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Marchevsky AM, Khoor A, Walts AE, Nicholson AG, Zhang YZ, Roggli V, Carney J, Roden AC, Tazelaar HD, Larsen BT, LeStang N, Chirieac LR, Klebe S, Tsao MS, De Perrot M, Pierre A, Hwang DM, Hung YP, Mino-Kenudson M, Travis W, Sauter J, Beasley MB, Galateau-Sallé F. Localized malignant mesothelioma, an unusual and poorly characterized neoplasm of serosal origin: best current evidence from the literature and the International Mesothelioma Panel. Mod Pathol 2020; 33:281-296. [PMID: 31485011 PMCID: PMC10428660 DOI: 10.1038/s41379-019-0352-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 12/12/2022]
Abstract
Localized malignant mesotheliomas (LMM) is an uncommon and poorly recognized neoplasm. Its pathologic diagnosis is often surprising in patients with serosal/subserosal based localized tumors that are clinically suspicious for metastatic lesions or primary sarcomas. Once a tumor is diagnosed as "mesothelioma", LMM is often mistaken for diffuse malignant mesothelioma (DMM). Best currently available evidence about LMM was collected from the literature and cases diagnosed by members of the International Mesothelioma Panel (IMP). One hundred and one (101) LMM have been reported in the English literature. Patients had localized tumors with identical histopathologic features to DMM. Patients ranged in age from 6 to 82 years; 75% were men. Most (82%) of the tumors were intrathoracic. Others presented as intrahepatic, mesenteric, gastric, pancreatic, umbilical, splenic, and abdominal wall lesions. Tumors varied in size from 0.6 to 15 cm. Most patients underwent surgical resection and/or chemotherapy or radiation therapy. Median survival in a subset of patients was 29 months. Seventy two additional LMM from IMP institutions ranged in age from 28 to 95 years; 58.3% were men. Sixty tumors (83.3%) were intrathoracic, others presented in intraabdominal sites. Tumors varied in size from 1.2 to 19 cm. Median survival for 51 cases was 134 months. Best evidence was used to formulate guidelines for the diagnosis of LMM. It is important to distinguish LMM from DMM as their treatment and prognosis is different. A multidisciplinary approach is needed for the diagnosis of LMM as it shows identical histopathology and immunophenotype to DMM.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Child
- Diagnosis, Differential
- Evidence-Based Medicine
- Female
- Humans
- Male
- Mesothelioma, Malignant/diagnostic imaging
- Mesothelioma, Malignant/mortality
- Mesothelioma, Malignant/pathology
- Mesothelioma, Malignant/therapy
- Middle Aged
- Pleural Neoplasms/diagnostic imaging
- Pleural Neoplasms/mortality
- Pleural Neoplasms/pathology
- Pleural Neoplasms/therapy
- Predictive Value of Tests
- Prognosis
- Solitary Fibrous Tumor, Pleural/diagnostic imaging
- Solitary Fibrous Tumor, Pleural/mortality
- Solitary Fibrous Tumor, Pleural/pathology
- Solitary Fibrous Tumor, Pleural/therapy
- Tumor Burden
- Young Adult
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Affiliation(s)
| | | | - Ann E Walts
- Departments of Pathology Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Yu Zhi Zhang
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | - Sonja Klebe
- Flinders University, Adelaide, SA, Australia
| | - Ming-Sound Tsao
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Marc De Perrot
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrew Pierre
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David M Hwang
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Yin P Hung
- Massachusetts General Hospital, Boston, MA, USA
| | | | - William Travis
- Sloan Kettering Memorial Cancer Center, New York, NY, USA
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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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3
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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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Malignant Peritoneum Mesothelioma with Hepatic Involvement: A Single Institution Experience in 5 Patients and Review of the Literature. Gastroenterol Res Pract 2016; 2016:6242149. [PMID: 27069474 PMCID: PMC4812398 DOI: 10.1155/2016/6242149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/23/2016] [Accepted: 02/07/2016] [Indexed: 12/12/2022] Open
Abstract
Malignant peritoneal mesothelioma with invasion of the liver is an invariably fatal disease. We aimed to clarify the characteristics of malignant peritoneal mesothelioma cases with liver involvement. The clinical presentation, computed tomography images, and immunohistochemical and histopathological features of 5 patients with malignant peritoneal mesothelioma and liver involvement were evaluated. The diagnosis was established by imaging and immune profiles of the tumours. A review of 8 cases with primary or invading malignant mesothelioma in liver is presented. All 5 mesothelioma cases were asbestos-related. CT images of malignant peritoneal mesothelioma with the liver involvement typically showed that the lesion grew inside the liver along the capsule and was possibly accompanied by capsule breakthrough and extrahepatic infiltration. The tumours exhibited a common epithelioid appearance in all 5 patients and most cases revealed positive Cal, CK, and MC with negative CEA and HeP. Different from our findings, the review of literature revealed that most malignant mesothelioma of liver was due to primary intrahepatic malignant mesothelioma. Finally, we concluded that the diagnosis of malignant peritoneal mesothelioma cases with liver invasion is reliably achieved by the history of asbestos exposure, the characteristic CT imaging, and immune profiles of the tumours.
