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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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Pernthaler B, Brcic L, Aigner RM, Fuchsjäger M, Talakic E. 18F-FDG PET/CT in Primary Mesothelioma of the Liver. Clin Nucl Med 2023; 48:49-51. [PMID: 36469059 DOI: 10.1097/rlu.0000000000004445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT Primary malignant mesothelioma is a rarity among malignant liver tumors. We present the case of a 48-year-old woman presenting with increasing upper abdominal discomfort and inappetence accompanied by a weight loss of approximately 10 kg. CT and MRI revealed a highly suspicious mass lesion in the liver. 18F-FDG PET/CT performed for staging showed a pathological 18F-FDG uptake of the known liver tumor. Histology and immunohistochemistry indicated mesothelioma of the liver. Herein we present a rare case of primary mesothelioma in the liver with CT, MRI, and 18F-FDG PET/CT.
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Affiliation(s)
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology
| | | | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Emina Talakic
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
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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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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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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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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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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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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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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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12
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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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13
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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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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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15
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You Q, Zhao J, Shi G, Deng J, Teng X. Epithelioid malignant mesothelioma presenting with features of gastric tumor in a child. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:2636-2640. [PMID: 24966978 PMCID: PMC4069876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 04/10/2014] [Indexed: 06/03/2023]
Abstract
Localized malignant mesothelioma is very uncommon and mainly arises in pleura and peritoneum, and preferentially occurs in older adults. In this article, we report a case of a Localized malignant mesothelioma that was developed in the stomach of a 6-year-old boy. This boy was admitted to hospital for anemia. An epigastric mass was palpated through systemic physical examination and MR scanning demonstrated an 8×6 cm-sized, well-defined elliptic mass at gastric corpus. Partial resection of the stomach was performed for this boy and no nodules were found on the liver, peritoneum, and other abdominal sites in surgery. In view of the morphological and immunohistochemical findings, a diagnosis of localized malignant mesothelioma, epithelial type was made. This is the first case report of localized malignant mesothelioma arising in the stomach of a child. Accumulation of more cases of malignant mesothelioma involving gastrointestinal tract and longer follow-up of the patients are necessary to further characterize the features of this rare disease.
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Affiliation(s)
- Qihan You
- Department of Pathology, The First Hospital Affiliated to Medical School of Zhejiang UniversityHangzhou, China
| | - Jing Zhao
- Department of Pathology, The First Hospital Affiliated to Medical School of Zhejiang UniversityHangzhou, China
| | - Genming Shi
- Department of Medical Oncology, The First Hospital Affiliated to Medical School of Zhejiang UniversityHangzhou, China
| | - Jing Deng
- Department of Medical Oncology, The First Hospital Affiliated to Medical School of Zhejiang UniversityHangzhou, China
| | - Xiaodong Teng
- Department of Pathology, The First Hospital Affiliated to Medical School of Zhejiang UniversityHangzhou, China
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Giansanti M, Bellezza G, Guerriero A, Pireddu A, Sidoni A. Localized Intrasplenic Mesothelioma: A Case Report. Int J Surg Pathol 2013; 22:451-5. [PMID: 24050959 DOI: 10.1177/1066896913503492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Malignant mesothelioma is a primary neoplasm of the serosal membranes that usually presents with a diffuse pattern of growth. However, cases of localized mesotheliomas have been described. The predominant localization is the pleura; peritoneum and pericardium being rarer localizations. Only few cases of true intraparenchymal mesothelioma arising in organs such as liver, gonads, lung, and pancreas have been described. We report a case of an otherwise healthy 48-year-old man without asbestos exposure with a nodule of 3 cm in diameter, localized in the spleen, discovered incidentally at the ultrasonographic examination, for which histopathological and immunohistochemical findings were consistent with epithelioid mesothelioma: large round cells with eosinophil dense cytoplasm and macronucleoli and with immunohistochemical positivity for pancytokeratins, calretinin, Wilms tumor-1, and others markers of mesothelial differentiation. The diagnosis of localized intrasplenic epithelioid malignant mesothelioma was carried out. To the best of our knowledge, this is the first case of a localized intrasplenic mesothelioma published in the indexed literature.
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Affiliation(s)
- Michele Giansanti
- Department of Experimental Medicine, Section of Pathology, Medical School, University of Perugia, Italy
| | - Guido Bellezza
- Department of Experimental Medicine, Section of Pathology, Medical School, University of Perugia, Italy
| | - Angela Guerriero
- Department of Experimental Medicine, Section of Pathology, Medical School, University of Perugia, Italy
| | - Anjuta Pireddu
- Department of Experimental Medicine, Section of Pathology, Medical School, University of Perugia, Italy
| | - Angelo Sidoni
- Department of Experimental Medicine, Section of Pathology, Medical School, University of Perugia, Italy
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Baadh AS, Xiong X, Singh S, Kapoor R, Zhou J, Katz DS. Radiology-pathology conference: primary peritoneal mesothelioma. Clin Imaging 2013; 37:1142-5. [PMID: 23953740 DOI: 10.1016/j.clinimag.2013.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/12/2013] [Indexed: 11/29/2022]
Abstract
Primary peritoneal mesothelioma is a rare neoplasm which carries a dismal prognosis. These highly aggressive tumors arise from mesothelial cells lining the peritoneum and are rapidly fatal. The neoplasm is typically associated with crocidolite asbestos exposure. We present the case of a 75-year-old man with primary peritoneal mesothelioma, with invasion into the right hepatic lobe.
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Affiliation(s)
- Amanjit S Baadh
- Department of Radiology, Winthrop-University Hospital, Mineola, NY 11501, USA.
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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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Abstract
Context.—Diagnosing epithelioid serosal lesions remains a challenge because numerous different processes—primary or secondary, benign or malignant—occur in body cavities, some of which are very rare.
Objectives.—To review the newest literature and to describe the morphologic criteria and immunohistochemical markers that are useful for distinguishing epithelioid serosal lesions.
Data Sources.—Previously published literature concentrating on the newest research findings. Earlier reviews are principally referred to for established diagnostic criteria.
Conclusions.—Immunohistochemistry with a panel of antibodies has made the diagnosis of epithelioid serosal lesions very reliable. When deciding on antibodies used in differential diagnosis, it is important to consider tumor location, clinical and radiologic information, and morphologic features. Immunohistochemistry is less useful in the differential diagnosis of benign versus malignant mesothelial lesions. The diagnosis of benign versus malignant mesothelial proliferations still relies on the histologic criteria of invasion.
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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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