Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Feb 7, 2009; 15(5): 615-621
Published online Feb 7, 2009. doi: 10.3748/wjg.15.615
Primary localized malignant biphasic mesothelioma of the liver in a patient with asbestosis
Motoko Sasaki, Ichiro Araki, Toshiaki Yasui, Masaru Kinoshita, Keita Itatsu, Takayuki Nojima, Yasuni Nakanuma
Motoko Sasaki, Keita Itatsu, Yasuni Nakanuma, Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan
Ichiro Araki, Department of Internal Medicine, Asanogawa General Hospital, Kanazawa 920-8621, Japan
Toshiaki Yasui, Department of Surgery, Asanogawa General Hospital, Kanazawa 920-8621, Japan
Masaru Kinoshita, Hanazono Medical Office, Kanazawa 920-0293, Japan
Takayuki Nojima, Department of Pathology, Kanazawa Medical University, Ishikawa 920-0293, Japan
Author contributions: Araki I, Yasui T and Kinoshita M performed the patient’s care and the operations; Itatsu K, Nojima T and Nakanuma Y were the consultants overseeing the radiological and histopathological findings; Sasaki M wrote the manuscript.
Correspondence to: Yasuni Nakanuma, MD, Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan. pbcpsc@kenroku.kanazawa-u.ac.jp
Telephone: +81-76-2652195
Fax: +81-76-2344229
Received: October 9, 2008
Revised: November 19, 2008
Accepted: November 26, 2008
Published online: February 7, 2009
Abstract

We report a case of primary localized malignant biphasic mesothelioma of the liver in a 66-year-old man associated with asbestosis. The tumor was detected as a hepatic nodule, 4 cm in diameter, in the right lobe (S8 segment) on CT scan. Histopathological examination demonstrated an intrahepatic tumor with central necrosis consisting of a papillary epithelioid pattern on the surface of the liver, microcystic (microglandular or adenomatoid) pattern mainly in the subcapsular area and sarcomatoid pattern intermingled with microcystic pattern in the major part of the hepatic nodular tumor. Tumor cells, especially of epithelioid type, showed distinct immunoreactivity for mesothelial markers (WT-1, calretinin, D2-40, CK5/6, mesothelin, thrombomodulin) and no immunoreactivity for epithelial (adenocarcinoma) markers (CEA, CD15, BerEP4, BG8, MOC31). P53 immunoreactivity was detected focally in papillary epithelioid tumor cells and extensively in microcystic and sarcomatoid components, suggesting that the papillary epithelioid mesothelioma arose on the surface of the liver, and tumor cells showing microcystic and sarcomatoid patterns invaded and grew into the liver. To date, this is the first case of primary localized malignant biphasic mesothelioma of the liver, since all three primary hepatic mesotheliomas reported so far were epithelioid type.

Keywords: Malignant mesothelioma; Pulmonary asbestosis; Liver; Immunohistochemistry