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An unusual liver mass: primary malignant mesothelioma of the liver : CT and MRI findings and literature review. Jpn J Radiol 2014; 33:102-6. [PMID: 25518822 DOI: 10.1007/s11604-014-0379-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/01/2014] [Indexed: 01/22/2023]
Abstract
Primary malignant mesothelioma of the liver is extremely rare, and radiologic features have been defined in only one case. We present radiologic findings of two cases which are pathologically proven as primary malignant mesothelioma of the liver. Malignant mesothelioma of the liver may be included in a differential diagnosis list if there is a heterogeneous, hemorrhagic and necrotic lesion in the liver, with peripheral serpiginous vascular structures and increasing septal enhancement in post-contrast images.
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6
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Perysinakis I, Nixon AM, Spyridakis I, Kakiopoulos G, Zorzos C, Margaris I. Primary intrahepatic malignant epithelioid mesothelioma. Int J Surg Case Rep 2014; 5:1098-101. [PMID: 25460485 PMCID: PMC4275834 DOI: 10.1016/j.ijscr.2014.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 11/09/2014] [Accepted: 11/09/2014] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Primary malignant hepatic mesotheliomas are extremely rare. We report the case of a patient with primary intrahepatic malignant mesothelioma who was treated in our department. PRESENTATION OF CASE A 66-year old male patient was admitted to our department for the evaluation of anemia. An abdominal computed tomography scan revealed a large space occupying lesion in the right liver lobe. DISCUSSION The tumor was subsequently resected and a diagnosis of primary intrahepatic malignant mesothelioma was made after pathologic examination. The patient did not receive adjuvant therapy and is currently alive and free of disease, 36 months after the resection. CONCLUSION To our knowledge this is the eighth adult case of primary intrahepatic malignant mesothelioma reported in the literature. These tumors are rarely diagnosed preoperatively. Absence of previous asbestos exposure does not exclude malignant mesothelioma from the differential diagnosis. Proper surgical treatment may offer prolonged survival to the patient, without adjuvant therapy.
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Affiliation(s)
- Iraklis Perysinakis
- Third Surgical Department, "George Gennimatas" General Hospital of Athens, Mesogeion Ave 154, 156 69 Athens, Greece.
| | - Alexander M Nixon
- Third Surgical Department, "George Gennimatas" General Hospital of Athens, Mesogeion Ave 154, 156 69 Athens, Greece
| | - Ioannis Spyridakis
- Third Surgical Department, "George Gennimatas" General Hospital of Athens, Mesogeion Ave 154, 156 69 Athens, Greece
| | - George Kakiopoulos
- Pathology Department, "George Gennimatas" General Hospital of Athens, Mesogeion Ave 154, 156 69 Athens, Greece
| | - Charalampos Zorzos
- Pathology Department, "George Gennimatas" General Hospital of Athens, Mesogeion Ave 154, 156 69 Athens, Greece
| | - Ilias Margaris
- Third Surgical Department, "George Gennimatas" General Hospital of Athens, Mesogeion Ave 154, 156 69 Athens, Greece
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7
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Multiple Primary Hepatic Malignant Mesotheliomas Mimicking Cystadenocarcinomas on Enhanced CT and FDG PET/CT. Clin Nucl Med 2014; 39:619-22. [DOI: 10.1097/rlu.0b013e31828da61d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Inagaki N, Kibata K, Tamaki T, Shimizu T, Nomura S. Primary intrahepatic malignant mesothelioma with multiple lymphadenopathies due to non-tuberculous mycobacteria: A case report and review of the literature. Oncol Lett 2013; 6:676-680. [PMID: 24137389 PMCID: PMC3789073 DOI: 10.3892/ol.2013.1461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 07/09/2013] [Indexed: 11/26/2022] Open
Abstract
Primary intrahepatic malignant mesothelioma (PIHMM) is an extremely rare tumor with clinicopathological characteristics that remain to be elucidated. The current study presents the case of a 68-year-old female with PIHMM and multiple lymphadenopathies due to non-tuberculous mycobacteria. The patient presented with an intrahepatic tumor, 70 mm in diameter, in the right lobe of the liver. An ultrasound-guided fine-needle aspiration biopsy of the liver tumor revealed findings that were consistent with an intrahepatic malignant mesothelioma. The systemic lymph node swellings were due to epithelioid granulomas that were caused by non-tuberculous mycobacteria. However, a hepatic rupture occurred due to the rapid growth of the liver tumor and consequently, a surgical resection was not performed. A review of the literature revealed that the clinicopathological characteristics of PIHMM are similar to those of non-occupational mesothelioma. However, PIHMM is usually a solitary tumor and is rarely associated with cavity effusion in contrast with conventional mesothelioma. Therefore, surgical resection with curative intent is often recommended for patients with PIHMM.
