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Shaw C, Iype S. Peritoneal mesothelioma presenting with 'kissing' liver metastases. Ann R Coll Surg Engl 2022; 104:e161-e163. [PMID: 34860121 PMCID: PMC9157946 DOI: 10.1308/rcsann.2021.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 61-year-old woman was diagnosed with an incidental liver lesion with a satellite lesion that had features of a secondary liver metastasis. Investigations for primary sites did not reveal a primary tumour. The lesion was not amenable to biopsy due to location. Intraoperatively, the two lesions were adjacent, but the first was on the diaphragm and the lesion was in segment 7 of the liver. The liver lesion underwent non-anatomical resection and the diaphragmatic lesion was resected separately. The histopathology diagnosed peritoneal mesothelioma in the lesion removed from diaphragm and the liver lesion to be local metastatic spread to an area of liver that was in close contact (a 'kissing' lesion). This report portrays a rare occurrence of liver metastases from peritoneal mesothelioma and discusses the current evidence for diagnosis and treatment.
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Affiliation(s)
- C Shaw
- Royal Free London NHS Foundation Trust, UK
| | - S Iype
- Royal Free London NHS Foundation Trust, UK
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Carlson B, Harmath C, Turaga K, Kindler HL, Armato SG, Straus C. The role of imaging in diagnosis and management of malignant peritoneal mesothelioma: a systematic review. Abdom Radiol (NY) 2022; 47:1725-1740. [PMID: 35257201 DOI: 10.1007/s00261-022-03464-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Imaging of the peritoneum and related pathology is a challenge. Among peritoneal diseases, malignant peritoneal mesothelioma (MPeM) is an uncommon tumor with poor prognosis. To date, there are no specific guidelines or imaging protocols dedicated for the peritoneum and MPeM. The objective of this study was to analyze the literature describing imaging modalities used for MPeM to determine their relative clinical efficacy and review commonly reported imaging features of MPeM to promote standardized reporting. METHODS We performed a systematic review of original research articles discussing imaging modalities in MPeM from 1999 to 2020. Effectiveness measures and common findings were compared across imaging modalities. RESULTS Among 582 studies analyzed, the most-used imaging modality was CT (54.3%). In the differentiation of MPeM from peritoneal carcinomatosis, one study found CT had a diagnostic sensitivity of 53%, specificity of 100%, and accuracy of 68%. Two studies found fluorodeoxyglucose positron emission tomography (FDG-PET) had sensitivity of 86-92%, specificity of 83-89%, and accuracy of 87-89%. Another study found magnetic resonance imaging (MRI) was the best predictor of the peritoneal carcinomatosis index. Characteristics shown to best differentiate MPeM from other diseases included ascites, peritoneal thickening, mesenteric thickening, pleural plaques, maximum tumor dimension, and number of masses. CONCLUSION Most published MPeM imaging studies utilized CT. PET/CT or MRI appear promising, and future studies should compare effectiveness of these modalities. MPeM imaging reports should highlight ascites, number of and maximum tumor dimension, peritoneal/mesenteric thickening, and associated pleural plaques, allowing for better aggregation of MPeM imaging data across studies.
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Affiliation(s)
- Bradley Carlson
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
- , Chicago, IL, USA.
