Collision tumors of hepatocellular carcinoma and malignant peritoneal mesothelioma

Our plain-English summary of Collision tumors of hepatocellular carcinoma and malignant peritoneal mesothelioma, by J. Uemoto, N. Hoshi, K. Hirabayashi, et al (Medical Molecular Morphology, 2013).

The study

• Authors: J. Uemoto, N. Hoshi, K. Hirabayashi, S. Hoshi, K. Onodera, T. Nishi, M. Tomikawa, S. Igarashi
• Journal: Medical Molecular Morphology
• Published: 2013;46(3):177-83
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a case of synchronous hepatocellular carcinoma (HCC) and malignant peritoneal mesothelioma (MM-per). A 56-year-old man with no past history of asbestos exposure, chronic viral hepatitis, or alcoholic liver injury was admitted to our hospital with left flank pain and abdominal tumor. Partial hepatectomy, splenectomy, partial diaphragm resection, and partial gastrectomy were performed. The tumor in the lateral segment of the liver was gray to white, massive in appearance, and contained focal bile-producing nodules and extensive fibrous firm lesion. It had directly invaded the spleen and diaphragm. Liver cirrhosis was not found. The peritoneum contained multiple small nodules especially around the diaphragm, which mimicked carcinoma dissemination. After histological examination, the liver tumor was diagnosed as HCC. It had trabecular and scirrhous patterns and positive immunoreactivities for Hep-Par-1 and α-fetoprotein. The peritoneal nodules were diagnosed as MM-per, epithelioid type, with positive immunoreactivities for calretinin and cytokeratin 5/6. The two tumors collided around the diaphragm. Cases of MM synchronous with other primary malignant tumors have been reported, but most had a history of asbestos exposure unlike the present case. The carcinogenic background was unclear for two tumors in this case. This is an extremely rare and valuable case.

In plain English

This case report described one patient, a 56-year-old man at the Tochigi Cancer Center in Japan, who had two separate cancers at the same time: hepatocellular carcinoma (a liver cancer) and malignant peritoneal mesothelioma (cancer of the abdominal lining). The authors reported that he had no history of asbestos exposure. Tests for hepatitis B and C were negative, and the liver outside the tumor showed no cirrhosis. Surgeons removed his spleen and parts of his liver, diaphragm and stomach. The 13-cm liver tumor was diagnosed as hepatocellular carcinoma. Small nodules on the abdominal lining, first suspected to be spread from that tumor, were diagnosed as epithelioid peritoneal mesothelioma. The two tumors met around the diaphragm. Staining did not detect asbestos or ferruginous bodies in either tumor. Both tumors stained positive for the markers HGF-b, c-Met and TGF-b. He died 11 months after surgery. The authors concluded that the cause of the two cancers was unclear and suggested the tumors might share growth mechanisms. They also wrote that mesothelioma should be considered when nodules resembling cancer spread are found in the abdomen.

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 patient)
• Who was studied: One 56-year-old man treated at the Tochigi Cancer Center, Utsunomiya, Japan; the dates of care are not given
• Exposure: The authors reported that the patient had no history of asbestos exposure (and no chronic viral hepatitis or alcoholic liver injury); no fiber type or occupation is described
• Main results:
  • In the patient, laboratory tests for hepatitis B and C infection and for liver dysfunction were negative
  • The patient's liver tissue outside the tumor showed no cirrhosis or alcoholic degeneration
  • The surgery removed part of the liver, the whole spleen, part of the diaphragm and part of the stomach
  • The liver tumor was diagnosed as hepatocellular carcinoma, with a classical component consistent with poorly differentiated HCC and a scirrhous component
  • The small white peritoneal nodules were first suspected to be peritoneal dissemination of the cancer
  • The small peritoneal nodules were diagnosed as malignant peritoneal mesothelioma, epithelioid type
  • The mesothelioma lay on the peritoneum, especially around the liver cancer, and the two tumors collided around the diaphragm
  • On the largest cut surface of the tumor, classical HCC, scirrhous HCC and peritoneal mesothelioma made up 60%, 38% and 2% of the area, respectively
  • Asbestos and ferruginous bodies were not detected in either tumor by hematoxylin and eosin or Berlin blue staining
  • Both tumors showed similar staining: positive for HGF-b, c-Met and TGF-b, and negative for HGF-a
  • Both tumors could not be fully removed. The patient received sorafenib (800 mg/day, reduced to 400 mg/day), the disease progressed after 23 weeks, and he died 11 months after surgery
• The authors' conclusion: The authors concluded that the carcinogenic factor behind the two synchronous tumors was unclear. They suspected common or synergic growth mechanisms, possibly involving TGF-b and HGF. They wrote that mesothelioma should be considered when peritoneal tumors that look like cancer dissemination are found.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Carcinoma, Peritoneal Mesothelioma, Asbestos Exposure, Diaphragm, Peritoneum, Trabecular, Epithelioid, Calretinin.

Related studies

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• Whole exome sequencing of independent lung adenocarcinoma, lung squamous cell carcinoma, and malignant peritoneal mesothelioma: A case report — I. Vanni, S. Coco, et al. (2016)
• Asbestosis, laryngeal carcinoma, and malignant peritoneal mesothelioma in an insulation worker — A. Fischbein, J.C. Luo, et al. (1991)
• Simultaneous bilateral spontaneous pneumothorax in a patient with peritoneal and pleural papillary mesothelioma — P. Höllinger, D. Gaeng (1997)
• Comparative genetic analysis of a rare synchronous collision tumor composed of malignant pleural mesothelioma and primary pulmonary adenocarcinoma — T. Naka, Y. Hatanaka, et al. (2016)
• Malignant mesothelioma of the peritoneum invading the liver and mimicking metastatic carcinoma: a case report — S. Nagata, M. Tomoeda, et al. (2011)

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