Primary malignant mesothelioma of the diaphragm with liver invasion: A case report and review of literature

Our plain-English summary of Primary malignant mesothelioma of the diaphragm with liver invasion: A case report and review of literature, by W.J. Huang, Z.H. Li, Z. Wang, et al (Medicine, 2019).

The study

• Authors: W.J. Huang, Z.H. Li, Z. Wang, M.Q. Yang, H.T. Xu
• Journal: Medicine
• Published: 2019;98(15):e15147
• Type of article: Case report, Review
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Rationale: Malignant mesothelioma is a malignant tumor with poor prognosis, which usually originates in the pleura, peritoneum, and pericardial cavity. Mesotheliomas that originate from the diaphragm are very rare. Here, we report a case of primary malignant mesothelioma of the diaphragm with liver invasion.

Patient Concerns: A 66-year-old woman was admitted to our hospital because of a "liver space-occupying lesion," without any special clinical symptoms. Imaging examinations suggested a cystic-solid mixed lesion in the right lobe of the liver.

Diagnosis: The tumor was diagnosed as epithelioid mesothelioma of the diaphragm with liver invasion.

Intervention: The patient underwent abdominal surgery in our hospital to remove the diaphragmatic mass, liver mass, and part of the diaphragm.

Outcomes: The postoperative course was uneventful.

Lessons: Primary diaphragmatic malignant mesothelioma is very rare and may involve liver or lung tissue and be mistaken for liver or lung tumor. Accurate diagnosis depends on careful pathological examination. Immunohistochemical staining is very useful to distinguish this tumor from other liver or diaphragmatic tumors.

In plain English

This article is a case report with a short review of earlier published cases. The authors described a 66-year-old woman seen at their hospital in China in December 2017 for what imaging suggested was a mass in the right lobe of the liver. She had no notable symptoms and denied any history of asbestos exposure. At surgery, the tumor was found to grow from the right side of the diaphragm and bulge down into the liver. It was removed along with part of the diaphragm and the affected liver. Tissue staining led to a diagnosis of epithelioid mesothelioma (microcystic type) of the diaphragm with liver involvement. She received no radiotherapy or chemotherapy, and after 11 months of follow-up she showed no evidence of recurrence. The authors' table listed 7 cases of primary diaphragmatic mesothelioma, including this one: 5 were epithelioid, 1 biphasic and 1 sarcomatoid, and only 1 patient had a history of asbestos exposure. The authors concluded that this tumor may be mistaken for a liver or lung tumor and that accurate diagnosis depends on careful pathological examination.

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 with a review of previously reported cases
• Who was studied: one 66-year-old woman seen at the authors' hospital (China Medical University, Shenyang, China) in December 2017 for a liver space-occupying lesion
• Exposure: No asbestos exposure was reported for this patient; she denied any history of asbestos exposure. No fiber types, products or jobs are described.
• Main results:
  • Based on imaging, which included a CT showing a round lesion of about 8.2 by 8.2 by 7.3 cm, the tumor was thought to be a liver tumor, and open abdominal surgery was performed.
  • During surgery the tumor (about 8 by 8 by 7 cm) was found to grow from the right side of the diaphragm and bulge downward into the liver, partially invading the right liver.
  • Almost all tumor cells stained strongly positive for mesothelial and related markers, including WT1, calretinin, CK5/6 and D2-40. The Ki-67 proliferation index was about 5% to 10%.
  • The tumor was diagnosed as epithelioid mesothelioma (microcystic type) of the diaphragm with liver involvement.
  • The patient was not given radiotherapy or chemotherapy. After 11 months of follow-up she was in good condition with no evidence of recurrence.
  • In the authors' summary of 7 primary diaphragmatic mesothelioma cases (the table includes the present case), 5 were epithelioid type (71.4%), 1 biphasic (14.3%) and 1 sarcomatoid (14.3%).
  • Of the 7 summarized cases, only 1 patient had a history of asbestos exposure.
• The authors' conclusion: The authors concluded that primary diaphragmatic malignant mesothelioma may involve the liver or lung and be mistaken for a liver or lung tumor, that accurate diagnosis depends on careful pathological examination, and that immunohistochemical staining is very useful to distinguish it from other liver or diaphragmatic tumors.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Diaphragm, Prognosis, Pleura, Peritoneum, Pericardial, Epithelioid, Immunohistochemistry.

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