breast cancer, so the determination of blood CA125 for the differential diagnosis of peritoneal mesothelioma is of little significance.

2. Ascites examination

The ascites of peritoneal mesothelioma may be bloody or yellow exudate. Since mesothelioma cells have an active function of secreting hyaluronic acid, the concentration of hyaluronic acid in the serosal exudate may reach 0.2-0.8 g/L ( Turbidity test), although the concentration of hyaluronic acid in the serous effusion caused by infection, metastatic tumor and heart failure can also be increased, but more than 0.8g/L is only seen in malignant mesothelioma, therefore, hyaluronic acid in ascites Determination of acid content has a reference value for the diagnosis of peritoneal mesothelioma. Because of the lack of carcinoembryonic antigen (CEA) in mesothelioma tissue, such as CEA content in ascites is higher than 10 ~ 15g / L, the diagnosis of malignant mesothelioma is excluded. In a certain sense, in addition, it has been found that the level of acid mucopolysaccharide in the ascites of patients with mesothelioma is increased, and the anti-mesothelioma cell serum can be used to detect the corresponding antigen from the serosal exudate. In addition, human chorionic gonadotropin in ascites Increased levels of (HCG) and normal plasma HCG levels can help distinguish between benign and malignant grades of peritoneal mesothelioma. The presence of collagen in ascites can help distinguish lesions from mesothelioma or metastatic adenocarcinoma.

Ascites exfoliation cytology has certain clinical application value. Domestic and foreign literature reports that typical mesothelioma cells cannot be found in ascites of patients with peritoneal mesothelioma. If a large number of atypical or atypical mesothelial cells or tumor cells are found in ascites. By analyzing and measuring the nuclear area, cytoplasmic area and nucleoplasmic ratio and other parameters, combined with electron microscopy and immunohistochemistry to identify with proliferative mesothelial cells and metastatic adenocarcinoma, sarcoma.

Film degree exam

Gastrointestinal contrast

Gastrointestinal angiography mainly has the following manifestations:

(1) The intestinal varicose pressure changes, the intestinal fistula is distorted, the spacing is widened, and the shape is not complete.

(2) Abnormal distribution of intestinal curvature, which is crowded around the periphery of the tumor.

(3) If the tumor is severely severe, causing intestinal stenosis, it may be manifested as incomplete intestinal obstruction.

(4) In the late stage, the intestinal tract can be adhered and fixed, while the mucosal folds are intact. The above expressions are non-specific and can only indirectly suggest the disease.

2. Abdominal ultrasound

Because peritoneal mesothelioma is often accompanied by ascites, the production of ascites provides good acoustic conditions for ultrasound observation of the peritoneum. The location of ascites and its morphology, size and echo, and the common ultrasound of peritoneal mesothelioma can be clearly observed during ascites. The image has the following characteristics:

(1) The peritoneum is irregularly thickened, and some of them have large substantial mass changes, and the shape is irregular, and some of them are lobulated.

(2) may be associated with ascites, retroperitoneal lymphadenopathy or metastasis of other organs.

(3) accompanied by greater omentum, thickening of the mesentery and intestinal compression caused by incomplete intestinal obstruction and intestinal adhesions.

(4) Color Doppler ultrasonography, abundant blood flow around the mass and internal cavity, ultrasound examination has a certain diagnostic value for peritoneal mesothelioma, ultrasound-guided biopsy can obtain accurate pathological diagnosis.

3.CT scan

CT scan is helpful for the diagnosis of peritoneal mesothelioma. Ascites is the most common CT manifestation of peritoneal mesothelioma. CT of early peritoneal lesions is difficult to display. When the peritoneum, omentum and mesentery are widely adhered, CT can be seen extensively. Irregular thickening of the peritoneum, involvement of the greater omentum, adhesion to form a cake-like abdominal mass, increased mesenteric density, adhesion to form a star-shaped or wrinkled paper-like mass, but CT findings are not easy with ovarian cancer, gastrointestinal tumor metastasis and Identification of chronic infection of the abdominal cavity, regular CT examination is very useful for observing the progression and efficacy of the lesion.

Other imaging examinations such as celiac angiography, MRI, etc., can also be used for the diagnosis of peritoneal mesothelioma, but because of its traumatic or expensive, it is not commonly used in clinical practice.

