Intradural pleural malignant mesothelioma

Pleural Neoplasms-What Could MRI Change?

The primary pleural neoplasms constitute around 10% of the pleural tumors. The currently recommended method for their imaging is CT which has been shown to have certain limitations. Strong development of the MRI within the last two decades has provided us with a number of sequences that could potentially be superior to CT when it comes to the pleural malignancies' detection and characterization. This literature review discusses the possible applications of the MRI as a diagnostic tool in patients with pleural neoplasms. Although selected MRI techniques have been shown to have a number of advantages over CT, further research is required in order to confirm the obtained results, broaden our knowledge on the topic, and pinpoint the sequences most optimal for pleural imaging, as well as the best methods for reading and analysis of the obtained data.

Intramedullary Metastasis to the Cervical Spinal Cord from Malignant Pleural Mesothelioma: Review of the Literature and Case Reports

Context:

Malignant mesothelioma is an aggressive tumor; median survival of patients following diagnosis is 12 months.

Aims:

Pleural malignant mesothelioma tends to spread along preexisting tissue planes and has the rare ability to spread along the nerve root into the spinal cord. In our case, there is an evidence of exceptional direct hematogenous spread to the spinal cord by the spinal branch of the intercostal arteries or the veins of Batson's plexus.

Settings and Design:

The authors report a case of intramedullary hematogenous metastasis to the cervical spinal cord from malignant mesothelioma, with a review of the literature.

Materials and Methods:

A 68-year-old male was admitted to our department because of a slowly progressive mild weakness of both low extremities, more pronounced on the left side. The patient has been treated for a malignant mesothelioma with left thoracotomy and subsequently underwent radiotherapy. Magnetic resonance imaging of the cervical-thoracic spine revealed a contrast-enhancing intramedullary expansive lesion of the left half of the spinal cord at the C6–C7 level.

Results:

The patient underwent surgical treatment through a C6–C7 laminectomy. Through a median posterior spinal cord incision, an intramedullary grayish lesion was completely removed. The paraparesis progressively improved and 20 days after surgery, the patient had regained normal lower extremity function.

Conclusions:

Malignant mesothelioma can spread to the spinal canal by the direct extension through the intervertebral foramina, by hematogenous spread to the spinal meninges, and by perineural growth along a single nerve root. The cleavage plane of the tissue may determine whether a successful gross total resection can be achieved with a good outcome for the patient.

Primary Spinal Malignant Mesothelioma: A Case Report and Literature Review

BACKGROUND

Malignant mesotheliomas are aggressive and rapidly fatal neoplasms arising from the mesothelial cells. The most common sites of origin are the pleural and peritoneal cavities; the pericardium and the tunica vaginalis are infrequently involved, and malignant mesothelioma in the spinal canal is extremely rare. Here we report a case of primary spinal malignant mesothelioma. We also report the results of a literature search conducted in PubMed with specific key terms, inclusion criteria, and exclusion criteria, with a comparison of elected case studies and case series, and statistical analysis as appropriate.

CASE DESCRIPTION

A 35-year-old man presented with a 3-month history of swelling and pain in the left lower extremity. Neurologic examination revealed a loss of sensation below the L5 dermatome. Magnetic resonance imaging (MRI) showed a mass at the L4-5 level. A diagnosis of schwannoma was suspected, and surgical resection was performed. Histopathological findings were consistent with sarcomatoid malignant mesothelioma. Thoracic and whole-abdomen computed tomography yielded normal results. The patient refused adjuvant radiotherapy or chemotherapy. Positron emission tomography-computed tomography performed at 3 months postoperatively showed no abnormality. At 8 months postoperatively, the patient developed back pain and difficulty with defecation; MRI demonstrated tumor recurrence. During a second operation, invasion of the vertebra and cauda equina was noted. A subtotal resection was achieved, and the pain was partially alleviated. Two months later, the patient succumbed to a traffic accident.

CONCLUSIONS

Spinal malignant mesothelioma is an extremely rare but highly aggressive entity. Preoperative identification is challenging, and definitive diagnosis depends on histopathological evidence. Surgical resection can help relieve the symptoms, but the overall prognosis is poor.

Invasive sarcomatoid mesothelioma resulting in spinal cord compression: case report

Mesothelioma is more likely to metastasize by local invasion, and metastases to the nervous system are rare. There are currently 10 reported cases of spinal cord compression as a result of mesothelioma. We report a 74-year-old patient with sarcomatoid mesothelioma that spreads across the dura into the spinal cord at T4/T5 level. This case report illustrates an unusual presentation of spinal cord compression by mesothelioma. It details the presenting symptoms, examinations and management of the patient and provides an overview of other potential metastatic sites of mesothelioma.

Malignant mesothelioma and central nervous system metastases. Report of two cases, pooled analysis, and systematic review

RATIONALE

The incidence and patterns of metastatic disease to the central nervous system (CNS) from malignant mesothelioma are not well characterized.

OBJECTIVES

We describe the treatment of two cases of pleural mesothelioma with CNS metastases. We also report the results of a systematic review with pooled data analysis of CNS metastases from malignant mesothelioma.

METHODS

PubMed, Scopus, EMBASE, and Web of Science were searched to identify relevant published studies. Inclusion criteria for the pooled analysis were any clinical or autopsy study in which patients had a confirmed histological diagnosis of malignant mesothelioma and CNS metastasis was identified by autopsy, clinical pathological specimen, or compelling radiographic imaging. Case reports were excluded from the pooled analysis but were incorporated into the discussion. One hundred forty-one potentially relevant references were identified. Seven studies including 655 patients were included in the pooled analysis. Ninety-seven additional cases were identified and incorporated into the discussion. A systematic review of the literature is provided with pooled data analysis.

