Localized multiple malignant epithelioid peritoneal mesotheliomas arising from the hepatoduodenal ligament and diaphragm: a case report

Our plain-English summary of Localized multiple malignant epithelioid peritoneal mesotheliomas arising from the hepatoduodenal ligament and diaphragm: a case report, by T. Miyata, Y. Fujiwara, K. Nishijima, et al (Journal of Medical Case Reports, 2019).

The study

• Authors: T. Miyata, Y. Fujiwara, K. Nishijima, F. Futagami, T. Nakamura, H. Takamura
• Journal: Journal of Medical Case Reports
• Published: 2019;13(1):66
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant peritoneal mesothelioma is a rare aggressive tumor of the peritoneum. We report a rare case of resection of multiple localized malignant peritoneal mesotheliomas.

Case Presentation: A 55-year-old Japanese woman was admitted to our hospital because liver tumors were detected by abdominal ultrasonography during a screening examination. Blood examination findings, including tumor makers, were within normal ranges. She had no evidence of exposure to asbestos. Computed tomography showed four hypervascular, round liver tumors, one in the lateral liver segment adjacent to the hepatic hilus, and the other three on the liver surface. Computed tomography angiography revealed that the tumor in the lateral segment had strong enhancement and was fed from the left gastric artery. In contrast, the other tumors showed no enhancement, and were fed from the right inferior phrenic artery. Abnormal accumulation was identified in the four tumors only with 18F-fluorodeoxyglucose positron emission tomography. It was very difficult to obtain a definitive preoperative diagnosis, but surgical resection was performed because we considered potential malignancy. Laparotomy revealed the principal site of the tumor in the lateral segment was on the hepatoduodenal ligament, and all other tumors were on the diaphragm. A left lobectomy and partial diaphragmatic resection were performed. The final pathological diagnosis was multiple malignant epithelioid mesotheliomas. Our patient has had no recurrence for 20 months postoperatively.

Conclusions: In general, malignant peritoneal mesotheliomas are classified as diffuse tumors, which are often unresectable and have a poor prognosis. However, early diagnosis and treatment, particularly with the localized type, as in our patient, could lead to long-term survival of the patient. We recommend that multiple malignant epithelioid mesotheliomas be included in the differential diagnosis for patients with subcapsular hepatic tumors.

In plain English

This case report described one patient: a 55-year-old Japanese woman whose occupational and residential history showed no apparent exposure to asbestos. Tumors near her liver were found by ultrasound during a screening examination. Her blood tests, including tumor markers, were within normal ranges. CT showed four round tumors at the edge of the liver, measuring 32, 7, 17 and 15 mm. The authors at first diagnosed multiple liver hemangiomas. CT angiography then showed that the largest tumor was fed by the left gastric artery and the other three by the right inferior phrenic artery, which indicated the liver was not their origin. At surgery, the largest tumor was on the hepatoduodenal ligament and the other three were on the diaphragm. All were removed by left liver lobectomy and partial diaphragm resection. The final diagnosis from tissue testing was multiple malignant epithelioid mesotheliomas. Scans showed no recurrence 20 months after surgery, without further therapy. The authors concluded that early diagnosis and treatment, particularly of the localized type, could lead to long-term survival.

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 55-year-old Japanese woman referred to the Department of Surgery, Japanese Red Cross Kanazawa Hospital, Japan, after hepatic tumors were detected on screening ultrasonography
• Exposure: No asbestos exposure: her occupational and residential history showed no apparent exposure to asbestos. She did not smoke or drink alcohol.
• Main results:
  • All laboratory data, including serum tumor markers (CEA, CA19-9, AFP, PIVKA-II, CA125), were within normal ranges in this patient
  • Enhanced CT showed four hypervascular, round tumors: 32 mm in contact with the lateral liver segment and hepatic hilus, and 7 mm (segment 4), 17 mm (segment 7) and 15 mm (segment 8) in contact with the diaphragm
  • CT during hepatic arteriography showed the lateral-segment tumor was strongly enhanced and fed by the left gastric artery. The other three tumors had no enhancement and were fed by the right inferior phrenic artery, indicating the liver was not the origin
  • All tumors showed increased fluorodeoxyglucose uptake on PET-CT, with a standardized uptake value of 7.8
  • At laparotomy the lateral-segment tumor was in contact with the hepatoduodenal ligament and the other three tumors were on the diaphragm. Tumorectomy with left liver lobectomy and partial diaphragmatic resection was performed
  • The final pathological diagnosis was multiple malignant epithelioid mesotheliomas
  • Histopathology and immunohistochemistry (positive for CD34, CD31, D2-40 and calretinin) confirmed epithelioid mesothelioma. The tumor cells were negative for p53, and the Ki-67 labeling index was below 20%
  • The patient was discharged 10 days after surgery without complications. CT and PET-CT showed no recurrence 20 months after surgery, without adjuvant therapy
• The authors' conclusion: The authors concluded that malignant peritoneal mesothelioma generally has a poor prognosis, but early diagnosis and treatment, particularly with the localized type as in this patient, could lead to long-term survival. They recommended including it in the differential diagnosis of subcapsular hepatic tumors, and suggested identifying feeding vessels by angiography or CT angiography as an aid to diagnosis.

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: Epithelioid, Peritoneal Mesothelioma, Diaphragm, Peritoneum, Surgical Resection, Laparotomy, Diaphragmatic Resection, Mesothelioma.

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• Malignant mesothelioma of the peritoneum invading the liver and mimicking metastatic carcinoma: a case report — S. Nagata, M. Tomoeda, et al. (2011)
• Collision tumors of hepatocellular carcinoma and malignant peritoneal mesothelioma — J. Uemoto, N. Hoshi, et al. (2013)
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