A case of brain metastasis with pathological transformation of long-surviving malignant pleural mesothelioma: illustrative case

Our plain-English summary of A case of brain metastasis with pathological transformation of long-surviving malignant pleural mesothelioma: illustrative case, by R. Noda, S. Yanagisawa, M. Inoue, et al (Journal of Neurosurgery. Case Lessons, 2021).

The study

• Authors: R. Noda, S. Yanagisawa, M. Inoue, T. Hara
• Journal: Journal of Neurosurgery. Case Lessons
• Published: 2021;1(3):CASE2099
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare cancer, and in 80% of cases the cause is asbestos exposure. In 1972, the World Health Organization (WHO) declared asbestos is a carcinogenic substance. Since then, every developed country has restricted and banned the product. Because of its high heat resistance, asbestos had been widely used as building material for decades. The WHO estimated that approximately 125 million people are exposed to asbestos, and more than 107,000 die from asbestos-related diseases annually. Because of its long incubation period, the number of patients is estimated to keep increasing in the near future.

Observations: The authors report a case of long-surviving MPM with a rushed clinical course after brain metastasis. A 69-year-old woman diagnosed with MPM (epithelial type) 6 years earlier presented with a brain metastasis. The pathological result of the brain metastasis was the sarcomatoid type. This case showed the possibility of subtype transition after long survival.

Lessons: This article aids in understanding the long-term natural history of MPM and the possibility of epithelial-mesenchymal transition. Neurosurgeons have to be aware of its the natural history and the possibility of brain metastasis.

© 2021 The authors.

In plain English

This case report, by neurosurgeons in Tokyo, Japan, described one woman with malignant pleural mesothelioma and a history of asbestos exposure. The article did not describe the type of asbestos or how she was exposed. Six years earlier, pleural tissue had shown the epithelial type. She received pemetrexed plus cisplatin, then 60 courses of pemetrexed, then nivolumab after the disease progressed. At 69, she was brought to hospital after a seizure, and a 2.5 cm tumor was found in her brain. After radiation it shrank, then regrew to 3 cm with paralysis, and it was removed completely. The brain tumor was the sarcomatoid type, with p53 at 15% and Ki67 at 50%. In the original tumor, p53 had been negative and Ki67 at most 10%. New small brain metastases followed, the pleural tumor grew rapidly, and she died 6 months after the operation. The authors suspected the tumor had changed subtype (epithelial-mesenchymal transition). They concluded that neurosurgeons should be aware of possible brain metastasis in long-term survivors.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 69-year-old woman with malignant pleural mesothelioma, treated at the Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan; she had no prior medical history apart from asbestos exposure
• Exposure: A history of asbestos exposure; the article gives no fiber type, job, product or dose
• Main results:
  • Primary pleural tumor, diagnosed 6 years earlier by partial resection of the pleura: epithelial type, with p53 negative and Ki67 at most 10%
  • Treatment before the brain metastasis: 6 courses of pemetrexed plus cisplatin, then 60 courses of pemetrexed as maintenance, then nivolumab after the disease progressed
  • She was brought to hospital by ambulance after a convulsive seizure, and a 2.5 cm mass was found in the right parietal lobe of the brain
  • After intensity-modulated radiation therapy the brain tumor shrank, then regrew to 3 cm with neurological symptoms such as paralysis, and it was removed
  • The brain tumor was a metastasis of the mesothelioma but of the sarcomatoid type, with p53 at 15% and Ki67 at 50%
  • Multiple new small brain metastases appeared at 2 and 4 months after surgery, the pleural tumor grew rapidly, and the patient died 6 months after the operation
• The authors' conclusion: The authors concluded that the subtypes of the primary and brain tumors differed and suspected epithelial-mesenchymal transition. They said neurosurgeons should be aware of the natural history of MPM and of the possibility of brain metastasis in long-term survivors.

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Asbestos Exposure, Carcinogenic, Sarcomatoid.

Related studies

• MicroRNA gene expression signatures in long-surviving malignant pleural mesothelioma patients — R.C. Lin, M.B. Kirschner, et al. (2016)
• Simian virus 40 transformation, malignant mesothelioma and brain tumors — F. Qi, M. Carbone, et al. (2011)
• Brain metastasis in malignant pleural mesothelioma — A. Kawai, Y. Nagasaka, et al. (1997)
• Brain metastasis in malignant pleural mesothelioma presenting as intratumoral hemorrhage — T. Ishikawa, H. Wanifuchi, et al. (2010)
• Gamma knife radiosurgery of brain metastasis from malignant pleural mesothelioma--report of three cases with autopsy study in a case — T. Kobayashi, T. Tsugawa, et al. (2014)
• Brain Metastasis of Pleural Mesothelioma after a Subarachnoid Hemorrhage — A. Hirooka, A. Tamiya, et al. (2016)

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