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Jia J, Tan X, Gao F, Shao Z, Zhang M. Primary Intrahepatic Mesothelioma: Case Series and Systematic Review of Literature. J Gastrointest Cancer 2024:10.1007/s12029-024-01075-x. [PMID: 39141212 DOI: 10.1007/s12029-024-01075-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Primary intrahepatic mesothelioma (PIHMM) has been rarely reported. Its typical clinical presentation, radiological features and pathology have not been defined. Here, we aimed to summarize its diagnosis and treatment. METHODS We conducted a retrospective analysis of three cases of PIHMM in the First Affiliated Hospital of Zhejiang University School of Medicine and reviewed the current literature to investigate the clinical and pathological characteristics and prognosis of PIHMM. RESULTS Based on our case series and the literature, the mean age of PIHMM was 59.7 (41-83) years. Most patients present with nonspecific symptoms such as abdominal pain, fever, weight loss and weakness. On imaging, PIHMM usually presented as a solid, heterogeneous soft tissue mass with irregular margins and significant enhancement of the margins in the arterial phase. Immunohistochemical markers such as calretinin, cytokeratin (CK)5/6, D2-40, WT-1, mesothelin CK and vimentin may be useful for diagnosis. The 3-year relapse-free survival rate (RFS) was 51.85%, the 3-year overall survival (OS) rate was 83.33% and the 3-year postoperative overall survival rate was 100%. CONCLUSION PIHMM can only be diagnosed by careful postoperative pathology, because of its nonspecific clinical presentations, serological indicators or imaging features. Immunohistochemical staining is very useful to distinguish this tumor from other liver tumors. Surgery is the mainstay of treatment.
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Affiliation(s)
- Junjun Jia
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China
| | - Xinyue Tan
- College of Pediatrics, Capital Medical University, 100045, Beijing, China
| | - Feng Gao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China
| | - Zhou Shao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China
| | - Min Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang Province, China.
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Mehta K, Mehta S, Joshi M, Bharadwaj HR, Ardeshana G, Tenkorang PO. Challenging diagnosis of sarcomatoid hepatic mesothelioma: a case report with review of literature. Ann Med Surg (Lond) 2023; 85:5123-5126. [PMID: 37811036 PMCID: PMC10552978 DOI: 10.1097/ms9.0000000000001148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Mesothelioma is a rare and aggressive cancer that is primarily caused by asbestos exposure. However, cases of mesothelioma without asbestos exposure suggest the involvement of other risk factors. Sarcomatoid mesothelioma, which is characterized by spindle-shaped cells, is a particularly aggressive subtype with limited treatment options. Case presentation The authors present a case of a 72-year-old man with no history of asbestos exposure who presented with abdominal pain, fatigue, and weight loss. Imaging revealed a large cystic mass in the liver. A Liver biopsy confirmed the diagnosis of sarcomatoid mesothelioma. Immunohistochemistry results further supported this diagnosis. Due to the advanced stage and tumor size, surgical resection was not feasible. Palliative chemotherapy was initiated, but the patient's condition deteriorated rapidly, leading to his demise. Conclusion This case highlights the complexity of mesothelioma and the need for further research to identify the nonasbestos-related risk factors. Understanding alternative causative agents and mechanisms is crucial for the early detection, the development of targeted therapies, and improving patient outcomes. The presented case contributes to the existing literature and aligns with the Surgical CAse REport (SCARE) Criteria.