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Affiliation(s)
- Noriko Inagaki
- First Department of Internal Medicine, Kansai Medical University, Moriguchi, Osaka 570-8506, Japan
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9
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Khalil MW, Sharkey AJ, Loubani M. Bronchial deposits--another abnormal presentation of pleural mesothelioma. Asian Cardiovasc Thorac Ann 2013; 20:754. [PMID: 23284136 DOI: 10.1177/0218492312461925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mohammed W Khalil
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
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10
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Kim JH, Kwon KY, Jeon YK, Nam JH, Choi C, Hyeon CL, Choi YD. Mucin-positive epithelial mesothelioma of the peritoneum: small bowel involvement. Pathol Int 2011; 61:756-61. [PMID: 22126385 DOI: 10.1111/j.1440-1827.2011.02732.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mucin-positive epithelial mesothelioma has been reported in the peritoneum only once, and that mainly involved the stomach wall. We report the second peritoneal case and this is the first case mainly involving the small bowel wall. A 65-year-old man showed diffuse involvement from the duodenum to the ileum and metastatic masses in the left adrenal gland. Segmental resection of the small bowel was performed; 2 months later the patient died. Light microscopy showed diffusely anaplastic epithelioid cell proliferation and foci of glandular formation with granular mucinous materials in the cytoplasmic vacuoles or within glandular lumina. Histochemically, these mucin materials were PAS-positive and diastase-resistant. Immunohistochemically, the various mesothelial markers were positive, and a few adenocarcinoma markers were focally positive. Ultrastructurally, the tumor cells showed long slender microvilli on the apical surface, consistent with mesothelioma. Electron microscopy can play a decisive role in the case of ambiguous histochemical and immunohistochemical results.
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Affiliation(s)
- Jo-Heon Kim
- Department of Pathology, Jeju National University Medical School, Jeju, Korea
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11
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Khalil MW, Campbell AP, Cowen ME. Epithelioid malignant mesothelioma presenting with features of esophageal tumor. Asian Cardiovasc Thorac Ann 2011; 19:260-1. [PMID: 21885553 DOI: 10.1177/0218492311406748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intrathoracic epithelioid mesothelioma commonly presents as a diffuse tumor of the pleura. It rarely occurs as a localized tumor that might be surgically resectable. We report a case of one such localized mesothelioma in a 72-year-old woman, which arose from the wall of the esophagus and had all the presenting features of an esophageal tumor.
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Affiliation(s)
- Mohammed W Khalil
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, HU16 5JQ, UK.
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12
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Localized intrapancreatic malignant mesothelioma: a rare entity that may be confused with other pancreatic neoplasms. Virchows Arch 2010; 456:455-61. [PMID: 20148337 DOI: 10.1007/s00428-010-0885-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/22/2009] [Accepted: 01/11/2010] [Indexed: 12/19/2022]
Abstract
Malignant mesothelioma usually presents with diffuse involvement of the pleura or peritoneum. Circumscribed or localized malignant mesothelioma has been described in these locations, as well as the viscera, in which case it may cause diagnostic confusion with other, more common entities. Herein, we describe the first well-documented case of primary intrapancreatic malignant mesothelioma in the English literature. The patient was an otherwise healthy 39-year-old woman who presented with a symptomatic mass in the head of the pancreas that was completely resected via pancreaticoduodenectomy. The tumor was composed of cysts, papillae, and tubules lined by cells with abundant eosinophilic cytoplasm and immunohistochemically expressed CA-125, calretinin, and D2-40. Follow-up revealed no evidence of residual or recurrent disease 32 months after surgery. This report also describes the clinical and pathologic characteristics of an intrapancreatic mesothelioma and provides a review of the literature regarding entities that may be considered in the differential diagnosis of this tumor.
