Primary intrahepatic malignant mesothelioma with multiple lymphadenopathies due to non-tuberculous mycobacteria: A case report and review of the literature

Our plain-English summary of Primary intrahepatic malignant mesothelioma with multiple lymphadenopathies due to non-tuberculous mycobacteria: A case report and review of the literature, by N. Inagaki, K. Kibata, T. Tamaki, et al (Oncology Letters, 2013).

The study

• Authors: N. Inagaki, K. Kibata, T. Tamaki, T. Shimizu, S. Nomura
• Journal: Oncology Letters
• Published: 2013;6(3):676-680
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary intrahepatic malignant mesothelioma (PIHMM) is an extremely rare tumor with clinicopathological characteristics that remain to be elucidated. The current study presents the case of a 68-year-old female with PIHMM and multiple lymphadenopathies due to non-tuberculous mycobacteria. The patient presented with an intrahepatic tumor, 70 mm in diameter, in the right lobe of the liver. An ultrasound-guided fine-needle aspiration biopsy of the liver tumor revealed findings that were consistent with an intrahepatic malignant mesothelioma. The systemic lymph node swellings were due to epithelioid granulomas that were caused by non-tuberculous mycobacteria. However, a hepatic rupture occurred due to the rapid growth of the liver tumor and consequently, a surgical resection was not performed. A review of the literature revealed that the clinicopathological characteristics of PIHMM are similar to those of non-occupational mesothelioma. However, PIHMM is usually a solitary tumor and is rarely associated with cavity effusion in contrast with conventional mesothelioma. Therefore, surgical resection with curative intent is often recommended for patients with PIHMM.

In plain English

This article was a case report combined with a review of the published literature on primary intrahepatic malignant mesothelioma (PIHMM), a mesothelioma arising inside the liver. The patient was a 68-year-old woman seen at a hospital in Osaka, Japan. She had a 70 mm tumor in the right lobe of the liver, swollen lymph nodes in several places, and a prolonged low-grade fever. She had no history of asbestos exposure or smoking. A needle biopsy of the liver tumor showed features of malignant mesothelioma. A lymph node biopsy showed granulomas containing acid-fast bacteria rather than spread of the cancer, and the exact mycobacterium species was not identified. Planned surgery was not performed because the liver ruptured as the tumor grew rapidly. The authors reviewed this case together with six previously reported cases. One of the seven patients had a history of asbestos exposure. All seven tumors were single and in the right lobe, and none came with fluid in a body cavity. The authors concluded that PIHMM resembles non-occupational mesothelioma but is usually a single tumor, and wrote that surgical removal is often recommended.

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 plus a literature review of six previously published cases
• Who was studied: One 68-year-old female patient at Kansai Medical University Takii Hospital, Osaka, Japan; the literature review covered seven PIHMM patients in total (this case plus six published cases)
• Exposure: The patient had no history of asbestos exposure or cigarette smoking; no fiber types were named. In the reviewed cases, one of seven patients had a history of asbestos exposure.
• Main results:
  • In the patient, the liver tumor cells stained positive for calretinin, WT-1 and D2-40, which the authors said strongly suggested malignant mesothelioma
  • In the patient, the lymph node swellings were epithelioid granulomas with acid-fast bacilli, not mesothelioma spread; the mycobacterium species was not identified
  • In the patient, the PET/CT scan did not show a difference in metabolic behavior between the liver tumor and the lymph node lesions
  • In the patient, planned surgery was not performed because a hepatic rupture occurred
  • Across the seven reviewed cases there were five males and two females, aged 53 to 68 years (median 62)
  • Across the seven reviewed cases, one patient (14.3%) had a history of asbestos exposure
  • Across the seven reviewed cases, all tumors were in the right lobe, beneath the liver capsule, and 3.2 to 16 cm in diameter (mean 7.8 cm)
  • None of the reviewed cases had fluid in a body cavity (cavity effusion)
  • Of the seven reviewed cases, five were epithelioid and two were biphasic
• The authors' conclusion: The authors concluded that the clinical and pathological features of PIHMM are similar to those of non-occupational mesothelioma, but that PIHMM is usually a single tumor rarely accompanied by cavity effusion, so surgical resection with curative intent is often recommended
• Limitations the authors state:
  • Survival factors were not evaluated because the number of cases was small and survival information was inadequate

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Ultrasound, Fine-Needle Aspiration, Epithelioid, Granuloma, Surgical Resection.

Related studies

• Primary intrahepatic mesotheliomas: A case presentation and literature review — H. Ismael, S. Cox (2018)
• Primary intrahepatic malignant epithelioid mesothelioma — I. Perysinakis, A.M. Nixon, et al. (2014)
• Asymptomatic primary tuberculous pleurisy with intense 18-fluorodeoxyglucose uptake mimicking malignant mesothelioma — T. Shinohara, N. Shiota, et al. (2013)
• Primary malignant peritoneal mesothelioma mimicking tuberculous peritonitis: A case report — L.C. Lin, W.Y. Kuan, et al. (2022)
• Multiple malignant epithelioid mesotheliomas of the liver and greater omentum: a case report and review of the literature — K. Minami, H. Okumura, et al. (2017)
• Multiple intracranial metastases from postoperative giant sarcomatoid malignant pleural mesothelioma: A case report and literature review — D. Tian, H. Wen, et al. (2018)

Browse more research in Oncology Letters, or return to medical research.