Lymph node dissection in primary intrahepatic malignant mesothelioma: case report and implications for diagnosis and therapy.
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.
Buchholz
Bettina M
BM
Department of Surgery, University of Bonn Medical Center, Bonn, Germany. Bettina.Buchholz@ukb.uni-bonn.de
Gütgemann
Ines
I
Fischer
Hans-Peter
HP
Gorschlüter
Marcus
M
Türler
Andreas
A
Kalff
Jörg C
JC
Hirner
Andreas
A
Standop
Jens
J
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