A Case of Peritoneal Lymphomatosis Diagnosed by Laparoscopic Biopsy

Peritoneal lymphomatosis is an extremely rare presentation of lymphoma. We report a case of peritoneal lymphomatosis diagnosed by laparoscopic biopsy. A 56-year-old female presented to our hospital with a 2-week history of increasing abdominal distension associated with anorexia and generalized weakness. Abdominal CT findings demonstrated extensive disseminated peritoneal disease with marked thickening of the peritoneal surfaces and a large omental cake with large volume ascites. The examination of blood data and cytology of ascites indicated to the diagnosis of malignant lymphoma. She was proceeded to an urgent laparoscopic biopsy for diagnosis and observed the thickening of the peritoneal surfaces and large volume ascites. Pathological and immunohistochemical examination of the omentum revealed that it was diffuse large B-cell lymphoma presented by peritoneal lymphomatosis. The patient started an immediate course of combination chemotherapy consisting of rituximab, cyclophosphamide, doxorubicin vincristine and prednisolone(R-CHOP)and no recurrence has been noted for 5 years and 10 months from first visit. The differential diagnosis for disseminated peritoneal disease is vast. Laparoscopic biopsy was minimally invasive, and useful for an urgent and accurate the diagnosis and the treatment strategy of disseminated peritoneal disease.