Hematogenous dissemination of malignant pleural mesothelioma: An autopsy case of gallbladder metastasis causing obstructive jaundice

Our plain-English summary of Hematogenous dissemination of malignant pleural mesothelioma: An autopsy case of gallbladder metastasis causing obstructive jaundice, by S. Okamoto, M. Shinomiya (Respiratory Medicine Case Reports, 2025).

The study

• Authors: S. Okamoto, M. Shinomiya
• Journal: Respiratory Medicine Case Reports
• Published: 2025;58:102315
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive cancer with poor prognosis. Although hematogenous metastasis is rare, we report an autopsy case in which gallbladder metastasis had caused fatal obstructive jaundice. A 72-year-old man, who had experienced long-term exposure to asbestos, was diagnosed with epithelioid MPM. Despite immuno- and chemotherapy, the disease progressed. Nineteen months later, the patient was admitted with jaundice and renal failure. Imaging showed mild gallbladder wall thickening, but no overt obstruction. The patient died 10 days after admission. An autopsy revealed widespread metastases, including full-thickness gallbladder infiltration and bile stasis in the liver. Acute tubular necrosis of the kidneys and bile protein casts in the renal tubules suggested bile cast nephropathy. The findings of this case suggest that gallbladder metastasis from MPM may cause obstructive jaundice and multi-organ failure, potentially contributing to death. Clinicians should be aware of this rare metastatic pattern when evaluating liver dysfunction in patients with advanced MPM.

© 2025 The Authors.

In plain English

This case report described one patient: a 72-year-old man in Japan who had never smoked and had a 30-year history of occupational asbestos exposure. The article did not name a fiber type or job. CT showed a left-sided pleural effusion and pleural plaques on both sides, and epithelioid malignant pleural mesothelioma was diagnosed. The disease progressed despite immunotherapy and then chemotherapy. Nineteen months after diagnosis, the patient was admitted with jaundice and kidney failure. CT showed mild gallbladder wall thickening but no significant blockage of the bile or urinary tracts. The patient died on hospital day 10. At autopsy, the tumor had spread to many organs, and tumor cells inside blood vessels, mainly veins, indicated spread through the bloodstream. Tumor ran through the full thickness of the gallbladder wall, the liver showed bile stasis, and the kidneys showed acute tubular necrosis with casts consistent with bile pigment. The authors concluded that obstructive jaundice from the gallbladder metastasis likely led to liver failure and then kidney injury (bile cast nephropathy). They stated that, to their knowledge, this was the first report of gallbladder metastasis from this cancer.

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 autopsy case)
• Who was studied: One 72-year-old man who had never smoked, seen at Osaka Saiseikai Ibaraki Hospital, Japan
• Exposure: 30-year history of occupational asbestos exposure; fiber type and job not reported
• Main results:
  • At presentation, CT showed left-sided pleural effusion and bilateral pleural plaques.
  • The patient was diagnosed with epithelioid malignant pleural mesothelioma, stage IB (cT2N0M0).
  • The patient received three cycles of nivolumab and ipilimumab; the disease was assessed as progressive.
  • Nineteen months after diagnosis, the patient was admitted with jaundice. Total bilirubin was 7.0 mg/dL and creatinine was 2.7 mg/dL.
  • Imaging on admission found no significant blockage of the hepatobiliary or urinary tracts, but showed mild gallbladder wall thickening and perihepatic ascites.
  • By Day 7, total bilirubin had reached 15.5 mg/dL and ALP 1,973 IU/L, creatinine had risen to 8.3 mg/dL, and potassium to 6.8 mEq/L. The patient died on Day 10.
  • At autopsy, tumor cells were found within blood vessels, mainly veins, which the authors took to indicate spread through the bloodstream.
  • Tumor cells infiltrated the entire thickness of the gallbladder wall, and compressing the gallbladder by hand failed to express bile.
  • The liver showed patchy green discoloration suggestive of bile stasis.
  • The kidneys showed changes consistent with acute tubular necrosis, with greenish casts in the renal tubules.
• The authors' conclusion: The authors concluded that this case illustrates that malignant pleural mesothelioma can spread extensively through the bloodstream to the gallbladder. They described this as, to their knowledge, the first such report, and judged that obstructive jaundice likely led to liver failure and then kidney impairment (bile cast nephropathy).

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Autopsy, Metastasis, Prognosis, Epithelioid, Chemotherapy, Necrosis, Tubule.

Related studies

• An autopsy case of serous papillary carcinoma of peritoneum with distant metastases but no peritoneal dissemination — O. Miyaishi, K. Iida, et al. (1994)
• Gingival metastasis as first sign of multiorgan dissemination of epithelioid malignant mesothelioma — A. Billè, M. Platania, et al. (2014)
• Gamma knife radiosurgery of brain metastasis from malignant pleural mesothelioma--report of three cases with autopsy study in a case — T. Kobayashi, T. Tsugawa, et al. (2014)
• Pseudomesotheliomatous carcinoma of the pleura: an autopsy case of metastasis from a G-CSF-producing anaplastic carcinoma of the pancreas — Y. Hattori, K. Sentani, et al. (2018)
• Loss of BAP1 expression is associated with genetic mutation and can predict outcomes in gallbladder cancer — T. Hirosawa, M. Ishida, et al. (2018)
• Asbestos fibers in the gallbladder of patients affected by benign biliary tract diseases — F. Grosso, L. Randi, et al. (2015)

Browse more research in Respiratory Medicine Case Reports, or return to medical research.