Challenging diagnosis of sarcomatoid hepatic mesothelioma: a case report with review of literature

Our plain-English summary of Challenging diagnosis of sarcomatoid hepatic mesothelioma: a case report with review of literature, by K. Mehta, S. Mehta, M. Joshi, et al (Annals of Medicine and Surgery, 2023).

The study

• Authors: K. Mehta, S. Mehta, M. Joshi, H.R. Bharadwaj, G. Ardeshana, P.O. Tenkorang
• Journal: Annals of Medicine and Surgery
• Published: 2023;85(10):5123-5126
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

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.

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

In plain English

This article is a case report with a short review of earlier published cases. The authors described a 72-year-old man with abdominal pain, fatigue and a 10 kg weight loss over 6 months. He did not report any asbestos exposure, and the authors stated that the other factors they asked about, including carbon nanotube exposure and family history, were negative. A CT scan showed a 13.6 cm by 11 cm mass in the liver with cystic lesions, and there was no evidence of spread to other organs. A liver biopsy showed spindle-shaped cells consistent with sarcomatoid mesothelioma, and immunohistochemistry stains supported this. Surgery was not considered viable. He received palliative chemotherapy with cisplatin and pemetrexed and died within a few months of diagnosis. The authors also reviewed 12 earlier reported cases of mesothelioma in the liver, and three of those patients had a history of asbestos exposure. The authors believed this man's tumor was spontaneous or idiopathic. They concluded that more research is needed into risk factors other than asbestos. Parts of the article give conflicting treatment details and case counts.

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 of one patient, with a review of 12 previously published cases of primary mesothelioma of the liver, reported following the SCARE 2020 criteria
• Who was studied: One 72-year-old man with abdominal pain, fatigue and 10 kg weight loss over 6 months, with a history of hypertension, diabetes mellitus and coronary artery disease. The author affiliations are in India, the UK and Ghana; the article does not state where or when the patient was treated.
• Exposure: No asbestos exposure was reported by the patient. The authors state that carbon nanotube exposure, family history and lifestyle factors were all negative. No fiber type is discussed.
• Main results:
  • CT showed a 13.6 cm by 11 cm mass in the patient's liver with cystic lesions.
  • There was no evidence of spread (metastasis) to other organs in the patient.
  • Liver biopsy showed spindle-shaped cells consistent with sarcomatoid mesothelioma.
  • Immunohistochemistry was positive for cytokeratin, vimentin, calretinin, D2-40 and WT-1, and negative for CD117, CD34, CD31, PSA, CEA, P40, TTF1, SALL4 and EMA.
  • Surgery was not considered viable. The patient was given palliative cisplatin and pemetrexed chemotherapy, deteriorated rapidly, and died within a few months of diagnosis.
  • The literature review covered 12 earlier cases, five male and seven female patients.
  • Three of the 12 earlier reviewed cases had a history of asbestos exposure (25%).
  • Among the reviewed earlier cases, only one was of the sarcomatoid type.
• The authors' conclusion: The authors believed this patient's tumor was spontaneous or idiopathic, given the negative history. They concluded that the case highlights the complexity of mesothelioma and the need for further research into risk factors not related to asbestos.

Topics

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Mesothelioma, Asbestos Exposure, Spindle Cell, Biopsy, Immunohistochemistry, Surgical Resection, Palliative Care.

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