Giant primary malignant mesothelioma of the liver: A case report

Our plain-English summary of Giant primary malignant mesothelioma of the liver: A case report, by R. Haji Ali, M. Khalife, G. El Nounou, et al (International Journal of Surgery Case Reports, 2017).

The study

• Authors: R. Haji Ali, M. Khalife, G. El Nounou, R. Zuhri Yafi, H. Nassar, Z. Aidibe, R. Raad, R. Abou Eid, W. Faraj
• Journal: International Journal of Surgery Case Reports
• Published: 2017;30:58-61
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

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 41year old woman. She had no history of asbestos exposure or cancer. Abdominal computed tomography (CT) showed 21cm 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.

Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

In plain English

This was a case report of one patient, a 41-year-old woman treated at the authors' hospital in Beirut, Lebanon. She had primary malignant mesothelioma of the liver, a rare site for this cancer. She had right upper abdominal pain, dizziness, fatigue and weight loss. She had no history of asbestos exposure, smoking or alcohol use. A CT scan showed a 21 by 20 by 15.5 cm mass in the right lobe of the liver. Surgeons removed the right part of the liver and the gallbladder; she went home on day 10. The removed mass measured 24 by 20 by 12 cm and weighed 4.6 kg. It showed a biphasic cell pattern, and staining results fit primary intrahepatic malignant mesothelioma. No cancer was found at the surgical margins and no chemotherapy was given after surgery; the authors' table recorded no relapse but gave no follow-up period. The authors also reviewed eleven earlier published cases, two of which had a history of asbestos exposure. The authors concluded that liver mesothelioma should not be ruled out even in a young woman without a clear history of asbestos exposure.

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 eleven previously published cases
• Who was studied: one 41-year-old woman referred to the authors' institution (American University of Beirut Medical Center, Lebanon) with right upper abdominal pain and dizziness for one month
• Exposure: the patient had no history of asbestos exposure; no fiber type or job exposure is described
• Main results:
  • CT showed a liver mass measuring 21 by 20 by 15.5 cm in the right lobe, with multiple cystic lesions and a few small calcifications
  • The patient had a right hepatectomy with cholecystectomy and was discharged on day 10 after surgery
  • The removed mass measured 24 by 20 by 12 cm and weighed 4.6 kg
  • Pathology showed a biphasic cellular pattern. Tumor cells were positive for Calretinin, CK5/6, CK7, CKAEI 1/3, WT-1 and Vimentin and negative for AFP, TTP-1, HSA, Synaptophysin, CK20 and CDx-2, which the authors found consistent with primary intrahepatic malignant mesothelioma
  • Surgical margins were free of disease and no adjuvant (after-surgery) chemotherapy was given
  • For the present case, Table 1 records 'No' under relapse, while the follow-up period is marked 'N/E' (not evaluated)
  • In the authors' review of eleven earlier published cases (seven females, four males, aged 50 to 83), only two patients (18.1%) had a history of asbestos exposure
  • The authors stated that their patient's tumor, at 21 cm in its largest dimension, was the largest such mesothelioma reported
• The authors' conclusion: The authors concluded that hepatic mesothelioma should not be ruled out even in a young woman without a clear history of asbestos exposure, and that more cases need study to understand its features and prognosis and to develop treatment

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Neoplasm, Mesothelial Cells, Pleura, Peritoneum, Asbestos Exposure, Pathology, Biphasic Mesothelioma.

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