Localized Biphasic Malignant Peritoneal Mesothelioma with Rhabdoid Features Involving the Liver: Case Report and Review of the Literature

Our plain-English summary of Localized Biphasic Malignant Peritoneal Mesothelioma with Rhabdoid Features Involving the Liver: Case Report and Review of the Literature, by D. Hassan, S. Ligato (Case Reports in Pathology, 2019).

The study

• Authors: D. Hassan, S. Ligato
• Journal: Case Reports in Pathology
• Published: 2019;2019:2732674
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Localized malignant mesotheliomas, defined as sharply circumscribed tumors of the serosal membrane with the microscopic appearance of diffuse malignant mesothelioma, are rare tumors; their behavior and prognosis are uncertain. Intrahepatic mesotheliomas are postulated to arise from mesothelial cells of Glisson's capsule.

Case Presentation: A 69-year-old female with no history of asbestos exposure presented with a one-month history of increasing abdominal pain associated with constitutional symptoms. Computerized Tomography (CT) scan of the abdomen and pelvis revealed a sizable soft tissue mass within the right paracolic gutter, abutting the inferior hepatic margin, the lateral abdominal wall, and descending colon. Ultrasound-guided biopsy of the mass suggested a poorly differentiated hepatocellular carcinoma. There was no disease elsewhere on PET scan. Surgical resection of the mass was performed. Pathological assessment suggested the tumor to be arising from the liver with invasion of the liver, abdominal wall musculature, and the adventitial surface of the ascending colon. A final diagnosis of localized biphasic malignant peritoneal mesothelioma with rhabdoid features was rendered based on morphology and the result of immunohistochemical studies. The abdominal wall margin was positive. The patient progressed over the course of 6 months despite receiving adjuvant chemotherapy and immunotherapy with metastases and a decline in performance status and was transitioned to hospice.

Conclusion: Localized malignant peritoneal mesotheliomas are rare tumors that may present clinically as a liver mass and simulate primary hepatic or secondary tumors. Definitive diagnosis is obtained by surgical resection in most cases. The clinical outcome is variable with most cases having a poor outcome.

In plain English

This article is a case report with a review of earlier published cases. The authors described a 69-year-old woman with no known asbestos exposure who had a month of worsening abdominal pain, weakness, fatigue and weight loss. A CT scan showed a 9.5 x 8.5 x 7 cm mass beside the liver. A needle biopsy suggested a liver cancer (poorly differentiated hepatocellular carcinoma). After surgical removal, laboratory stains supported a final diagnosis of localized biphasic malignant peritoneal mesothelioma with rhabdoid features. Tumor reached the abdominal wall edge of the removed tissue. After three cycles of cisplatin and pemetrexed, a CT scan showed the disease had returned and spread in the liver and peritoneum. She then received two doses of pembrolizumab, but her condition declined and she moved to hospice care. Reviewing published cases, the authors reported that 75% had no prior asbestos exposure, a figure that included 3 cases with no reported exposure history. The authors concluded that these rare tumors can mimic liver tumors, that not all patients have asbestos exposure, and that most reported outcomes were unfavorable.

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 literature review of published cases of localized malignant peritoneal mesothelioma
• Who was studied: One 69-year-old woman with coronary artery disease, hypertension, hyperlipidemia and polymyalgia rheumatica, plus the earlier published cases listed in the authors' literature table
• Exposure: The patient had no known history of cancer and no past asbestos exposure
• Main results:
  • In the patient, a CT scan showed a 9.5 x 8.5 x 7 cm soft tissue mass in the right paracolic gutter, beside the lower edge of the liver
  • In the patient, an ultrasound-guided biopsy suggested a poorly differentiated hepatocellular carcinoma
  • In the patient's surgically removed tumor, the tumor appeared to arise from the surface of the liver and invaded the liver, abdominal wall muscle, omental fat and the outer layer of the ascending colon
  • In the patient's tumor, stains for markers of liver-cell (hepatocellular) differentiation were all negative
  • In the patient, tumor was present at the abdominal wall margin over more than 2 cm, while the liver and colon margins were free of tumor
  • In the patient, after three cycles of cisplatin and pemetrexed, follow-up CT showed recurrence and progression with multiple liver and peritoneal metastases
  • In the patient, after the recurrence was found, she additionally received 2 doses of pembrolizumab, but her performance status declined significantly and she was transitioned to hospice
  • In the reviewed cases, 90% of tumors arose in or close to the liver
  • In the reviewed cases, the authors reported that 75% had no prior history of asbestos exposure; the authors counted 3 cases with no reported exposure history within this figure
  • In the reviewed cases with follow-up data, outcomes varied: 5 cases had no recurrence after surgery, and 2 cases resulted in the patient's death
• The authors' conclusion: The authors concluded that localized malignant peritoneal mesotheliomas are rare tumors that can present as a liver mass and mimic other tumors, and that not all patients have a history of asbestos exposure. They also concluded that the clinical course varies, with an unfavorable outcome reported in most cases.
• Limitations the authors state:
  • The authors stated that more cases are needed to describe how these tumors behave and what the prognosis is

Topics

Medical terms in this study, explained in our Lexicon: Biphasic Mesothelioma, Peritoneal Mesothelioma, Rhabdoid, Localized Malignant Mesothelioma, Malignant Mesothelioma, Prognosis, Mesothelioma, Mesothelial Cells.

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• Localized biphasic malignant peritoneal mesothelioma presenting as a rectal tumor — K. Saisho, S. Fujiwara, et al. (2020)
• Mesothelioma with rhabdoid features: an ultrastructural and immunohistochemical study of 10 cases — N.G. Ordóñez (2006)
• Pseudomesotheliomatous adenocarcinoma of the lung with rhabdoid features — J.H. Attems, F. Lintner (2001)
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