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Affiliation(s)
- Kahan Mehta
- Department of Internal Medicine, GMERS Medical College and Hospital, Vadodara
| | - Samir Mehta
- General Medicine, B.J. Medical College, Ahmedabad
| | - Maurya Joshi
- Department of Internal Medicine, GMERS Medical College and Hospital, Vadodara
| | | | | | - Pearl O. Tenkorang
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
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Localized biphasic malignant mesothelioma presenting as a giant pelvic wall mass: a rare case report and literature review. BMC Med Imaging 2020; 20:48. [PMID: 32375654 PMCID: PMC7203907 DOI: 10.1186/s12880-020-00443-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/15/2020] [Indexed: 11/28/2022] Open
Abstract
Background Localized biphasic MPeM is rare in clinical practice, we reviewed 8 cases of localized biphasic MPeM (including our present case), and summarized the clinical and imaging features of the disease. Case presentation We reported a 79-year-old man with chief complaint of a narrowing in the caliber of the stool for one year. A soft tissue shadow was occasionally found by CT examination in the right pelvic wall, and it was diagnosed as localized biphasic malignant peritoneal mesothelioma (MPeM) by postoperative pathology. Radical excision was performed and no radio-chemotherapy was applied. Nearly six years after surgery, the mass was significantly enlarged, and the neighboring tissues including rectum, prostate, seminal vesicle, and right ischial ramus were all infiltrated. The patient was in the end stage of cancer with poor prognosis. Conclusions The localized biphasic MPeM may show following characteristics: (1) with heterogeneous low-density and obscure margin; (2) with low incidence rate of ascites; (3) with few central hemorrhage and necrosis; (4) with few calcified structures; (5) with mild to moderate heterogeneous delayed enhancement on contrast-enhanced CT. The imaging characteristics can provide further information for the diagnosis of localized biphasic MPeM in the future.
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Huang JW, Li ZH, Wang Z, Yang MQ, Xu HT. Primary malignant mesothelioma of the diaphragm with liver invasion: A case report and review of literature. Medicine (Baltimore) 2019; 98:e15147. [PMID: 30985689 PMCID: PMC6485870 DOI: 10.1097/md.0000000000015147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RATIONALE Malignant mesothelioma is a malignant tumor with poor prognosis, which usually originates in the pleura, peritoneum, and pericardial cavity. Mesotheliomas that originate from the diaphragm are very rare. Here, we report a case of primary malignant mesothelioma of the diaphragm with liver invasion. PATIENT CONCERNS A 66-year-old woman was admitted to our hospital because of a "liver space-occupying lesion," without any special clinical symptoms. Imaging examinations suggested a cystic-solid mixed lesion in the right lobe of the liver. DIAGNOSIS The tumor was diagnosed as epithelioid mesothelioma of the diaphragm with liver invasion. INTERVENTION The patient underwent abdominal surgery in our hospital to remove the diaphragmatic mass, liver mass, and part of the diaphragm. OUTCOMES The postoperative course was uneventful. LESSONS Primary diaphragmatic malignant mesothelioma is very rare and may involve liver or lung tissue and be mistaken for liver or lung tumor. Accurate diagnosis depends on careful pathological examination. Immunohistochemical staining is very useful to distinguish this tumor from other liver or diaphragmatic tumors.
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Ismael H, Cox S. Primary intrahepatic mesotheliomas: A case presentation and literature review. Int J Surg Case Rep 2018; 47:1-6. [PMID: 29698884 PMCID: PMC5994865 DOI: 10.1016/j.ijscr.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/18/2018] [Accepted: 04/12/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Primary Intrahepatic mesotheliomas are malignant tumors arising from the mesothelial cell layer covering Glisson's capsule of the liver. They are exceedingly rare with only fourteen cases reported in the literature. They have nonspecific signs and symptoms and need a high index of suspicion and an extensive workup prior to surgery. Surgery remains the mainstay of treatment. PRESENTATION OF CASE 48 year old male presented with a 3 months history of abdominal pain, productive cough, anemia and weight loss. He had no history of asbestos exposure. A computed tomography scan and magnetic resonance study demonstrated a heterogeneous subscapular mass within the dome of the right hepatic lobe measuring 11.3 × 6.1 cm involving the diaphragm. Combined resection of the liver and diaphragm was performed to achieve negative margins. Pathology demonstrated an epithelioid necrotic intrahepatic mesothelioma that stained positive for calretinin, CK AE1/AE3, WT-1, D2-40 and CK7. DISCUSSION Primary intrahepatic mesotheliomas originate from the mesothelial cells lining Glisson's capsule of the liver. They predominantly invade the liver but may also abut or involve the diaphragm. Surgery should include a diagnostic laparoscopy to rule out occult disease or diffuse peritoneal mesothelioma. Complete resection with negative margins should be attempted while maintaining an adequate future liver remnant. Attempts at dissecting the tumor off the involved diaphragm will result in excessive bleeding and may leave residual disease behind. CONCLUSION Intrahepatic mesotheliomas are rare peripherally-located malignant tumors of the liver. They require a high index of suspicion and a comprehensive workup prior to operative intervention.