| | - Carla Harmath
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Kiran Turaga
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Hedy L Kindler
- Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Samuel G Armato
- Department of Radiology, University of Chicago, Chicago, IL, USA
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Liu Y, Zheng G, Yang D, Guo X, Tian L, Song H, Liang Y. Osteopontin, GLUT1 and Ki-67 expression in malignant peritoneal mesothelioma: prognostic implications. Intern Med J 2021; 51:896-904. [PMID: 32510678 PMCID: PMC8362107 DOI: 10.1111/imj.14936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/25/2020] [Accepted: 05/15/2020] [Indexed: 12/15/2022]
Abstract
Background Malignant peritoneal mesothelioma is the most common primary peritoneal neoplasm. The only universally recognised pathological prognostic factor is histopathological subtype. Prognostic markers based on patient features and clinical stages have been disappointing. Aims To assess the prognostic role of several clinicopathological features in a retrospective cohort of 60 patients diagnosed with peritoneal mesothelioma. Methods Sixty patients were centrally collected and were immunohistochemically analysed for the expression of osteopontin (OPN), GLUT1 and Ki‐67. Labelling was assessed by two pathologists. Complete clinical information and follow‐up were obtained from patients' records. Results OPN expression was identified in 52 (86.6%) of 60 specimens, and GLUT1 in 39 (65%) of 60 specimens. Univariate Cox regression analysis showed that a lower peritoneal carcinomatosis index (PCI), tumour‐directed treatment (chemotherapy or surgery alone or in any combination), lower Ki‐67, GLUT1 and lower OPN expression had a statistically significant positive effect on overall survival (OS). PCI (hazard ratio (HR) = 1.032 (95% confidence interval (CI): 1.000–1.067); P = 0.054) and tumour‐directed treatment (HR = 0.211 (95% CI: 0.104–0.430); P < 0.001), Ki‐67 (HR = 22.326 (95% CI: 3.523–141.498); P = 0.003) and OPN (HR = 7.268 (95% CI: 1.771–29.811); P = 0.009) retained independent prognostic significance in the multivariate analysis, all with a positive effect on OS with the exception of GLUT1. Conclusions OPN, Ki‐67, treatment and PCI were independent indicators for OS, and a higher level of OPN expression correlated significantly with poorer OS.
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Affiliation(s)
- Yingying Liu
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, China
| | - Guoqi Zheng
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, China
| | | | - Xiaozhong Guo
- Department of Pathology, Cangzhou Central Hospital, Cangzhou, China
| | - Liang Tian
- Department of Pathology, Cangzhou Central Hospital, Cangzhou, China
| | - Hui Song
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, China
| | - Yufei Liang
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, China
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Yin W, Zheng G, Su S, Liang Y. The Value of COX-2, NF-κB, and Blood Routine Indexes in the Prognosis of Malignant Peritoneal Mesothelioma. Oncol Res Treat 2019; 42:334-341. [PMID: 31063993 DOI: 10.1159/000499677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/15/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND/AIMS To investigate differences in blood routine indexes and the expression of cyclooxygenase-2 (COX-2) and nuclear factor-kappa B (NF-κB) in malignant peritoneal mesothelioma (MPeM) and their relationship with clinical prognosis. METHODS We investigated changes in blood routine indexes between the MPeM patients and healthy subjects and detected the expression of COX-2 and NF-κB in peritoneal tissues by a streptavidin-peroxidase immunohistochemistry method. Potential prognostic factors were analyzed including age, gender, white blood cell count (WBC), absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute platelet count (APC), absolute monocyte count (AMC), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), COX-2, and NF-κB. Cox regression model analysis established independent factors for the survival prognosis of the patients. RESULTS Compared with the control group, AMC, MXD%, ANC, neutrophilic granulocyte percentage (NEUT%), APC, NLR, MLR, and PLR were markedly increased (p < 0.05) in the MPeM group. The positivity rates for COX-2 and NF-κB expression were 59.4 and 44.9%, respectively. Single factor analyses indicated that PLR, NLR, MLR, COX-2, and NF-κB were factors that affected the overall survival of MPeM patients, but multivariate analyses identified MLR and COX-2 as independent prognostic factors. CONCLUSIONS High blood levels of MLR and COX-2 are adverse prognostic factors for patients with MPeM.
