Malignant Peritoneum Mesothelioma with Hepatic Involvement: A Single Institution Experience in 5 Patients and Review of the Literature

Our plain-English summary of Malignant Peritoneum Mesothelioma with Hepatic Involvement: A Single Institution Experience in 5 Patients and Review of the Literature, by S.S. Su, G.Q. Zheng, Y.G. Liu, et al (Gastroenterology Research and Practice, 2016).

The study

• Authors: S.S. Su, G.Q. Zheng, Y.G. Liu, Y.F. Chen, Z.W. Song, S.J. Yu, N.N. Sun, Y.X. Yang
• Journal: Gastroenterology Research and Practice
• Published: 2016;2016:6242149
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma with invasion of the liver is an invariably fatal disease. We aimed to clarify the characteristics of malignant peritoneal mesothelioma cases with liver involvement. The clinical presentation, computed tomography images, and immunohistochemical and histopathological features of 5 patients with malignant peritoneal mesothelioma and liver involvement were evaluated. The diagnosis was established by imaging and immune profiles of the tumours. A review of 8 cases with primary or invading malignant mesothelioma in liver is presented. All 5 mesothelioma cases were asbestos-related. CT images of malignant peritoneal mesothelioma with the liver involvement typically showed that the lesion grew inside the liver along the capsule and was possibly accompanied by capsule breakthrough and extrahepatic infiltration. The tumours exhibited a common epithelioid appearance in all 5 patients and most cases revealed positive Cal, CK, and MC with negative CEA and HeP. Different from our findings, the review of literature revealed that most malignant mesothelioma of liver was due to primary intrahepatic malignant mesothelioma. Finally, we concluded that the diagnosis of malignant peritoneal mesothelioma cases with liver invasion is reliably achieved by the history of asbestos exposure, the characteristic CT imaging, and immune profiles of the tumours.

In plain English

This was a report of 5 patients treated at a hospital in Cangzhou, Hebei, China, between May 2011 and September 2014 for malignant peritoneal mesothelioma, a cancer of the abdominal lining, that had spread into the liver. It also reviewed 8 earlier single-case reports of mesothelioma in the liver. The patients were 1 man and 4 women, with a mean age of 57.6 years. All 5 had a history of asbestos exposure, which the authors described as chrysotile exposure. All 5 tumours were of the epithelioid type. CT scans showed pleural plaques in 3 of the 5. Only one patient was alive at the time of writing. The other 4 survived an average of 6.5 months (range 5 to 8 months). Of the 8 published cases, 7 had been reported as primary liver mesothelioma, and only 1 of the 8 patients had a history of asbestos exposure. The authors concluded that peritoneal mesothelioma invading the liver is likely more common than primary liver mesothelioma. They said that asbestos exposure history, CT findings and tumour staining patterns can help identify it.

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 series of 5 patients from a single hospital, combined with a review of 8 previously published case reports
• Who was studied: 5 patients (1 male, 4 female; mean age 57.6, range 45 to 69 years) diagnosed with malignant peritoneal mesothelioma invading the liver, treated at Cangzhou Central Hospital, Hebei, China, May 2011 to September 2014
• Exposure: All 5 patients had a history of asbestos exposure, described by the authors as chrysotile exposure; no doses or job details are given for the individual patients
• Main results:
  • The 5 patients were 1 male and 4 females, with a mean age at diagnosis of 57.6 years (range 45 to 69)
  • Average serum CA125 in the 5 patients was 263.5 U/mL (range 36.6 to 725.3 U/mL; normal below 35.0 U/mL)
  • Pleural plaques were seen in 3 of the 5 patients (cases 2, 3 and 5)
  • 4 of the 5 cases were localised peritoneal mesothelioma and 1 was the diffuse type
  • All 5 tumours had an epithelioid appearance
  • Staining results: calretinin positive in 5/5, mesothelin 3/5, cytokeratin 4/5, epithelial membrane antigen 2/2; hepatocyte marker 0/5 and carcinoembryonic antigen 0/5
  • On CT, the liver lesions typically grew inside the liver along its capsule, with breakthrough of the capsule and spread outside the liver
  • Only case 5, treated with intravenous pemetrexed and cisplatin, was alive at the time of writing. The other 4 patients survived a mean of 6.5 months (range 5 to 8 months)
  • Of the 8 published cases reviewed, 1 was reported as peritoneal mesothelioma invading the liver and 7 as primary hepatic mesothelioma. Only 1 of these 8 patients had a history of asbestos exposure
  • Radiology and surgery experts at the authors' hospital re-read the images in the published reports and judged the lesions to be under the liver capsule and possibly continuous with the peritoneum in all 7 other patients
• The authors' conclusion: The authors concluded that primary liver mesothelioma is likely rare and that peritoneal mesothelioma invading the liver is more common. They wrote that diagnosis is reliably achieved through asbestos exposure history, characteristic CT images and tumour staining profiles, while also stating that careful CT, histological and immunohistochemical analysis is required to reach a final diagnosis.
• Limitations the authors state:
  • The authors stated that more cases are needed to describe the features, biological behaviour and prognosis of this condition

Topics

Medical terms in this study, explained in our Lexicon: Peritoneum, Mesothelioma, Peritoneal Mesothelioma, Malignant Mesothelioma, Epithelioid, Asbestos Exposure.

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