MEASUREMENTS AND MAIN RESULTS

CNS involvement of malignant mesothelioma may occur by hematogenous spread or by local extension. Some cases may represent tumor dedifferentiation to a more aggressive histologic subtype. Surgery or stereotactic therapies may play a role for select patients; however, rapid recurrence has been reported.

CONCLUSIONS

The prognostic significance of CNS disease is not well characterized. Clinicians should consider and identify CNS involvement in patients with new or evolving neurologic symptoms because early identification may allow for palliative intervention.

Cerebral Metastasis of a Malignant Pleural Mesothelioma: A Case Report and Review of the Literature

BACKGROUND

Malignant pleural mesothelioma (MPM) is an aggressive malignant neoplasm that was thought to be a localised disease with limited metastatic capability. However, recent post-mortem studies have identified metastases to the central nervous system (CNS) in about 3% of cases.

CASE DESCRIPTION

We present the case of a 65-year-old with a solitary supratentorial metastatic deposit of MPM treated with surgical resection and adjuvant whole brain radiotherapy. Despite a good surgical outcome with symptomatic recovery, the patient died of cardiopulmonary compromise five months postoperatively.

CONCLUSIONS

Although rare, CNS metastasis of MPM is a condition that neurosurgeons should be aware of. CNS metastases may occur via three distinct mechanisms, namely perineural spread, leptomeningeal carcinomatosis and, most commonly, haematogenous spread leading to parenchymal deposits. Surgical resection of these deposits can lead to symptomatic improvement, and together with radiotherapy, to local disease control. However, the overall survival remains poor.

Sarcomatoid malignant mesothelioma presenting with intramedullary spinal cord metastasis: a case report and literature review

Study Design Case report. Objective Malignant mesothelioma (MM) is an uncommon tumor of the pleural epithelium with a predilection for local spread into adjacent tissues. The sarcomatoid type accounts for ∼10% of MM cases and is associated with poorer survival than the epithelioid, desmoplastic, and biphasic types. MM commonly presents with involvement of the vertebral body or epidural space. However, intradural spinal extension of MM is extremely rare. Only eight cases of intradural spinal extension have been reported. We report this rare case and discuss the clinical manifestations of intradural spinal extension of MM with literature review. Methods This report describes the case of a 62-year-old man with Brown-Séquard syndrome and radiculopathy of the left C5 nerve root detected during treatment for pleural sarcomatoid MM. Magnetic resonance imaging (MRI) showed an intramedullary lesion at the C3 level and a small nodule at the left C5 nerve root with cervical canal stenosis. Results The patient underwent surgery, and intramedullary metastasis of sarcomatoid MM was diagnosed. Subsequently, radiotherapy was administered, resulting in temporary improvement of the patient's condition. Thereafter, his condition gradually deteriorated, and follow-up MRI showed a more extensive residual C3 intramedullary lesion. Thus, a second surgery was performed after chemotherapy, but the patient died 5 months after the initial diagnosis. Conclusion We present this rare case, and emphasize intramedullary spinal cord metastasis of MM as differential diagnosis in primary cord lesion.

Malignant pleural mesothelioma presenting as low back pain: diagnosed by bone scan coordinating with F-18 FDG PET/CT

STUDY DESIGN

Case report.

OBJECTIVE

We report malignant pleural mesothelioma (MPM) discovered in a Tc-99m MDP bone scan as a photopenic lesion in a 64-year-old man presenting with low back pain and diagnosed with F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT).

SUMMARY OF BACKGROUND DATA

Malignant pleural mesothelioma, an uncommon neoplasm with a poor prognosis, arises from mesothelial cells of the pleura. Typically, the patient presents with either chest pain or symptoms derived from a pleural effusion such as dyspnea, or both. Most cases of MPM are initially detected on chest radiographs and primarily diagnosed with a CT scan.

METHODS

Case study with bone scan and F-18 FDG PET/CT.

RESULTS

The Tc-99m MDP bone scan showed a photopenic defect occupying the left side of the T11 vertebra and implicated the existence of a tumor. Pathologic analysis of the paraspinal tumor indicated metastatic neoplastic cells, which we initially suspected originated from the gastrointestinal tract. The CT and magnetic resonance imaging showed no additional information about the primary malignancy; therefore, we did an F-18 FDG PET/CT study, which suggested malignant pleural mesothelioma.

CONCLUSION

The present case highlights both the value of a Tc-99m MDP bone scan when MPM presents, unusually, as low back pain, and the importance of carefully interpreting bone scan images, especially for photopenic defects. It also indicates the usefulness of F-18 FDG PET/CT study in MPM in a difficult histopathological diagnosis.

Intradural intramedullary spinal cord metastasis due to mesothelioma

To report the occurrence of intramedullary spinal cord metastases in a patient with a mesothelioma. A case report.

SETTING

University medical center. A 67-year old man with mesothelioma developed paraparesis 6-months after diagnostic thoracotomy. MR spine imaging revealed an intramedullary spinal cord metastases. Cyberknife radiotherapy. Intramedullary spinal cord metastases, although rare, is increasingly recognized with spinal cord MRI. Treatment remains unsatisfactory as treatment with surgery or irradiation is only partially effective.