Hematogenous dissemination of malignant pleural mesothelioma: An autopsy case of gallbladder metastasis causing obstructive jaundice

Malignant pleural mesothelioma (MPM) is an aggressive cancer with poor prognosis. Although hematogenous metastasis is rare, we report an autopsy case in which gallbladder metastasis had caused fatal obstructive jaundice. A 72-year-old man, who had experienced long-term exposure to asbestos, was diagnosed with epithelioid MPM. Despite immuno- and chemotherapy, the disease progressed. Nineteen months later, the patient was admitted with jaundice and renal failure. Imaging showed mild gallbladder wall thickening, but no overt obstruction. The patient died 10 days after admission. An autopsy revealed widespread metastases, including full-thickness gallbladder infiltration and bile stasis in the liver. Acute tubular necrosis of the kidneys and bile protein casts in the renal tubules suggested bile cast nephropathy. The findings of this case suggest that gallbladder metastasis from MPM may cause obstructive jaundice and multi-organ failure, potentially contributing to death. Clinicians should be aware of this rare metastatic pattern when evaluating liver dysfunction in patients with advanced MPM.