Table 1 Laboratory findings on admission Figure 2. Clinical course after admission 1-a 1-b 1-c 3-a 3-b 3-c Figure 1. CT findings on first admission: S

FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF Vol. 32, pp. 105 110, 2004 FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF 1 1 1 1 1 1 1 1 2 2 1 1 16 4 13 72 CRP CA125 IAP CT 1 cm 4 cm 5 cm 11 1 600 10 1 1 2 72 45 20 / 50 10 11 38 CRP 47

Table 1 Laboratory findings on admission Figure 2. Clinical course after admission 1-a 1-b 1-c 3-a 3-b 3-c Figure 1. CT findings on first admission: Scarcely enhancing tumors were found in the left lobe of the liver, 4cm in diameter, and in the spleen, 5cm in diameter (1-a, 1-b). An enhancing tumor, 1cm in diameter, was found in the right kidney (1-c). 11 19 143 cm 45 kg 128/67 mmhg 74 / 36.5 5 cm Table 1 ALP-GTP CRP 26.2 mg/dl 15200 ng/ml CA125 IAP immunosuppressive acidic protein Figure 3. Histological findings of biopsied specimen: a: HE staining (10X). Mesothelial cells were aligned and formed ductal structure b: Carletinine staining (40X). Tumor cells were positive for carletinine. c: HE staining of right renal tumor (20X). Clear-cell type renal cell carcinoma was found. CT 4 cm 5 cm 1 cm Figure 1 CT Figure 2 48

4-a 4-b Figure 4. CT findings on second admission. Tumor on the left-lobe of liver was 5cm in diameter and tumor in the splenic flexure was 8cm in diameter (4-a, 4-b). 10 12 25 Figure 3 HE Figure 3-a Figure 3-b CA125 epithelial type Figure 2 CA125 11 8 9 2 CT 10 cm Figure 4 10 25 48 cm 32 cm Figure 5. Macroscopic findings at autopsy: Abdominal cavity was occupied by a large tumor mainly located in the splenic flexure. Figure 5 1 cm clear cell type Figure 3-c 0.2 % 35 % 1) 600 2, 3) 90 % 2) 38 1 cm 49

Table 2 Comparison of Long-survival and Short-survival Patients Age Sex Metastasis Localized Epithelioid Operation (mean SD) (M:F) at the time of or or diagnosis diffuse non-epithelioid (R: P: N)* (pos:neg) Long survival (n=33) 53.5 14.5 20 : 13 24 : 8 2 : 31 18 : 7 1 : 5 : 27 Short survival (n=85) 51.5 17.0 47 : 38 59 : 21 10 : 75 36 : 37 9 : 5 : 71 P 0.54+ 0.60++ 0.89++ 0.35++ 0.049++ 0.824** ++ Long-survival: survival for equal or more than one year, Short-survival: survival for less than one year * R: resection, P: partial resection, N: not operated, ** Operatesd vs. non-operated + analyzed by unpaired t-test, ++ analyzed by chi-square test p<0.05 was regarded as significant. 5 % 3) 2 1 1 4) 0.3 % 0.5 % 5) 2, 6) ferric nitrilotriacetate Fe-NTA 7) 2 1 1 8) 118 1 33 1 85 Table 2 1 50

1) Moertel CG. Peritoneal mesothelioma. Gastroenterology 1972; 63: 346-350. 2), : 100. 30: 1984, 1-10 3),,, : 1. 54: 1993, 1659-1663 4),,, : 1. 38: 1992, 937-940 5) Suzuki Y. Pathology of human malignant mesothelioma-preliminary analysis of 1,517 mesothelioma cases. Industrial Health 2001; 39: 183-5. 6) McLaughlin JK, Lipworth L. Epidemiologic aspects of renal cell cancer. Semin Oncol 2000; 27: 115-123. 7) Nishiyama Y, Suwa H, Okamoto K, Fukumoto M, Hiai H, Toyokuni S. Low incidence of point mutations in H-, K- and N-ras oncogenes and p53 tumor suppressor gene in renal cell carcinoma and peritoneal mesothelioma of Wistar rats induced by ferric nitrilotriacetate. Jpn J Cancer Res.1995; 86: 1150-8. 8),,, : 1. 40: 1994, 439-444. 51

Abstract A Case of Peritoneal Mesothelioma with Renal Cell Carcinoma Mitsuya Mugikura 1, Hiroshi Yotsuyanagi 1, Tatsuro Osada 1, Mayu Orita 1, Noriaki Okuse 1, Takeshi Hayashi 1, Michihiro Suzuki 1, Hiroki Nakazawa 2, Masayuki Takagi 2, Shiro Iino 1 and Fumio Itoh 1 A 72-year-old female was admitted complaining of appetite loss and fever. Physical examination on admission revealed a tumor in the left lateral abdomen. Blood examination showed elevated levels of CA125, IAP and hyalulonic acid in addition to anemia, liver dysfunction and CRP elevation. Abdominal CT disclosed an enhancing tumor, 1cm in diameter, in the right kidney. Scarcely enhancing tumors were disclosed in the left lobe of the liver, 4cm in diameter and in the spleen, 5cm in diameter. Explorative laparotomy revealed peritoneal malignant mesothelioma and renal cell carcinoma. She received palliative treatment alone and was dead 11 months after diagnosis. She was the second reported case in Japan who suffered both peritoneal malignant mesothelioma and renal cell carcinoma. 1 Department of Internal Medicine, Division of Gastroenterology and Hepatology 2 Department of Pathology St. Marianna University 52