Hepatic Benign Cystic Mesothelioma in Adults: A Case Report of a Rare Hepatic Cyst

Our plain-English summary of Hepatic Benign Cystic Mesothelioma in Adults: A Case Report of a Rare Hepatic Cyst, by A. Mohamed, S. Elsherif, R. Makary (Curēus, 2024).

The study

• Authors: A. Mohamed, S. Elsherif, R. Makary
• Journal: Curēus
• Published: 2024;16(1):e51832
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Benign cystic mesothelioma (BCM), also known as peritoneal inclusion cyst, is a benign mesothelial lined cystic lesion, nearly always described in the pelvis of adult females. The hepatic location of BCM is rarely reported in the literature. We report a case of hepatic benign cysts in a 65-year-old woman that was incidentally discovered by imaging studies 12 years ago as a small cyst. Recently, the patient started having abdominal discomfort, distension, and anxiety. A CT scan revealed two low-density fluid-filled cystic lesions, the largest in the caudate lobe measuring up to 10.7 cm and causing a mass effect on hepatic veins and inferior vena cava. Laparoscopic marsupialization of the large liver cyst was done without complications. On gross examination, the collapsed cyst wall was a thin partly translucent pale tan to pink membranous structure with fine vascularity. No discrete nodularity or solid lesion was identified. Microscopic examination showed a thin fibro-connective wall lined by a single layer of flat cuboidal cells with no cellular atypia. The cyst lining showed characteristic calretinin-positive immunohistochemical reactivity for mesothelium, supporting the diagnosis of BCM. Hepatic BCM is among a broad differential spectrum of cystic liver lesions ranging from developmental, reactive, inflammatory, and infectious lesions, benign to premalignant or frankly malignant neoplasms with different treatment strategies. Although BCM is the rarest among the long list of differential diagnoses of hepatic cysts, its identification in this rarely reported location is essential to avoid aggressive surgical treatment.

Copyright © 2024, Mohamed et al.

In plain English

This article is a case report about one patient: a 65-year-old woman with benign cystic mesothelioma (BCM) of the liver, which the authors describe as a benign cyst lined by mesothelial cells. BCM is also called peritoneal inclusion cyst. It is usually found in the pelvis of adult women, and the authors found only one earlier English-language report of it in an adult liver. Small liver cysts had been found by chance on imaging 12 years before. She later had abdominal discomfort, fatigue and sleep disturbance. A CT scan showed two fluid-filled cysts in the liver. The largest, in the caudate lobe, measured up to 10.7 cm and pressed on the hepatic veins and inferior vena cava. One year earlier it had measured 7.5 x 6.7 cm. The cyst was drained and its wall removed by laparoscopic surgery. Under the microscope it showed benign mesothelium that stained positive for calretinin, with no cellular atypia or mitoses. She recovered fully. The article does not mention asbestos or any other exposure.

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 brief literature review
• Who was studied: One 65-year-old woman seen at an outpatient clinic. Her small liver cysts had been found by chance on imaging 12 years earlier, during evaluation for fatty liver (hepatosteatosis). The article does not state where or when she was treated.
• Exposure: Not reported. The article does not mention asbestos or any other exposure.
• Main results:
  • In this patient, CT showed two fluid-filled cystic lesions in the liver. The largest was in the caudate lobe, measured up to 10.7 cm, and caused a mass effect on the hepatic veins and inferior vena cava.
  • On her CT scan one year earlier, the large caudate lobe cyst had measured 7.5 x 6.7 cm.
  • Her serum carcinoembryonic antigen was elevated at 4.8 (normal below 2.5 in non-smokers). The authors said this did not raise strong concern for malignancy.
  • The cyst was drained by laparoscopic marsupialization. A culture of the cyst fluid was negative.
  • Under the microscope, the cyst wall was lined by a single layer of flat to low cuboidal cells. These cells were consistent with benign mesothelium and stained positive for calretinin. The lack of cellular atypia or mitoses was consistent with BCM.
  • The patient recovered completely, with no complications, and her symptoms resolved.
  • In their literature review, the authors found only one previous English-language case of BCM in an adult liver.
• The authors' conclusion: The authors concluded that BCM is extremely rare in the liver and has non-specific symptoms. They also concluded that recognizing it in this rarely reported location is essential to avoid aggressive surgical treatment.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, CT Scan, Calretinin, Mesothelium, Neoplasm.

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• Intra-abdominal cystic lymphangioma of the mesocolon sigmoids: a rare entity in adult patient woman — A. Guachilema Ribadeneira, Á.R.T. Monard, et al. (2020)
• A rare case of benign multicystic peritoneal mesothelioma misdiagnosed as hydatid cyst found in the liver parenchyma and abdomen cavity of a male with asbestos exposure — A.B. Kelarji, M.S. Alshutaihi, et al. (2021)
• Benign cystic mesothelioma of the peritoneum: a rare case and review of the literature — S. Khuri, H. Gilshtein, et al. (2012)

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