Case Report: Whispers of the serpent: exploring uncommon imaging features in primary hepatic malignant mesothelioma

Our plain-English summary of Case Report: Whispers of the serpent: exploring uncommon imaging features in primary hepatic malignant mesothelioma, by G. Li, S. Hong, T. He, et al (Frontiers in Medicine, 2025).

The study

• Authors: G. Li, S. Hong, T. He, J. Xu
• Journal: Frontiers in Medicine
• Published: 2025;12:1713971
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Primary hepatic malignant mesothelioma (PHMM) is an uncommon and aggressive neoplasm with vague clinical and radiological features, posing challenges for preoperative diagnosis. In our case, a lobulated hepatic mass demonstrated a serpiginous peripheral enhancement pattern on contrast-enhanced CT and MRI. This uncommon imaging manifestation has been sporadically documented in previous reports. By consolidating these findings, our report emphasizes serpiginous peripheral enhancement as a potential diagnostic clue for PHMM. Recognition of this pattern may aid earlier detection, improve differential diagnosis, and guide timely surgical decision-making in affected patients.

Copyright © 2025 Li, Hong, He and Xu.

In plain English

This article was a case report, with a brief literature review, from a hospital in Huai'an, China. It described primary hepatic malignant mesothelioma (PHMM), a mesothelioma arising in the liver. The patient was a 66-year-old male farmer with right upper abdominal discomfort who denied any asbestos exposure. At another hospital the mass had been misdiagnosed as a liver abscess, and a needle biopsy found only liver fibrosis. Three months later, a CT showed the mass had not decreased. Contrast-enhanced CT showed a lesion of about 5.8 cm in segments VI to VII of the liver, and MRI showed a 5.6-cm lobulated lesion. Both showed a serpiginous (snake-like) pattern of enhancement around the edge of the lesion. Blood tumor markers were negative. Surgeons removed the tumor with negative margins, and tissue tests were consistent with PHMM of the epithelioid type. A CT three months after discharge showed no recurrence. The authors noted that this enhancement pattern had been described in earlier PHMM reports but is not unique to PHMM. They concluded it may be a potential diagnostic clue for PHMM.

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 brief literature review, including a table of PHMM cases reported in the previous 5 years
• Who was studied: One 66-year-old male farmer treated at The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, China; report published 2025
• Exposure: The patient denied any asbestos exposure; no fiber type or occupational asbestos exposure is reported
• Main results:
  • At an outside hospital the patient was misdiagnosed with a liver abscess and had a needle biopsy that found only liver fibrosis
  • Three months later, CT showed the liver mass had not decreased or resolved
  • Contrast-enhanced CT showed a hypodense lesion in liver segments VI to VII measuring approximately 5.8 cm
  • MRI showed a 5.6-cm lobulated lesion in the liver
  • Both CT and MRI showed a serpiginous (serpentine) distribution of enhancement along the edge of the lesion
  • Serum tumor markers CA19-9, CEA and AFP were negative
  • The tumor was completely removed with negative margins
  • Tissue and immunohistochemistry findings were consistent with PHMM of the epithelioid type
  • Contrast-enhanced CT at the first follow-up, three months after discharge, showed no signs of tumor recurrence
  • In their literature review, the authors noted that serpiginous peripheral enhancement had been sporadically described in earlier reported PHMM cases
• The authors' conclusion: The authors concluded that serpiginous peripheral enhancement is a potential diagnostic clue for PHMM, and that with more case reports it may contribute to earlier recognition and more accurate differential diagnosis
• Limitations the authors state:
  • The authors noted that serpiginous peripheral enhancement is not unique to PHMM and may be seen in other liver lesions
  • The authors stated that the imaging characteristics of PHMM are not yet fully defined

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Neoplasm, Differential Diagnosis.

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