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13
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Hayashi H, Notohara K, Yoshioka H, Matsuoka T, Ikeda H, Kagawa K, Fukuoka T, Ishida T. Localized malignant pleural mesothelioma showing a thoracic mass and metastasizing to the stomach. Intern Med 2010; 49:671-5. [PMID: 20371957 DOI: 10.2169/internalmedicine.49.2592] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Malignant mesothelioma typically shows either diffuse tumors or multiple pleura-based nodules. Localized malignant mesothelioma is rare. In this case report, a 70-year-old man with left chest wall tumor underwent tumor resection, and the lesion was pathologically diagnosed as biphasic malignant mesothelioma. Tumor recurrence was detected in the stomach due to vomiting of blood, and also spread to the mediastinal lymph node, and bone 3 months postoperatively. Total gastrectomy was performed and the histopathological diagnosis of metastasis of mesothelioma was made. In the previously reported cases, all of the localized malignant mesothelioma arose in the pleural space and there was no metastasis of localized malignant mesothelioma to the stomach. In the present case, gross and histological examinations were performed for both the primary lesion and gastric metastatic tumor. Though it was very difficult to distinguish mesothelioma from sarcoma and other chest wall tumors, immunochemical staining was able to facilitate making the diagnosis. This case suggests that localized malignant mesothelioma is capable of showing multiple forms and a variety of clinical courses. Localized malignant mesothelioma can arise primarily from the chest wall.
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Affiliation(s)
- Hidetoshi Hayashi
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki.
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14
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Buchholz BM, Gütgemann I, Fischer HP, Gorschlüter M, Türler A, Kalff JC, Hirner A, Standop J. Lymph node dissection in primary intrahepatic malignant mesothelioma: case report and implications for diagnosis and therapy. Langenbecks Arch Surg 2009; 394:1123-30. [PMID: 19280219 DOI: 10.1007/s00423-009-0476-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 02/20/2009] [Indexed: 12/29/2022]
Abstract
INTRODUCTION In this rare case of intrahepatic malignant mesothelioma with subsequent lymph node metastases, hepatic segmentectomy in combination with repeated lymphadenectomy resulted in prolonged survival, currently 37 months after initial diagnosis. DISCUSSION Immunohistochemically, vascular endothelial growth factor receptor-1 expressing tumor cells were surrounded by a dense D 2-40-positive lymphangiovascular network, suggesting tumor induced lymphangiogenesis correlating to 2-deoxy-2[(18)F]fluoro-d-glucose-positron emission tomography/computed tomography-positive recurrent intraabdominal and intrathoracic lymphatic tumor spread. Therefore, extended lymphadenectomy during primary tumor resection and combined adjuvant chemotherapy with promising anticancer agents possessing antilymphangiogenic and antimetabolite properties should be considered to prolong survival in cases of extrathoracic malignant mesothelioma. Additionally, as shown in our case, individual operative concepts and (sometimes) multiple operations can be beneficial for highly selected patients. Importantly, a case-by-case optimized antitumor regimen requires interdisciplinary expertise and consensus of all involved faculties.
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Affiliation(s)
- Bettina M Buchholz
- Department of Surgery, University of Bonn Medical Center, Bonn, Germany.
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15
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Sasaki M, Araki I, Yasui T, Kinoshita M, Itatsu K, Nojima T, Nakanuma Y. Primary localized malignant biphasic mesothelioma of the liver in a patient with asbestosis. World J Gastroenterol 2009; 15:615-21. [PMID: 19195066 PMCID: PMC2653355 DOI: 10.3748/wjg.15.615] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a case of primary localized malignant biphasic mesothelioma of the liver in a 66-year-old man associated with asbestosis. The tumor was detected as a hepatic nodule, 4 cm in diameter, in the right lobe (S8 segment) on CT scan. Histopathological examination demonstrated an intrahepatic tumor with central necrosis consisting of a papillary epithelioid pattern on the surface of the liver, microcystic (microglandular or adenomatoid) pattern mainly in the subcapsular area and sarcomatoid pattern intermingled with microcystic pattern in the major part of the hepatic nodular tumor. Tumor cells, especially of epithelioid type, showed distinct immunoreactivity for mesothelial markers (WT-1, calretinin, D2-40, CK5/6, mesothelin, thrombomodulin) and no immunoreactivity for epithelial (adenocarcinoma) markers (CEA, CD15, BerEP4, BG8, MOC31). P53 immunoreactivity was detected focally in papillary epithelioid tumor cells and extensively in microcystic and sarcomatoid components, suggesting that the papillary epithelioid mesothelioma arose on the surface of the liver, and tumor cells showing microcystic and sarcomatoid patterns invaded and grew into the liver. To date, this is the first case of primary localized malignant biphasic mesothelioma of the liver, since all three primary hepatic mesotheliomas reported so far were epithelioid type.
