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Abstract：
BACKGROUND Malignant peritoneal mesothelioma (MPM) is a rare, lethal tumor of serous membranes. The most common factor reported in association with MPM is asbestos exposure, while viral infections, genetic predisposition, paraneoplastic syndrome, and altered immunity have been described as well. The diagnosis can be challenging among those with lower tumor burden as well as nonspecific symptoms, and it is not unusual to discover the diagnosis incidentally. CASE REPORT A middle-aged woman with decompensated cirrhosis underwent extensive pre-transplant workup, showing no evidence of malignancy. She had a personal history of asbestos exposure and family history of MPM in the extended family. During transplant surgery, a few peritoneal nodules were noted, leading to termination of the procedure. Pathological analysis confirmed malignant MPM. A multidisciplinary discussion led to following a conservative treatment approach without any intervention, due to higher risk of worsening hepatic decompensation associated with peritonectomy and intraperitoneal chemotherapy. The patient\'s hepatic decompensation resolved 6 months after the aborted liver transplant operation. Since the diagnosis of MPM, positron emission tomography scans have shown no recurrence of MPM for 3 consecutive years. CONCLUSIONS This is the first case of MPM diagnosed incidentally during a liver transplantation surgery. This case highlights the challenges in the diagnosis and management of MPM in a patient with decompensated liver disease. A multidisciplinary approach and following a consensus decision led to prolonged survival in the described patient.
摘要：
背景技术恶性腹膜间皮瘤(MPM)是一种罕见的,浆液性膜的致死性肿瘤。据报道，与MPM相关的最常见因素是石棉暴露，而病毒感染，遗传易感性,副肿瘤综合征,和改变的免疫力也有描述。在肿瘤负担较低以及非特异性症状的患者中，诊断可能具有挑战性。偶然发现诊断并不罕见。病例报告一名患有失代偿期肝硬化的中年女性接受了广泛的移植前检查，没有显示恶性肿瘤的证据.她有石棉暴露的个人病史和大家庭中的MPM家族史。在移植手术中,注意到一些腹膜结节，导致程序终止。病理分析证实为恶性MPM。多学科的讨论导致遵循保守的治疗方法，没有任何干预，由于与腹膜炎切除术和腹膜内化疗相关的肝功能失代偿恶化的风险较高。患者的肝功能失代偿在肝移植手术中止后6个月得到解决。由于MPM的诊断，正电子发射断层扫描显示MPM连续3年没有复发。结论这是在肝移植手术中偶然诊断出的第一例MPM。此病例突出了失代偿性肝病患者MPM的诊断和管理方面的挑战。多学科方法并遵循共识决定导致所述患者的生存期延长。
