title: Lymph node dissection in primary intrahepatic malignant mesothelioma: case report and implications for diagnosis and therapy.
abstract: BACKGROUND
  In this rare case of intrahepatic malignant mesothelioma with subsequent lymph node metastases, hepatic segmentectomy in combination with repeated lymphadenectomy resulted in prolonged survival, currently 37 months after initial diagnosis.
  
  
  CONCLUSIONS
  Immunohistochemically, vascular endothelial growth factor receptor-1 expressing tumor cells were surrounded by a dense D 2-40-positive lymphangiovascular network, suggesting tumor induced lymphangiogenesis correlating to 2-deoxy-2[(18)F]fluoro-d-glucose-positron emission tomography/computed tomography-positive recurrent intraabdominal and intrathoracic lymphatic tumor spread. Therefore, extended lymphadenectomy during primary tumor resection and combined adjuvant chemotherapy with promising anticancer agents possessing antilymphangiogenic and antimetabolite properties should be considered to prolong survival in cases of extrathoracic malignant mesothelioma. Additionally, as shown in our case, individual operative concepts and (sometimes) multiple operations can be beneficial for highly selected patients. Importantly, a case-by-case optimized antitumor regimen requires interdisciplinary expertise and consensus of all involved faculties.
authors.affiliation: Department of Surgery, University of Bonn Medical Center, Bonn, Germany. Bettina.Buchholz@ukb.uni-bonn.de
authors.forename: Bettina M
authors.initials: BM
authors.lastname: Buchholz
authors.forename: Ines
authors.initials: I
authors.lastname: Gütgemann
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Fischer
authors.forename: Marcus
authors.initials: M
authors.lastname: Gorschlüter
authors.forename: Andreas
authors.initials: A
authors.lastname: Türler
authors.forename: Jörg C
authors.initials: JC
authors.lastname: Kalff
authors.forename: Andreas
authors.initials: A
authors.lastname: Hirner
authors.forename: Jens
authors.initials: J
authors.lastname: Standop
mesh_terms: D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation