Diffuse abdominal ossification
Introduction
Introduction Peritoneal mesothelioma refers to a tumor that originates in the peritoneal mesothelial cells. Clinical manifestations are not characteristic, common symptoms and signs are: abdominal pain, ascites, abdominal distension, abdominal mass, anorexia, nausea, vomiting, diarrhea, constipation, fatigue, fever, weight loss, anemia, hypoglycemia and diffuse abdominal ossification Etiology; peritoneal mesothelioma accounts for about 20% of all mesothelioma cases, can occur in 2-92 years, the average age is 54 years, of which about 63% of cases are between 45-64 years old, children are rare .
Cause
Cause
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 the occurrence of mesothelioma was closely related to asbestos exposure. The incidence of shipyard workers, plumbers, welders, paints and construction workers is 300 times higher than that of the average person. The close relationship between mesothelioma and asbestos contact has been confirmed and recognized by more and more facts. At the same time, European and American scholars found that about 60% of patients with peritoneal mesothelioma 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. Peritoneal mesothelioma indicates that the occurrence of peritoneal mesothelioma is also related to asbestos exposure.
The risk of different types of asbestos fibers is: asbestos > iron asbestos > chrysotile. It is generally believed that asbestos dust having a diameter of 0.5 to 50 m first enters the respiratory tract, and then enters the abdominal cavity through the transverse lymphatic tissue network or blood and deposits in the peritoneum to form an asbestos body, and sometimes a foreign body giant cell reaction may occur around the asbestos body. Asbestos fibers ingested through the digestive tract can also reach the peritoneum through the intestinal wall. From exposure to asbestos to the discovery of mesothelioma on average 35 to 40 years, the peak incidence after 45 years of exposure. The exact mechanism by which asbestos causes mesothelioma is still unclear. However, about 30% of patients with mesothelioma did not have a history of asbestos exposure, and asbestos fiber quantitative examination did not find exposure to large amounts of asbestos fibers. Other factors associated with the development of mesothelioma in the literature are radiation therapy, history of exposure to cerium oxide (usually patients have a history of relevant diagnostic tests). In addition, patients with a history of Hodgkin have an increased risk of mesothelioma.
Viral infection: Simian virus 40 (SV40), 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 telomerase activity in human primary mesothelioma cells, but does not affect fibroblasts. Telomerase activity was measured 72 h after infection with wild-type SV40, and a clear DNA ladder was observed after 1 week. The telomerase activity in the cell structure is directly proportional to the number of SV40 T antigens. The telomerase activity of mesothelial cells infected with SV40 increases, making mesothelial cells less susceptible to apoptosis and prone to mesothelioma.
Mesothelioma may also be associated with fluorite exposure, tuberculous scarring, chronic inflammatory irritation, radioactive material, genetic susceptibility, and the like.
Examine
an examination
Related inspection
Abdominal plain film abdominal perspective abdominal abdomen abdominal auscultation abdominal CT
Clinical manifestations:
1. Abdominal pain, bloating, ascites, abdominal mass.
2. Anorexia, nausea, vomiting, diarrhea, constipation.
3. fatigue, fever, weight loss, anemia.
4. Hypoglycemia, diffuse abdominal ossification; 5. Combined with other sites of mesothelioma such as peritoneal mesothelioma, metastasis of other organs and comorbidities.
Diagnose based on:
1. Patients with abdominal pain, bloating, ascites, and abdominal masses, especially with a history of asbestos exposure.
2. Imaging examination of the peritoneum with flaky tumor signs and ascites.
3. Ascites exfoliation cytology.
4. Peritoneal biopsy, laparoscopic and laparotomy and tissue for pathological examination can confirm the diagnosis.
Diagnosis
Differential diagnosis
Peritoneal mesothelioma should be differentiated from tuberculous peritonitis, intraperitoneal metastatic tumors, and other tumors that originate in the peritoneum and omentum.
1. Tuberculous peritonitis: cases of malignant peritoneal mesothelioma misdiagnosed as tuberculous peritonitis and anti-tuberculosis treatment have been reported repeatedly, and the laparotomy was confirmed because of anti-tuberculosis treatment. In general, tuberculous peritonitis is mostly young and middle-aged. In addition to abdominal pain, abdominal distension, ascites and abdominal mass, fever is one of the common clinical manifestations. PPD positive, erythrocyte sedimentation rate (ESR, ESR) increased, supporting the diagnosis of tuberculous peritonitis. The ascites of tuberculous peritonitis is mainly exudate, mononuclear cells, ascites PCR, smear, culture, and tubercle bacilli are found to be useful for differential diagnosis. The activity of adenosine deaminase (ADA) in ascites is increased, which may be tuberculous peritonitis. Determination of ascites lactate dehydrogenase (LDH) is helpful for the identification. The ratio of LDH in ascites to serum is greater than 1 suggestive of malignant ascites. Clinically, cases of highly suspected tuberculous peritonitis can be observed under strict observation. treatment. When the anti-tuberculosis treatment is ineffective or the two are difficult to diagnose, it is necessary to seek laparoscopic or surgical exploration as soon as possible. Pathologically, caseous granuloma is easy to distinguish from peritoneal mesothelioma.
2. Peritoneal metastatic tumors: Peritoneal metastatic tumors are often derived from gastric cancer, ovarian cancer, pancreatic cancer, liver cancer, and colon cancer. Peritoneal pseudomyxoma is often caused by rupture of ovarian mucinous cystadenoma and peritoneal implantation (also caused by rupture of appendix or pancreatic cyst), which is characterized by swelling, ascites, and intra-abdominal mass, and the ascites is jelly-like mucus. When the clinical manifestations of primary cancer are concealed, peritoneal metastatic tumors are difficult to distinguish from peritoneal mesothelioma. Ascites cytology can improve the positive rate and false positives if the method is appropriate, 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, scan, blood AFP and Other related tumor glycoantigens are detected, even laparoscopically to look for the primary tumor carefully. Sometimes, even if the above-mentioned examination does not find a primary tumor, it is clinically impossible to completely rule out the possibility that the abdominal and pelvic lesions are metastatic tumors. In pathological examination, mesothelioma and metastatic adenocarcinoma and ovarian origin should be noted. Epithelial tumors are distinguished. When there is difficulty in identification, immunohistochemistry or even electron microscopy should be performed.
3. Other: primary peritoneal malignant tumor peritoneal serous borderline tumor, also known as atypical fallopian tube endometriosis, primary papillary peritoneal tumor and low-grade malignant peritoneal serous papilloma, is a A rare lesion of the primary peritoneum. Often occurring in women, can be affected at any age, most patients under the age of 40, the main symptoms are abdominal or pelvic pain, chronic pelvic inflammatory symptoms, and even intestinal adhesions or amenorrhea. Pathologically, it can be differentiated from peritoneal mesothelioma. The prognosis of this disease is good.
Other tumors originating from the peritoneum are adenocarcinoma, fibrosarcoma, liposarcoma, etc., which are very rare. It is clinically difficult to distinguish it from peritoneal mesothelioma, mostly at autopsy.
