@article {Gravito-Soaresbcr-2017-222565, author = {Marta Gravito-Soares and Elisa Gravito-Soares and Jo{\~a}o Almeida and Jo{\~a}o Fraga and Luis Tom{\'e}}, title = {Challenging and uncommon diagnosis of long-evolution ascites}, volume = {2017}, elocation-id = {bcr-2017-222565}, year = {2017}, doi = {10.1136/bcr-2017-222565}, publisher = {BMJ Publishing Group}, abstract = {This is a case report of a 45-year-old Caucasian man with chronic alcoholism. No history of liver disease or asbestos exposure. He complained of ascites during the last 3 years with worsening in the last year with severe ascites development. Diagnostic paracentesis showed SAAG 1.1 and high cellularity with neutrophil count \>250 cells/{\textmu}L. Ascitic fluid cytology revealed reactive mesothelial hyperplasia. Thoracoabdominopelvic ultrasonography/CT/MRI and fludeoxyglucose positron emission tomography/CT showed {\textquoteleft}omental cake{\textquoteright} pattern suggesting peritoneal carcinomatosis. An exploratory laparoscopy revealed moderate interloop adhesions and necrosis with whitish exudate in the right pelvic excavation. Biochemical/cytological/histological/microbiological study only revealed reactive mesothelial cells, necrosis and lymphohistiocytic inflammatory infiltrate. A second exploratory laparoscopy with liver and peritoneal biopsies and appendectomy/mesoappendix excision showed a well-differentiated tubulopapillary mesothelioma. The patient was referred for intraperitoneal chemotherapy and is undergoing monthly therapeutic paracentesis.}, URL = {https://casereports.bmj.com/content/2017/bcr-2017-222565}, eprint = {https://casereports.bmj.com/content/2017/bcr-2017-222565.full.pdf}, journal = {Case Reports} }