A Rare Clinical Presentation of Malignant Pleural Mesothelioma With Central Nervous System Metastases: A Case Report

Our plain-English summary of A Rare Clinical Presentation of Malignant Pleural Mesothelioma With Central Nervous System Metastases: A Case Report, by M.A. Miernik-Skrzypczak, E. Misztela-Lisiecka, P. Nowakowski, et al (Curēus, 2025).

The study

• Authors: M.A. Miernik-Skrzypczak, E. Misztela-Lisiecka, P. Nowakowski, A. Strozak, G. Waska
• Journal: Curēus
• Published: 2025;17(9):e92297
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is a rare and aggressive cancer arising from the pleural mesothelial cells, most often associated with long-term asbestos exposure. Symptoms are typically nonspecific, including shortness of breath, chest pain, and pleural effusion, which may delay diagnosis. We report a case of a 63-year-old woman with bilateral MPM and subsequent central nervous system (CNS) metastases. She received systemic chemotherapy with cisplatin and pemetrexed, achieving a partial radiological response. Several months after completing treatment, she developed neurological symptoms. Imaging revealed multiple CNS metastases. Palliative radiotherapy provided temporary control; however, her condition progressively deteriorated. This case illustrates an unusual presentation and metastatic pattern of MPM in a female patient, highlighting diagnostic and therapeutic challenges, as well as the aggressive nature of the disease despite palliative care.

Copyright © 2025, Miernik-Skrzypczak et al.

In plain English

This article was a case report about one 63-year-old woman. She was under intensified cancer surveillance because she carried a germline BRCA1 gene mutation and had a significant family history of cancer. She reported no history of occupational or environmental exposure to asbestos, radiation, or other known carcinogens. She came to the emergency department with low-grade fever, chest pain and breathlessness at rest, and fluid was found around her right lung. Tests on that fluid first showed cells resembling adenocarcinoma. Tissue biopsies and special staining then confirmed epithelioid malignant pleural mesothelioma on both sides of the chest. She received six cycles of cisplatin and pemetrexed chemotherapy over 18 weeks, and a CT scan showed a partial response. Seven months after chemotherapy ended, she developed headaches, unsteadiness, double vision and dizziness, and a brain scan showed multiple metastases. After palliative brain radiotherapy she worsened, fell into a coma and died 18 months after her symptoms began. The authors concluded that spread to the central nervous system, though rare, may occur in longer survivors and should be considered during follow-up.

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 (one patient)
• Who was studied: One 63-year-old woman with a germline BRCA1 mutation and a significant family history of cancer. The article does not state the hospital or the dates of treatment.
• Exposure: No asbestos exposure was reported. The patient reported no occupational or environmental exposure to asbestos, radiation, or other known carcinogens.
• Main results:
  • In this patient, initial pleural fluid cytology showed malignant cells that looked like adenocarcinoma.
  • In this patient, histopathology and immunohistochemical staining confirmed bilateral epithelioid malignant pleural mesothelioma.
  • The patient completed six cycles of cisplatin and pemetrexed over 18 weeks, with a partial radiological response on follow-up CT.
  • Seven months after chemotherapy ended, the patient had neurological symptoms, and a brain CT showed multiple metastases.
  • Eighteen months after symptoms began and one month after radiotherapy, the patient fell into a coma and died within a week.
  • The patient survived about three months from diagnosis of the central nervous system metastases and 18 months from symptom onset.
• The authors' conclusion: The authors concluded that central nervous system involvement, though rare, may occur in prolonged survivors and should be considered during follow-up.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelial Cells, Asbestos Exposure, Pleural Effusion, Bilateral, Chemotherapy, Cisplatin, Pemetrexed (Alimta).

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• Isolated Peripheral Nervous System Presentation in Ma/Ma2-Associated Autoimmunity — A. Vilaseca, M. Villagrán-García, et al. (2026)
• Nervous system metastases from malignant mesothelioma — N.M. Martinez, I.T. Gavrilovic, et al. (2013)

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