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Affiliation(s)
- Wenjie Yin
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, China
| | - Guoqi Zheng
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, China,
| | - Shanshan Su
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, China
| | - Yufei Liang
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, China
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Zhou D, Quan Z, Wang J. Current status of malignant mesothelioma with liver involvement in China: A brief report and review of the literature. Intractable Rare Dis Res 2018; 7:112-119. [PMID: 29862153 PMCID: PMC5982618 DOI: 10.5582/irdr.2018.01052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Primary and secondary intrahepatic malignant mesothelioma (PIHMM & SIHMM) caused by Peritoneal mesothelioma (PM) are extremely rare tumors and their clinicopathological characteristics remain unclear. The current study presented a case of a 63-year-old female with PIHMM and a literature review of Chinese case reports of SIHMM and PIHMM was performed. The patient received curative left hemihepatectomy because of a 5.5 × 5.0 × 4.0 cm mass occupying the II, III and the lateral portion of the IV segments and meanwhile tightly infiltrating the diaphragm (yellow arrow) was also observed. The pathological diagnosis was epithelial type PIHMM. Immunohistochemistry revealed that the tumor was positive for Calretinin, CK5/6, WT-1 and D2-40(N). The literature review included 11 studies and 6 case reports with a total of 293 PM patients accompanied with 31 SIHMM cases and then 3 case reports of PIHMM. SIHMM and PIHMM are extremely rare, easy to misdiagnose malignant tumors. Immunohistochemistry should be performed strictly in accordance with guidelines, which is crucial for pathological diagnosis. Comprehensive treatment of surgery combined with chemotherapy are mainstream methods for SIHMM and PIHMM. Also, exact survival data should be carefully explored so that objective evaluation of the efficacy of the treatment could be achieved.
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Affiliation(s)
| | - Zhiwei Quan
- Department of General Surgery, XinHua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Address correspondence to:Drs. Jiandong Wang and Zhiwei Quan, Department of General Surgery, XinHua Hospital, Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Road, Yangpu District, Shanghai 200092, China. E-mail: (Wang JD) zhiwquan@163. com (Quan ZW)
| | - Jiandong Wang
- Department of General Surgery, XinHua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
- Address correspondence to:Drs. Jiandong Wang and Zhiwei Quan, Department of General Surgery, XinHua Hospital, Shanghai Jiao Tong University, School of Medicine, 1665 Kongjiang Road, Yangpu District, Shanghai 200092, China. E-mail: (Wang JD) zhiwquan@163. com (Quan ZW)
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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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Prognostic Significance of Blood, Serum, and Ascites Parameters in Patients with Malignant Peritoneal Mesothelioma or Peritoneal Carcinomatosis. Gastroenterol Res Pract 2018; 2018:2619526. [PMID: 29643915 PMCID: PMC5832177 DOI: 10.1155/2018/2619526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/08/2018] [Indexed: 01/14/2023] Open
Abstract
To determine effects of the biochemical and cytological properties of blood, serum, and ascites on survival of patients with malignant peritoneal effusion (MPeE), including malignant peritoneal mesothelioma (MPeM) and peritoneal carcinomatosis (PC), we conducted a retrospective study of patients with MPeE and healthy controls. Potential prognostic factors were identified as follows: age, sex, blood neutrophil-to-lymphocyte ratio (NLR), serum parameters, ascites parameters, serum-ascites albumin gradient, and the ascites-serum LDH ratio. Compared to those of the control group, serum albumin levels were significantly lower, and the NLR and serum LDH levels were significantly higher in the MPeE group. Overall survival (OS) was longer in patients with MPeM compared to that in patients with PC. Compared with patients in the MPeM, patients with PC had higher NLRs, ascites glucose levels, serum-ascites albumin gradients, and serum LDH levels. In contrast, their ascites albumin levels and ascites-serum LDH ratios were lower. Univariate analyses indicated that the NLR, serum LDH levels, ascites LDH levels, ascites coenocyte levels, and the ascites coenocyte-to-monocyte ratios affected the OS. Multivariate analyses identified only serum and ascites LDH levels as independent prognostic factors.