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Affiliation(s)
- Hishaam Ismael
- Department of Surgery, The University of Texas Health Northeast, Tyler, TX, USA.
| | - Steven Cox
- Department of Surgery, The University of Texas Health Northeast, Tyler, TX, USA.
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Minami K, Okumura H, Hiwatashi K, Matsukita S, Setoyama T, Minamimagari K, Tsuruta Y, Kanetsuki I, Ogura Y, Maenohara S, Natsugoe S. Multiple malignant epithelioid mesotheliomas of the liver and greater omentum: a case report and review of the literature. Surg Case Rep 2017; 3:66. [PMID: 28493096 PMCID: PMC5425363 DOI: 10.1186/s40792-017-0342-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Malignant mesothelioma commonly arises from the pleura, but can also arise from the peritoneum, pericardium, and tunica vaginalis testis. However, malignant mesothelioma of the liver is extremely rare and coexistence with malignant mesothelioma of the greater omentum has not been described in the literature. In this case report, we present a case of multiple malignant mesothelioma of the liver and greater omentum. Case presentation A 36-year-old woman was admitted to our hospital for the evaluation of an elastic hard mass in the right upper abdomen. Abdominal contrast computed tomography showed a cystic mass measuring 13 × 14 × 11 cm in the right liver lobe with enhanced mural nodule. Abnormal accumulation was identified in the liver and lower abdominal area on 18F-fluorodeoxyglucose positron emission tomography. The patient underwent hepatectomy of the posterior segment and partial resection of the omentum. The final pathological diagnosis was low-grade multiple malignant epithelioid mesothelioma based on characteristic immunohistochemical findings. As of 6 months postoperatively, the patient has shown no disease recurrence. Conclusions We present the first case of a 36-year-old woman with multiple malignant mesothelioma of the liver and greater omentum.
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Affiliation(s)
- Koji Minami
- Department of Surgery, Kagoshima Kouseiren Hospital, Tenpozan 22-25, Kagoshima, 890-0061, Japan
| | - Hiroshi Okumura
- Department of Surgery, Kagoshima Kouseiren Hospital, Tenpozan 22-25, Kagoshima, 890-0061, Japan.
