Kim Dong-Sik, Lee Sung-Gyu, Jun Sun-Young, Kim Kyoung Won, Ha Tae-Yong, Kim Keon-Kuk
Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA.
Hepatogastroenterology. 2008 May-Jun;55(84):1081-4.
The following reports a rare case of primary localized malignant mesothelioma of the liver. A 53-year-old man with no history of exposure to asbestos was admitted to our department for evaluation of incidentally detected liver mass. Computed tomography and hepatic angiogram showed a tumor at the dome of the liver, which was fed mainly through the inferior phrenic artery. The mass was resected, including a portion of the diaphragm. Microscopically, the tumor was composed of cord-like or trabecular arrangements of epithelioid cells having abundant eosinophilic cytoplasm and prominent nucleoli. Immunohistochemically, the tumor cells were strongly positive for calretinin and cytokeratin 5 and negative for hepatocyte markers. These findings were consistent with our diagnosis of epithelioid mesothelioma. A local recurrence was noted 15 months after surgery, which was treated by radiofrequency ablation. At 23 months after initial surgery, locally recurrent masses with direct invasion of the diaphragm and a solitary intrahepatic metastasis were noted, which was treated by partial excision of the diaphragm with intraoperative RFA after transarterial chemoembolization.
以下报告了一例罕见的原发性肝脏局限性恶性间皮瘤病例。一名53岁男性，无石棉接触史，因偶然发现肝脏肿块入院接受评估。计算机断层扫描和肝脏血管造影显示肝脏顶部有一个肿瘤，主要由膈下动脉供血。该肿块被切除，包括部分膈肌。显微镜下，肿瘤由具有丰富嗜酸性细胞质和明显核仁的上皮样细胞呈索状或小梁状排列组成。免疫组化显示，肿瘤细胞钙视网膜蛋白和细胞角蛋白5呈强阳性，肝细胞标志物呈阴性。这些发现与我们对上皮样间皮瘤的诊断一致。术后15个月出现局部复发，通过射频消融治疗。初次手术后23个月，发现局部复发肿块直接侵犯膈肌并伴有孤立性肝内转移，经动脉化疗栓塞后，术中射频消融下部分切除膈肌进行治疗。