4. Laparoscopy

Laparoscopy is a simple and effective method for the diagnosis of malignant peritoneal mesothelioma. Microscopically, the peritoneal wall and visceral layer, diffuse distribution of nodules, plaques, masses, and hepatic fibrous sacs (Glisson's capsule) There may also be nodules, but the liver parenchyma is not invaded; under the microscope without metastatic liver cancer or abdominal cavity, evidence of other organ tumors in the pelvis, microscopically in the parietal and visceral peritoneum, omental lesions and A biopsy is taken at multiple junctions between the lesion and the normal tissue. A larger biopsy forceps can be used to obtain a satisfactory tissue for pathological examination. Laparoscopy can also exclude tumors and diseases of the abdominal cavity or other organs in the pelvic cavity. No microscopic examination occurs. Complications, but for a large number of ascites, extensive intra-abdominal lesions, and adhesion to organs are obvious, laparoscopic examination is limited.

B-ultrasound and CT examination, you can find flaky tumor image and ascites, ascites is exudate, can also be bloody, ascites in the ascites, such as increased to 120ug / ml, is helpful for diagnosis, find new in the ascites Biological mesothelioma cells have diagnostic value, and can also analyze the chromosomes of ascites mesothelial cells, which is helpful for diagnosis. Laparoscopy can be seen on the peritoneal surface with nodules and plaques. Biopsy pathological examination can confirm the diagnosis.

Diagnosis and diagnosis of peritoneal mesothelioma

Diagnosis based on clinical symptoms and findings.

Differential diagnosis

Peritoneal mesothelioma should be differentiated from tuberculous peritonitis, intra-abdominal metastatic tumors, and other tumors that originate in the peritoneum and omentum.

Tuberculous peritonitis

Cases of malignant peritoneal mesothelioma misdiagnosed as tuberculous peritonitis and treated with anti-tuberculosis have been reported repeatedly. Later, due to the ineffective treatment of anti-tuberculosis, laparotomy was confirmed. In general, tuberculous peritonitis is mostly young and middle-aged. Abdominal pain, abdominal distension, ascites and abdominal mass, fever is one of the common clinical manifestations, PPD positive, erythrocyte sedimentation rate (ESR, ESR) increased, support the diagnosis of tuberculous peritonitis, tuberculous peritonitis ascites Exudates are more, mononuclear cells, ascites PCR and smear. If the tuberculosis is found to be useful for differential diagnosis, the activity of adenine deaminase (ADA) in ascites may be increased. Peritonitis, determination of ascites lactate dehydrogenase (LDH) for the identification of a certain difference, the ratio of LDH value in ascites and serum is greater than 1 suggestive of malignant ascites, clinically highly suspected cases of tuberculous peritonitis can be strictly observed down the formal Anti-tuberculosis treatment, anti-tuberculosis treatment is not effective or the diagnosis of both is difficult, you should strive to do laparoscopy or hand as soon as possible Probe, found pathological caseous granuloma, peritoneal mesothelioma and is easy to identify.

2. Peritoneal metastatic tumor

Peritoneal metastatic tumors are often derived from gastric cancer, ovarian cancer, pancreatic cancer, liver cancer and colon cancer. Among them, peritoneal pseudomyxoma is often caused by rupture of ovarian mucinous cystadenoma and peritoneal implantation (also caused by rupture of appendix or pancreatic cyst). It is characterized by swelling, ascites, intra-abdominal mass, and its ascites is jelly-like mucus. When the clinical manifestations of primary cancer are concealed, the peritoneal metastatic tumor is difficult to distinguish from peritoneal mesothelioma. Ascites cytology can be improved if the method is proper. Positive rate and less false positives, such as ascites to find cancer cells, peritoneal metastasis can be diagnosed, and by means of digestive endoscopy, gastrointestinal angiography, abdominal pelvic ultrasound and CT, scanning, blood AFP and other related tumors, detection of carbohydrate antigens, and even Laparoscopy to carefully search for the primary tumor, sometimes, even if the above examination did not find the primary tumor, clinically can not completely exclude the abdomen, pelvic lesions for metastatic tumors, in the pathological examination, should pay attention to Skin tumors are distinguished from metastatic adenocarcinoma and ovarian-derived epithelial tumors. Immunohistochemistry should be performed when identification is difficult. Even electron microscopy.

3. Other malignant tumors originating from the peritoneum

Peritoneal serous borderline tumor, also known as atypical fallopian tube endometriosis, primary papillary peritoneal tumor and low-grade malignant peritoneal serous papilloma, is a rare primary lesion in the peritoneum, often Occurs in women, can be affected at any age, most patients under 40 years old, the main symptoms are abdominal or pelvic pain, chronic pelvic inflammatory symptoms, and even intestinal adhesions or amenorrhea, pathologically can be differentiated from peritoneal mesothelioma Diagnosis, the disease has a good prognosis.

Other tumors originating from the peritoneum include adenocarcinoma, fibrosarcoma, and liposarcoma. It is very rare, and it is difficult to distinguish it from peritoneal mesothelioma in clinical practice. Most of them are found at autopsy.

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