| | - Kiyokazu Hiwatashi
- Department of Surgery, Kagoshima Kouseiren Hospital, Tenpozan 22-25, Kagoshima, 890-0061, Japan
| | - Sumika Matsukita
- Department of Pathology, Kagoshima Kouseiren Hospital, Tenpozan 22-25, Kagoshima, 890-0061, Japan
| | - Tetsuro Setoyama
- Department of Surgery, Kagoshima Kouseiren Hospital, Tenpozan 22-25, Kagoshima, 890-0061, Japan
| | - Kota Minamimagari
- Department of Surgery, Kagoshima Kouseiren Hospital, Tenpozan 22-25, Kagoshima, 890-0061, Japan
| | - Yusuke Tsuruta
- Department of Surgery, Kagoshima Kouseiren Hospital, Tenpozan 22-25, Kagoshima, 890-0061, Japan
| | - Ichiro Kanetsuki
- Department of Radiology, Kagoshima Kouseiren Hospital, Tenpozan 22-25, Kagoshima, 890-0061, Japan
| | - Yoshito Ogura
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8520, Japan
| | - Shigeho Maenohara
- Department of Surgery, Kagoshima Kouseiren Hospital, Tenpozan 22-25, Kagoshima, 890-0061, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8520, Japan
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Abstract
Mesothelial cells (MCs) cover the surface of visceral organs and the parietal walls of cavities, and they synthesize lubricating fluids to create a slippery surface that facilitates movement between organs without friction. Recent studies have indicated that MCs play active roles in liver development, fibrosis, and regeneration. During liver development, the mesoderm produces MCs that form a single epithelial layer of the mesothelium. MCs exhibit an intermediate phenotype between epithelial cells and mesenchymal cells. Lineage tracing studies have indicated that during liver development, MCs act as mesenchymal progenitor cells that produce hepatic stellate cells, fibroblasts around blood vessels, and smooth muscle cells. Upon liver injury, MCs migrate inward from the liver surface and produce hepatic stellate cells or myofibroblast depending on the etiology, suggesting that MCs are the source of myofibroblasts in capsular fibrosis. Similar to the activation of hepatic stellate cells, transforming growth factor β induces the conversion of MCs into myofibroblasts. Further elucidation of the biological and molecular changes involved in MC activation and fibrogenesis will contribute to the development of novel approaches for the prevention and therapy of liver fibrosis.
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Affiliation(s)
- Ingrid Lua
- Southern California Research Center for ALPD and Cirrhosis, Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kinji Asahina
- Southern California Research Center for ALPD and Cirrhosis, Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Haji Ali R, Khalife M, El Nounou G, Zuhri Yafi R, Nassar H, Aidibe Z, Raad R, Abou Eid R, Faraj W. Giant primary malignant mesothelioma of the liver: A case report. Int J Surg Case Rep 2016; 30:58-61. [PMID: 27907819 PMCID: PMC5134082 DOI: 10.1016/j.ijscr.2016.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/14/2022] Open
Abstract
Malignant mesothelioma is a rare neoplasm of mesothelial cells. It occurs mostly in the pleura or peritoneum and less frequently in the liver. Primary intrahepatic mesothelioma is not in the WHO classification of hepatic tumors. Mesothelioma is more common in men with a mean age of 58 years. We present a rare case of primary liver malignant mesothelioma in a young female.
Introduction Malignant mesothelioma is a rare neoplasm of mesothelial cells arising most frequently in the pleura or peritoneum and less frequently in the liver. Case presentation We present a case of primary hepatic mesothelioma of 41 year old woman. She had no history of asbestos exposure or cancer. Abdominal computed tomography (CT) showed 21 cm intrahepatic mass in the right lobe with many cystic lesions and few small calcifications. Pathology showed a biphasic cellular pattern. In addition, the tumor cells were positive for Calretinin, Creatine Kinase (CK)5/6, CK7, CKAEI 1/3, Wilms Tumor protein (WT-1), and Vimentin, but were negative for Alpha Feto protein (AFP), Thrombotic Thrombocytopenic Purpura (TTP-1), Anti-Hepatocyte Specific Antigen (HSA), Synaptophysin, CK20, and Homeobox protein (CDx-2). Discussion Primary intrahepatic mesothelioma (PIHMM) is not included in the classification of the World Health Organization classification of hepatic tumors. Mesothelial cells are not normally found in the liver, but some reported cases suggest it may grow from the mesothelial cells of the Glisson’s capsule. Conclusion The probability of hepatic mesothelioma should not be ruled out, even in a young woman without a clear history of asbestos exposure.
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Affiliation(s)
- Ruba Haji Ali
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Mohamad Khalife
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
| | - Ghina El Nounou
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
| | - Ruba Zuhri Yafi
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Hussein Nassar
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
| | - Zeinab Aidibe
- American University of Beirut, Faculty of Arts and Sciences, Department of Biology, P.O. Box 11-0236, Beirut, Lebanon
| | - Randa Raad
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
| | - Rania Abou Eid
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon
| | - Walid Faraj
- Liver Transplantation and Hepatopancreaticobiliary Surgery, Department of General Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon.
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