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증가된 암 항원 125 때문에 결핵성 복막염으로 오인된 복막의 악성 중피종 1예

rimary Malignant Mesothelioma of the Peritoneum Mistaken for Peritoneal Tuberculosis due to Elevated Cancer Antigen 125

대한소화기학회지 2019년 74권 4호 p.232 ~ 238
오주현 ( Oh Ju-Hyun ) - 차의과대학교 구미차병원 소화기내과

오명진 ( Oh Myung-Jin ) - 차의과대학교 구미차병원 소화기내과

Abstract


Adifferential diagnosis of ascites is always challenging for physicians. Peritoneal tuberculosis is particularly difficult to distinguish from peritoneal carcinomatosis because of the similarities in clinical manifestations and laboratory results. Although the definitive diagnostic method for ascites is to take a biopsy of the involved tissues through laparoscopy or laparotomy, there are many limitations in performing biopsies in clinical practice. For this reason, physicians have attempted to find surrogate markers that can substitute for a biopsy as a confirmative diagnostic method for ascites. CA 125, which is known as a tumor marker for gynecological malignancies, has been reported to be a biochemical indicator for peritoneal tuberculosis. On the other hand, the sensitivity of serum CA 125 is low, and CA 125 may be elevated due to other benign or malignant conditions. This paper reports the case of a 66-year-old male who had a moderate amount of ascites and complained of dyspepsia and a febrile sensation. His abdominal CT scans revealed a conglomerated mass, diffuse omental infiltration, and peritoneal wall thickening. Initially, peritoneal tuberculosis was suspected due to the clinical symptoms, CT findings, and high serum CA 125 levels, but non-specific malignant cells were detected on cytology of the ascitic fluid. Finally, he was diagnosed with primary malignant peritoneal mesothelioma after undergoing a laparoscopic biopsy.

키워드

Ascites; CA-125 antigen; Mesothelioma; Peritonitis, tuberculous
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