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Lymph node dissection in primary intrahepatic malignant mesothelioma: case report and implications for diagnosis and therapy

  • Case Management and Clinical Consequences
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Abstract

Introduction

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.

Discussion

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[18F]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.

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Abbreviations

CA 12–5:

Carbohydrate antigen 12–5

CA 19–9:

Carbohydrate antigen 19–9

CEA:

Carcinoembryonic antigen

CT:

Computed tomography

FDG-PET:

2-Deoxy-2[18F]fluoro-d-glucose-positron emission tomography

MPM:

Malignant pulmonary mesothelioma

MRI:

Magnetic resonance imaging

NSCLC:

Nonsmall cell lung cancer

VEGF:

Vascular endothelial growth factor

VEGFR1:

Vascular endothelial growth factor receptor 1

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Acknowledgments

We are grateful to A.J. Bauer and R. S. Chanthaphavong for the editorial assistance and critical reading of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, University of Bonn Medical Center, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Bettina M. Buchholz, Andreas Türler, Jörg C. Kalff, Andreas Hirner & Jens Standop

  2. Institute of Pathology, University of Bonn Medical Center, Bonn, Germany

    Ines Gütgemann & Hans-Peter Fischer

  3. Department of Internal Medicine III, University of Bonn Medical Center, Bonn, Germany

    Marcus Gorschlüter

Authors
  1. Bettina M. Buchholz
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  2. Ines Gütgemann
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  6. Jörg C. Kalff
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Correspondence to Bettina M. Buchholz.

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Buchholz, B.M., Gütgemann, I., Fischer, HP. et al. Lymph node dissection in primary intrahepatic malignant mesothelioma: case report and implications for diagnosis and therapy. Langenbecks Arch Surg 394, 1123–1130 (2009). https://doi.org/10.1007/s00423-009-0476-x

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  • DOI: https://doi.org/10.1007/s00423-009-0476-x

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