Malignant mesothelioma of the peritoneum invading the liver and mimicking metastatic carcinoma: a case report

Our plain-English summary of Malignant mesothelioma of the peritoneum invading the liver and mimicking metastatic carcinoma: a case report, by S. Nagata, M. Tomoeda, C. Kubo, et al (Pathology, Research and Practice, 2011).

The study

• Authors: S. Nagata, M. Tomoeda, C. Kubo, H. Yoshizawa, M. Yuki, M. Kitamura, A. Takenaka, K. Nakanishi, T. Yagi, F. Imamura, Y. Tomita
• Journal: Pathology, Research and Practice
• Published: 2011;207(6):395-8
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We present a case of malignant mesothelioma of the peritoneum with massive direct invasion to the liver in a 58-year-old Japanese woman. She had no history of asbestos exposure or other malignancies. Abdominal computed tomography revealed one 8-cm intrahepatic mass adjacent to the abdominal wall with peritoneal thickening, multiple smaller nodules in the peritoneal cavity, and intra-abdominal lymphadenopathy. Liver biopsy showed a small cluster of atypical cells similar to epithelial neoplasm, which formed a tubulopapillary structure. The tumor cells were positive for calretinin with strong nuclear and cytoplasmic expression together with podoplanin (D2-40) and some cytokeratins, but were negative for hepatocyte paraffin 1 and other adenocarcinoma markers. We confirmed a diffuse peritoneal mesothelioma with direct invasion to the liver. Liver masses with other peritoneal nodules are mostly encountered as metastatic diseases. However, the possibility of mesothelioma should be considered, even in women without an apparent history of asbestos exposure.

Copyright © 2011 Elsevier GmbH. All rights reserved.

In plain English

This article was a case report of one patient: a 58-year-old Japanese woman admitted to the authors' hospital in Osaka after two months of abdominal discomfort. The patient had no past history of cancer or of asbestos exposure. Blood tests showed a markedly raised cancer antigen 125 level (706 U/mL). Imaging found an 8 cm mass in the liver, next to the abdominal wall, with thickening of the peritoneum (the abdominal lining). It also found multiple nodules in the pelvic cavity and enlarged lymph nodes. A liver needle biopsy showed a small cluster of abnormal cells, and the cytology result was inconclusive. Staining tests were positive for calretinin and podoplanin (D2-40), which the authors said suggested mesothelioma. They were negative for Hep Par-1 and several adenocarcinoma markers. The authors diagnosed diffuse epithelioid peritoneal malignant mesothelioma with extensive spread into the liver. The other peritoneal nodules were not examined under the microscope. The authors found no earlier report of such massive direct liver invasion. They concluded that pathologists should consider this diagnosis even in women without an evident 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 (single patient)
• Who was studied: One 58-year-old Japanese woman with 2 months of abdominal discomfort, admitted to the authors' hospital (Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan); dates of care not given
• Exposure: No asbestos exposure reported; the patient had no past history of malignancy or asbestos exposure
• Main results:
  • Cancer antigen 125 was markedly elevated at 706 U/mL; the patient also had low serum albumin (2.8 g/dL) and anemia (hemoglobin 10.6 g/dL)
  • Ultrasound showed an 8 cm mass in the liver; CT showed it adjacent to the abdominal wall with peritoneal thickening, plus multiple nodules in the pelvic cavity and enlarged para-aortic and intra-abdominal lymph nodes
  • The liver biopsy showed a small cluster of atypical cells forming a tubulopapillary structure; aspiration cytology indicated an epithelial or epithelioid malignant tumor but was inconclusive
  • Most tumor cells stained for calretinin and podoplanin (D2-40), suggesting mesothelioma, and for CK 19. They stained faintly for h-caldesmon and CK 7, and were negative for thrombomodulin, Hep Par-1, CEA, Ber-EP4, MOC-31, B72.3, CA 19-9, CK 5/6, WT-1 and estrogen receptor
  • The authors diagnosed diffuse epithelioid peritoneal malignant mesothelioma (PMM) with extensive liver involvement
  • The authors did not find massive direct invasion of the liver by diffuse PMM described in their literature search
• The authors' conclusion: The authors concluded that when liver masses occur with peritoneal nodules, pathologists should consider peritoneal mesothelioma with direct liver invasion, as well as metastatic disease, even in women without an evident history of asbestos exposure
• Limitations the authors state:
  • The other peritoneal nodules were not examined pathologically, although the authors classified the tumor as diffuse rather than localized

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Peritoneum, Carcinoma, Asbestos Exposure, Peritoneal Cavity, Lymphadenopathy, Biopsy, Neoplasm.

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