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fa b ric !C?7<f PERITONEAL MESOTHELIOMA AND ASBESTOSIS A CASE REPORT Liberato G. Cabotaje, MD Robert C. Burt, MD Division of Clinical Pathology William H. Singer Memorial Research Institute Malignant tumors arising from the mesothelial cells lining the peritoneum are uncommon. Winslow and Taylor in 1960 found only 13 cases of malignant peritoneal mesothelioma reported in the medical literature from 1908 to 1957 and described 12 additional cases from the files of the Armed Forces Institute of Pathology'.7 Wagner, et al, in 1960 first observed an increased incidence of meso thelial tumors among asbestos miners in South Africa.6 Since that time, numerous other reports have linked both pleural and peritoneal mesothelioma with asbestos exposure. Moertel in 1972 reviewed the literature and reported particularly vulnerable occupations are ship yard workers, asbestos textile and brake lining manufacturing and insulation workers.3 The following is a report of a fatal case of malignant peritoneal mesothelioma associated with lung asbestosis. The patient gave a history of working in the asbestos industry. The case is presented to emphasize the possible carcinogenic relationship of asbestos exposure to malignant mesothelioma. CASE REPORT A 45-year-old male was admitted to Allegheny General Hospital on January 5, 1973 because of lower quadrant abdominal pain of a month's duration. He was previously managed as a case of acute diverticulitis, with bland diet and penicillin. The pain was recurrent with varying degrees of severity associated with loss of appetite, alternating diarrhea and constipation. The patient was an asbestos worker of unknown duration. He was not a cigarette smoker or an excessive alcohol drinker. The physical examination revealed tenderness and guarding of the left lower quadrant of the abdomen and a questionable mass in the same area. A chest x-ray and barium enema were reported normal. An exploratory laparotomy performed on January 9, 1973, re vealed induration of the lower abdominal cavity structures with 29 409677 0368 ; 4 V' ;,'\\ -V '** ?*<'r^fa^< -'c* -fir. i r\',Z,%;ri`. -<:.-?<;-, % */-. 1. Microscopic view of malignant mesothelioma of peritoneum showing papillary formation. H&E XI 50` 51 409677 0370 # * 2. Arrows indicate asbestos bodies in lung tissue. H&E X600 33 409(677 0372