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16
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Guinee DG, Allen TC. Primary pleural neoplasia: entities other than diffuse malignant mesothelioma. Arch Pathol Lab Med 2008; 132:1149-70. [PMID: 18605768 DOI: 10.5858/2008-132-1149-ppneot] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Overwhelmingly, the most common neoplasm involving the pleura is metastatic carcinoma. In contrast, diffuse malignant mesothelioma occurs relatively rarely; however, it is nonetheless the most common neoplasm primary to the pleura. Metastatic carcinoma and diffuse malignant mesothelioma each have their own prognostic and therapeutic characteristics. Other primary pleural neoplasms occur uncommonly or rarely, with their own prognostic and therapeutic characteristics. OBJECTIVE To review primary pleural neoplasms other than diffuse malignant mesothelioma, to better ensure correct diagnosis and optimal assessment of prognosis and treatment. DATA SOURCES Literature review and primary material from the authors' institutions. CONCLUSIONS A nonexhaustive group of uncommon to rare benign and malignant primary pleural neoplasms--other than diffuse malignant mesothelioma--are presented, of which one must be aware in order to maintain an appropriate index of suspicion to include them in the differential diagnosis of a pleural tumor.
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Affiliation(s)
- Donald G Guinee
- Department of Pathology, Virginia Mason Medical Center, Seattle, WA, USA
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17
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Khan AM, Tlemcani K, Shanmugam N, Y D, Keller S, Berman AR. A localized pleural based mass with intense uptake on positron emission tomography scan. Chest 2007; 131:294-9. [PMID: 17218590 DOI: 10.1378/chest.06-0655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Amir M Khan
- Department of Pulmonary Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA.
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Gütgemann I, Standop J, Fischer HP. Primary intrahepatic malignant mesothelioma of epithelioid type. Virchows Arch 2006; 448:655-8. [PMID: 16541281 DOI: 10.1007/s00428-006-0175-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 02/12/2006] [Indexed: 10/24/2022]
Abstract
A case of epithelioid mesothelioma presenting as a primary intrahepatic tumor is described. The patient was a 62-year-old man with a 5.8-cm intrahepatic mass on an incidental intra-abdominal CT scan. Thorough clinical and radiographic examination did not reveal any evidence of tumor elsewhere. Macroscopic and microscopic examination demonstrated an intrahepatic tumor consisting of tubular and papillary proliferations of large epithelioid cells, surrounded by a densely mixed inflammatory infiltrate. The tumor cells were strongly positive for pancytokeratin, CK7, CA-12.5, and calretinin, as well as D2-40, and were faintly positive for thrombomodulin and vimentin. The proliferative rate was focally increased up to 20% by Ki-67 staining and the tumor expressed focally p53. Ultrastructurally, numerous microvilli on the cell surface, and abundant desmosomal plaques, characteristic of mesothelial cells, were found. To date, this is the third reported case of a primary intrahepatic mesothelioma.
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Affiliation(s)
- Ines Gütgemann
- Institute of Pathology, University of Bonn (UKB), Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
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Allen TC, Cagle PT, Churg AM, Colby TV, Gibbs AR, Hammar SP, Corson JM, Grimes MM, Ordonez NG, Roggli V, Travis WD, Wick MR. Localized malignant mesothelioma. Am J Surg Pathol 2005; 29:866-73. [PMID: 15958850 DOI: 10.1097/01.pas.0000165529.78945.dc] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Localized malignant mesotheliomas are uncommon sharply circumscribed tumors of the serosal membranes with the microscopic appearance of diffuse malignant mesothelioma but without any evidence of diffuse spread. Little is known about their behavior. We report 23 new cases. The mean age at presentation was 63 years, and the sex ratio was approximately 2:1 (male/female). Twenty-one tumors were pleural and 2 were peritoneal. Sixteen tumors reproduced microscopic patterns of diffuse epithelial mesotheliomas, 6 had mixed epithelial and sarcomatous patterns, and 1 was purely sarcomatous. After surgical excision of the tumor, 10 of 21 patients with follow-up data were alive without evidence of disease from 18 months to 11 years after diagnosis. Patients who died had developed local recurrences and metastases, but none had diffuse pleural spread. Localized malignant mesotheliomas should be separated from diffuse malignant mesotheliomas because of their localized presentation, quite different biologic behavior, and far better prognosis.
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