| Summary: | A 27 year old Thai male presented with progressive abdominal distension without leg edema, low grade fever and 10 Kgs weight loss over 2 months. Physical examination revealed cachexia,a markedly distended abdomen, with a fluid thrill, but no hepatosplenomegaly. An abdominal tap produced serosanguinous fluid. Analysis of the ascitic fluid demonstrated white blood cell 300 /mm3, red blood cell 270,000 /mm3, SAAG 0.9 gm/dl, ascites protein 3 gm/dl, AFB stain no organisms seen. Cytology showed a few mesothelial cells but no malignant cells. A chest X-ray was normal. The patient underwent laparoscopy. The peritoneum was studded with whitish miliary nodules and fibrin plaques. Peritoneal biopsy revealed chronic inflammation with fibrosis, no granuloma or specific organism. Abdominal CT images demonstrated a large multiseptated cystic mass with a thick wall, occupying almost the entire abdominal cavity. Abdominal exploration demonstrated a huge intraabdominal cystic mass, with multiple discrete white nodules on the surface of the cystic wall and the liver. Histology demonstrated most of tumor cells were deeply embedded in collagenous tissue with a biphasic pattern and high mitotic figure. Immunoperoxidase staining demonstrated tumor markers as follow vimentin, cytokeratin (AE1/AE3), epithelial membrane antigen (EMA) and neurospecific enolase (NSE). The final diagnosis was biphasic malignant mesothelioma. Up to now, no standard treatment is available. Surgery for localized tumors has been reported. Other treaments, such as external radiation, intraperitoneal instillation of radioactive gold and chemotherapy have generally failed to improve overall survival. The median survival is 2 to 12 months after diagnosis with a total duration of about 1 year from the onset of symptoms.
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