PMC5725154_01
Abdominal CT scan (A) revealed a severe hydronephrosis of the right kidney and bowel-wall thickening of the ascend colon.
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Initial computed tomography (CT) scan showed a 6.5*6.5 cm mass in the hepatic flexure (Fig. 1B and C), multiple low-density foci in the left lobe of liver, multiple small mesenteric nodules, and hydronephrosis of the right kidney. A large lymph node was also revealed on CT scan with a size of 5*5 cm, causing obstruction of the right ureter and hydronephrosis of the right kidney (Fig. 1A).
Multiple diminutive ill-defined hepatic lesions (arrow) were visualized during the surgery.
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During the surgical exploration, an 8*7*6 cm irregular globular clear-edged mass was identified in the ascending colon and multiple diminutive ill-defined hepatic lesions were visualized (Fig. 2), leading to right hemicolectomy (Fig. 3A) without hepatic resection.
The resected specimen of hepatic flexure of the colon (A) and right kidney (B).
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The patient then underwent right nephrectomy (Fig. 3B).
Histological finding (HE staining) showed that malignant mesothelioma invading the inferior vena cava (A) and duodenum (B) (black arrows). Evaluation of the nephrectomy and hemicolectomy specimen (HE staining) confirmed a non-invasive low-grade urothelial carcinoma (C) in the kidney and a moderately or poorly differentiated adenocarcinoma (D) in the hepatic flexure (black arrows).
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Postoperative examination of the specimen (hematoxylin-eosin staining, HE staining) revealed a moderately or poorly differentiated adenocarcinoma (Fig. 4D) (T4b), positive for Ki-67 (70%), MLH1, MSH6, PMS2, CDX2, human epidermal growth factor receptor-2 (HER2), cytokeratin (CK) 20, carcinoembryonic antigen (CEA) and negative for MSH2, CK5/6, MC, CK7. Histological findings (HE staining) of the ureter and adjacent tissue confirmed a non-invasive low-grade urothelial carcinoma (Fig. 4C) positive for CD10, Epithelial membrane antigen (EMA), CK20, Ki-67 (5%) and negative for Vimentin, CK7. Moreover, the resected tissue before the inferior vena cava (Fig. 4A) and the involved duodenal segment (Fig. 4B) (HE staining) were demonstrated to be malignant mesothelioma.