A case of delayed recurrence of pleural mesothelioma with intradural invasion

Our plain-English summary of A case of delayed recurrence of pleural mesothelioma with intradural invasion, by H. Sato, R. Omichi, Y. Nigami, et al (Surgical Neurology International, 2026).

The study

• Authors: H. Sato, R. Omichi, Y. Nigami, N. Shimokawa
• Journal: Surgical Neurology International
• Published: 2026;17:155
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pleural mesothelioma (PM) is a tumor of the pleural epithelium with a poor prognosis. Asbestos exposure is closely related to its occurrence. To date, there have been 13 reports of PM with intradural invasion.

Case Description: A 73-year-old male was admitted with rapid progression of back pain and paraparesis. At age 67, he was diagnosed with PM (epithelial type) and underwent chemotherapy and a left thoracotomy for tumor resection. At present, the magnetic resonance newly showed T7-T9 spinal cord compressed due to an intradural tumor. Originating from the left pleura and invading the spinal canal through the intervertebral foramina, the lesion was subtotally resected. Histology confirmed that the intradural tumor lesion was a PM (biphasic type) that had transformed into a malignant tumor. Postoperatively, the patient's paraparesis improved. Despite the administration of adjuvant chemotherapy, the tumor showed regrowth 5 months later; further treatment was purely palliative care.

Conclusion: In general, patients with PM have a poor prognosis. However, those with some favorable factors (i.e., epithelioid subtype, female sex, and early clinical stage) may survive for up to 5-years.

Copyright: © 2026 Surgical Neurology International.

In plain English

This case report from Tsukazaki Hospital in Himeji, Japan, described one man with a prior history of asbestos exposure. The article did not say what type of asbestos was involved or how exposure occurred. At age 67 the patient had a left thoracotomy to remove an epithelial pleural mesothelioma, followed by three courses of cisplatin and pemetrexed chemotherapy. No tumor was seen for six years. At 73 he developed leg weakness, worse on the left, plus left-sided sensory loss and urinary retention. MRI showed two tumors inside the spinal canal at T8 and T9. They pressed on the spinal cord and connected to tumor on the pleura. Surgeons removed most of the tumor. It was a biphasic mesothelioma, 85% sarcomatoid and 15% epithelioid. His back pain and left leg strength improved. The tumor progressed despite nivolumab and ipilimumab (after two months in the case text, five in the abstract), and he received palliative care. The authors found 13 earlier published cases. They suggested the late recurrence was triggered by a change from the epithelial to the biphasic type.

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), with a table of previously published cases
• Who was studied: one 73-year-old male patient treated in the Department of Neurosurgery, Tsukazaki Hospital, Himeji, Japan
• Exposure: prior history of asbestos exposure; no fiber type, job, product or dose given
• Main results:
  • At age 67 the patient had a thoracotomy to remove an epithelial pleural mesothelioma, followed by adjuvant chemotherapy
  • The adjuvant chemotherapy was 3 courses of cisplatin and pemetrexed
  • After the original surgery, no residual or recurrent tumor was seen for 6 years
  • MRI showed two intradural tumors compressing the spinal cord at T8 and T9
  • The spinal tumors were continuous with pleural lesions through the T8 and T9 intervertebral foramina
  • The intradural tumor was subtotally resected
  • The recurrent tumor was biphasic mesothelioma: 85% sarcomatoid and 15% epithelioid components
  • After surgery, the patient's back pain and left leg strength improved
  • MRI showed mediastinal lymph node metastases but no distant metastases
  • According to the case description, the tumor progressed 2 months after nivolumab and ipilimumab; treatment was withdrawn and palliative care was given
  • The article's abstract instead says the tumor regrew 5 months later, after which treatment was palliative only
  • The authors identified 13 prior published cases of spinal intradural metastasis from pleural mesothelioma
  • In the authors' tabulation, 11 cases had known histology: 6 sarcomatous, 2 desmoplastic, 2 biphasic and 1 epithelial
  • The authors reported a median interval of 17.6 months from diagnosis to intradural metastasis in the published cases, compared with 72 months for this patient
  • Most published lesions spread by direct invasion (9 of 13 cases)
• The authors' conclusion: The authors suggested that this recurrence after long-term survival was triggered by malignant transformation from the epithelial type to the biphasic type

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Epithelium, Prognosis, Asbestos Exposure, Chemotherapy, Thoracotomy, Pleura, Histology.

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• Intradural intramedullary spinal cord metastasis due to mesothelioma — M.C. Chamberlain, K.D. Eaton, et al. (2010)
• Clinical implications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at delayed phase for diagnosis and prognosis of malignant pleural mesothelioma — Y. Abe, K. Tamura, et al. (2012)
• Early and delayed effects of naturally occurring asbestos on serum biomarkers of inflammation and metabolism — U.P. Kodavanti, D. Andrews, et al. (2014)
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• Free radical oxidation in rats in the delayed period after combined exposure to dust and radiation — S.O. Tapbergenov, B.A. Zhetpisbaev, et al. (2013)

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