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Yin W, Zheng G, Yang K, Song H, Liang Y. Analysis of prognostic factors of patients with malignant peritoneal mesothelioma. World J Surg Oncol 2018; 16:44. [PMID: 29506546 PMCID: PMC5836427 DOI: 10.1186/s12957-018-1350-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 02/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The study aims to find out independent prognostic factors for patients with malignant peritoneal mesothelioma (MPeM). METHODS Patients with pathologically proven MPeM were retrospectively reviewed. Potential prognostic factors were analyzed, including age, gender, asbestos exposure, body mass index (BMI), treatment, and laboratory results, such as blood routine examination and liver functions. The influences of various risk factors on the prognoses were analyzed by univariate analysis. A Cox regression model analysis established independent factors for the survival prognosis of the patients. RESULTS Seventy MPeM patients, including 33 patients who received intraperitoneal chemotherapy with cisplatin, 14 patients who received systemic chemotherapy with cisplatin + pemetrexed, and 21 untreated patients were included in this study. The 1-year survival was 32.9%, the 2-year survival was 10%, and the 3-year survival was 2.9%. The median age of MPeM was 62 years, and the female-to-male ratio was 1:0.56. The univariate and multivariate analyses showed that treatment, albumin (ALB), and blood neutrophil-to-lymphocyte ratio (NLR) were independent factors that affected the overall survival (OS) of MPeM patients. CONCLUSION High blood NLR and hypoalbuminemia are adverse prognostic factors for MPeM patients. Systemic chemotherapy and intraperitoneal chemotherapy can prolong the survival period.
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Affiliation(s)
- Wenjie Yin
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, Hebei, 061001, China
| | - Guoqi Zheng
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, Hebei, 061001, China.
| | - Kunna Yang
- Department of Otolaryngology, Cangzhou Medical College, Cangzhou, Hebei, 061001, China
| | - Hui Song
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, Hebei, 061001, China
| | - Yufei Liang
- Department of Gastroenterology, Cangzhou Central Hospital, Cangzhou, Hebei, 061001, China
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Chandramohan A, Thrower A, Shah N, Mohamed F. Radiological predictors of complete cytoreduction in 59 patients with peritoneal mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy at a UK referral centre. Br J Radiol 2017; 90:20170361. [PMID: 28830230 DOI: 10.1259/bjr.20170361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the imaging features of peritoneal mesothelioma and identify key anatomical sites that aid patient selection for complete cytoreduction. METHODS Pre-operative imaging of 59 (32 males, 27 females) patients who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) for histologically proven peritoneal mesothelioma [36 malignant peritoneal mesothelioma, 23 cystic mesothelioma were reviewed. Imaging findings were correlated with surgical outcome. Best imaging predictors of complete cytoreduction, n = 22 and major tumour debulking, n = 12 were assessed. RESULTS Most patients (88.9%) had diffuse peritoneal disease with mean radiological peritoneal cancer index of 18 ± 12 (range 2-39). Disease in the lesser omentum (n = 10), porta hepatis (n = 8), perigastric area (n = 5), mesentery (n = 25), small bowel (n = 17), hydronephrosis (n = 1), concurrent pleural disease (n = 2), lymph nodes (n = 1) and abdominal wall disease (n = 4) was considered unfavourable. While 78.9% of patients who underwent complete cytoreduction had no disease at unfavourable sites, 75% of those who underwent MTD did have disease at these sites. There was significant difference in the radiological peritoneal cancer index, severity of upper abdominal disease, small bowel and mesenteric involvement between patients who underwent complete cytoreduction and MTD for malignant peritoneal mesothelioma. Complete cytoreduction was not achieved in the presence of a rind of soft tissue around the small bowel (p = 0.016) and was unlikely in the presence of large volume upper abdominal disease (p = 0.06). CONCLUSION Involvement of key anatomical sites such as small bowel serosa and large volume upper abdominal disease reduced the likelihood of achieving complete cytoreduction in patients with malignant peritoneal mesothelioma. Advances in knowledge: Demonstration of small bowel disease and large volume upper abdominal disease on imaging in patients with malignant peritoneal mesothelioma can be used to identify patients who may not benefit from cytoreductive surgery.
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Affiliation(s)
- Anuradha Chandramohan
- 1 Visiting Faculty, Abdominal Imaging Unit, Department of Radiology, MD Anderson Cancer Center, Houston, TX, USA.,2 Associate professor of Radiology, Christian Medical College, Vellore, India
| | - Andrew Thrower
- 3 Consultant Radiologist, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, England
| | - Nehal Shah
- 3 Consultant Radiologist, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, England
| | - Faheez Mohamed
- 4 Consultant Surgeon, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, England
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