Primary intrahepatic mesotheliomas: A case presentation and literature review

Our plain-English summary of Primary intrahepatic mesotheliomas: A case presentation and literature review, by H. Ismael, S. Cox (International Journal of Surgery Case Reports, 2018).

The study

• Authors: H. Ismael, S. Cox
• Journal: International Journal of Surgery Case Reports
• Published: 2018;47:1-6
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Primary Intrahepatic mesotheliomas are malignant tumors arising from the mesothelial cell layer covering Glisson's capsule of the liver. They are exceedingly rare with only fourteen cases reported in the literature. They have nonspecific signs and symptoms and need a high index of suspicion and an extensive workup prior to surgery. Surgery remains the mainstay of treatment.

Presentation Of Case: 48 year old male presented with a 3 months history of abdominal pain, productive cough, anemia and weight loss. He had no history of asbestos exposure. A computed tomography scan and magnetic resonance study demonstrated a heterogeneous subscapular mass within the dome of the right hepatic lobe measuring 11.3 × 6.1 cm involving the diaphragm. Combined resection of the liver and diaphragm was performed to achieve negative margins. Pathology demonstrated an epithelioid necrotic intrahepatic mesothelioma that stained positive for calretinin, CK AE1/AE3, WT-1, D2-40 and CK7.

Discussion: Primary intrahepatic mesotheliomas originate from the mesothelial cells lining Glisson's capsule of the liver. They predominantly invade the liver but may also abut or involve the diaphragm. Surgery should include a diagnostic laparoscopy to rule out occult disease or diffuse peritoneal mesothelioma. Complete resection with negative margins should be attempted while maintaining an adequate future liver remnant. Attempts at dissecting the tumor off the involved diaphragm will result in excessive bleeding and may leave residual disease behind.

Conclusion: Intrahepatic mesotheliomas are rare peripherally-located malignant tumors of the liver. They require a high index of suspicion and a comprehensive workup prior to operative intervention.

Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

In plain English

This article reported one patient's case and reviewed earlier published cases of primary intrahepatic mesothelioma, a mesothelioma based in the liver. The patient, a 48-year-old man, had three months of right upper abdominal pain, productive cough and a forty pound weight loss. He had no history of asbestos exposure. Scans showed an 11.3 by 6.1 cm mass in the right lobe of the liver involving the diaphragm. Surgeons removed part of the liver together with the involved part of the diaphragm, and all margins were free of tumor. Pathology showed a predominantly epithelioid mesothelioma. The authors searched PubMed and MEDLINE and tabulated 15 cases, including this one. In that group, 46.7% were male, the mean age was 60.4 years, at least 5 of 15 had anemia before surgery, and the majority had no history of asbestos exposure. The authors concluded that most cases are not related to asbestos exposure. They also concluded that surgery, removing the involved diaphragm together with the liver tumor, is the mainstay of treatment. The article gives his age as 48 in the text but 60 in its table.

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 previously published cases
• Who was studied: One 48-year-old man treated at the University of Texas Health Northeast (Tyler, Texas). The literature review tabulated 15 cases (14 published from 1989 to 2016, plus this one).
• Exposure: The patient had no history of asbestos exposure. In the review table, most cases were recorded as having no asbestos exposure, one earlier case (Sasaki et al., 2009) was recorded as exposed, and three were not recorded.
• Main results:
  • In the patient, CT and MRI showed a mass in the dome of the right liver lobe measuring 11.3 by 6.1 cm and involving the diaphragm.
  • Before surgery, a needle biopsy of the patient's mass could not distinguish between sarcomatoid carcinoma and mesothelioma.
  • The patient's operation lasted 230 minutes, with an estimated blood loss of 350 ml. He was discharged on postoperative day 4.
  • Pathology of the removed tumor showed a malignant, predominantly epithelioid intrahepatic mesothelioma measuring 10 by 7 by 5.5 cm, with 90% necrosis. All margins were negative.
  • The patient's tumor stained positive for calretinin, CK AE1/AE3, WT-1, D2-40 and CK7.
  • Across the 15 reviewed cases, 46.7% were male. Mean age at presentation was 60.4 years (range 41 to 83).
  • Across the reviewed cases, the majority had no history of asbestos exposure.
  • Across the reviewed cases, anemia before surgery affected at least one third of patients (5 of 15).
  • Across the reviewed cases, mean tumor diameter was 10.7 cm (range 3.2 to 24 cm), and 66.7% had epithelioid histology.
• The authors' conclusion: The authors concluded that most cases of primary intrahepatic mesothelioma are not related to asbestos exposure. They concluded that imaging and biopsy help confirm the diagnosis and guide therapy. They concluded that surgery is the mainstay of treatment, with the involved diaphragm removed together with the liver tumor.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Mesothelial Cells, Asbestos Exposure, Diaphragm, Pathology, Epithelioid, Calretinin, Wilms Tumor 1 (WT-1).

Related studies

• Primary intrahepatic malignant epithelioid mesothelioma — I. Perysinakis, A.M. Nixon, et al. (2014)
• A rare presentation of malignant mesothelioma of the tunica vaginalis managed with immunotherapy and review of the literature — K. Mishra, S. Siddiquee, et al. (2023)
• Malignant mesothelioma presenting as recurrent hydro-pneumothorax: An atypical case presentation and literature review — N. Sattar, R. Durrance, et al. (2018)
• Malignant Deciduoid Mesothelioma: case presentation of an exceptional variant and review of the literature — M. Khmou, S. Echcharif, et al. (2017)
• Spontaneous bilateral haemothorax as presentation of primary pleural epithelioid haemangioendothelioma — L. Ferreiro, E. San-José, et al. (2017)
• Pseudocarcinomatous Mesothelioma: A Hitherto Unreported Presentation closely simulating primary lung cancer — G. Rossi, G. Caroli, et al. (2021)

Browse more research in International Journal of Surgery Case Reports, or return to medical research.