A Single Liver Metastasis from Pleural Biphasic Mesothelioma

Our plain-English summary of A Single Liver Metastasis from Pleural Biphasic Mesothelioma, by A. Marzullo, G. Serio, F. Pezzuto, et al (Diagnostics, 2020).

The study

• Authors: A. Marzullo, G. Serio, F. Pezzuto, F. Fortarezza, G. Cazzato, C. Caporusso, T. Lettini, D. Cavone, M.C. Delfino, L. Vimercati
• Journal: Diagnostics
• Published: 2020;10(8)
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Virtually any malignancy can metastasize to the liver. Large solitary metastases are rare and can be difficult to distinguish from primary tumors. Malignant mesothelioma is often considered as a locally invasive cancer but tumor dissemination to extra-thoracic sites is possible, and the liver can be involved. Herein, we present a rare case of pleural mesothelioma with a solitary large liver metastasis diagnosed postmortem in a ninety-two-year-old man with 35 years of exposure to asbestos. Results of immunohistochemical staining of the pleural and liver tumor were similar, both positive for low-molecular weight keratins, calretinin, vimentin, and podoplanin, and negative for Claudin-4, TTF1, CEA, BerEP4, CK7, CK19, CK20, BAP1, Hep Par1, p40, and WT1. Fluorescent in-situ hybridization (FISH) for p16/CDKN2A was also performed and a homozygous deletion was detected in both tumors, supporting the diagnosis of mesothelioma. Reporting this case, we would like to point out that extra-thoracic dissemination from pleural mesothelioma, even if exceptional, can occur. In cases where differential diagnoses are challenging, the value of ancillary techniques and a practical approach to diagnostic work-up is of primary importance.

In plain English

This article is a case report about one man, aged ninety-two, whose body was examined at autopsy. The autopsy was done at his son's request because an occupational disease of legal concern was suspected. His history included 35 years of occupational exposure to asbestos on board ships. The article does not name the fiber type. In his last month he had weight loss, cough, chest pain, fever and general malaise. A chest CT scan showed a 6.7 by 6.5 cm mass in the right upper lobe, of probable pleural origin, and numerous pleural plaques on both sides. At autopsy the chest mass measured 9 cm. The right lobe of the liver was taken up by a partly necrotic mass 10 cm across. The two tumors showed the same pattern on a panel of tissue stains, and both had a homozygous deletion of the CDKN2A/p16 gene. The authors diagnosed biphasic pleural mesothelioma, with epithelioid and sarcomatoid areas, and a single liver metastasis. The authors concluded that pleural mesothelioma should be considered able to spread outside the chest, like most cancers, and that ancillary tests help in difficult diagnoses.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single autopsy case)
• Who was studied: One ninety-two-year-old man who died at home after a month of weight loss, coughing, chest pain, fever and general malaise
• Exposure: 35 years of occupational asbestos exposure on board ships; fiber type not stated
• Main results:
  • Chest CT showed a 6.7 by 6.5 cm mass in the right upper lobe, of probable pleural origin, and numerous bilateral pleural plaques
  • At autopsy, a 9 cm nodular mass at the right upper lobe adhered to the thoracic surface
  • The right lobe of the liver was entirely occupied by a partially necrotic 10 cm mass
  • Both tumors stained positive for calretinin, podoplanin (D2-40), CK5/6 and vimentin
  • Both tumors stained negative for CEA, TTF-1, p40, CD34, HMB45, Melan-A, CK7, CK19, CK20, PAX8, FLI-1 and BAP1
  • WT-1 staining was negative in both the lung and the liver tumor
  • In the liver tumor, FISH showed homozygous deletion of CDKN2A/p16 (more than 50%), and the pleural mass gave the same results
  • Final diagnosis: malignant biphasic pleural mesothelioma with a single liver metastasis
• The authors' conclusion: The authors concluded that ancillary techniques are valuable in difficult mesothelioma diagnoses, and that malignant pleural mesothelioma should be considered a tumor able to spread outside the chest, like most cancers

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Biphasic Mesothelioma, Malignant Mesothelioma, Pleural Mesothelioma, Immunohistochemistry, Calretinin, Podoplanin (D2-40), Claudin-4.

Related studies

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• Localized Biphasic Malignant Peritoneal Mesothelioma with Rhabdoid Features Involving the Liver: Case Report and Review of the Literature — D. Hassan, S. Ligato (2019)
• Giant solitary fibrous tumor of the liver with metastasis to the skeletal system successfully treated with trisegmentectomy — S. Yilmaz, V. Kirimlioglu, et al. (2000)
• Peritoneal Mesothelioma with Residential Asbestos Exposure. Report of a Case with Long Survival (Seventeen Years) Analyzed by Cgh-Array — G. Serio, F. Pezzuto, et al. (2017)
• Primary Ovarian Mesothelioma: A Case Series with Electron Microscopy Examination and Review of the Literature — L. Vimercati, D. Cavone, et al. (2021)
• Molecular Pathways in Peritoneal Mesothelioma: A Minireview of New Insights — F. Fortarezza, F. Pezzuto, et al. (2022)

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