Cerebral metastases of malignant mesothelioma

Our plain-English summary of Cerebral metastases of malignant mesothelioma, by A. Bathini, D.M. Kusyk, K. Stabingas, et al (Journal of Surgical Case Reports, 2022).

The study

• Authors: A. Bathini, D.M. Kusyk, K. Stabingas, B. Kujawski, J. Ahn, R. Williamson
• Journal: Journal of Surgical Case Reports
• Published: 2022;2022(2):rjac002
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma represents a rare etiology of lung cancer metastasis to the brain. Neurologically symptomatic presentations are extremely rare as these metastatic lesions are detected in the late stages of the disease. Despite many highly heterogenous treatment techniques reported in the literature, overall survival is poor. A 72-year-old male with a history of mesothelioma presented with recurrent episodes of altered mental status, confusion and expressive aphasia. Imaging indicated a large hemorrhagic, enhancing lesion in the anterior left frontal lobe resulting in midline shift of 6 mm. He underwent a left frontal craniotomy for resection, after which he had complete resolution of symptoms. The resected mass was metastatic high-grade malignant mesothelioma. On a 1-month follow-up, new lesions in the bilateral frontal lobes were discovered, and despite undergoing adjuvant stereotactic radiosurgery, the right one grew significantly, causing notable mass effect. The patient successfully underwent a right craniotomy for resection.

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2022.

In plain English

This case report described one patient: a 72-year-old man who had worked his whole career in construction with known extensive exposure to asbestos at work sites. Six months earlier, mesothelioma arising from the pleural surface had been found inside his pulmonary artery and surgically removed. He came to the emergency department with two days of recurrent confusion, altered mental status and trouble speaking. Brain scans showed a large bleeding lesion in the left frontal lobe that shifted the brain's midline by 6 mm, and a second lesion in the right cerebellum. Surgeons removed the frontal lesion. It proved to be metastatic high-grade malignant mesothelioma with sarcomatoid and epithelioid features, and his symptoms resolved within 5 days. One month later, new brain lesions had appeared. After stereotactic radiosurgery, the lesions in both frontal lobes grew significantly and a new lesion appeared in the right pons, while the others grew slightly or were stable. He then had a second operation to remove the large right frontal lesion. Systemic chemotherapy was not feasible for him. The report did not describe his outcome beyond that operation. The authors concluded that further metastatic lesions can occur despite multimodal treatment.

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 72-year-old male with a history of mesothelioma (discovered during a pulmonary thromboendarterectomy 6 months earlier) and prostate adenocarcinoma treated by prostatectomy a year earlier, who presented with neurological symptoms
• Exposure: Lifelong career in the construction industry with known extensive asbestos exposure at work sites; fiber type not stated
• Main results:
  • The original tumor, removed by pulmonary thromboendarterectomy 6 months before, arose from the pleural surface and sat within the pulmonary artery
  • CT and MRI showed a large hemorrhagic, enhancing lesion in the anterior left frontal lobe with a midline shift of 6 mm, and a secondary lesion in the right cerebellar hemisphere
  • Pathology of the resected brain mass showed metastatic high-grade malignant mesothelioma with sarcomatoid and epithelioid features
  • The patient's symptoms fully resolved within 5 days after the first operation
  • At 1-month follow-up MRI, the right cerebellar lesion had grown and new metastatic lesions were found in both frontal lobes and the right cerebral peduncle
  • One month after stereotactic radiosurgery, both frontal lobe lesions had increased significantly in size and a new lesion appeared in the right pons
  • After radiosurgery, the remaining lesions had either increased slightly in size or were stable
  • The patient underwent a second craniotomy to remove the large right frontal lesion
  • Systemic chemotherapy was not feasible because the patient was taking mycophenolate mofetil, had high supplemental oxygen demand and had pneumonitis
• The authors' conclusion: The authors concluded that despite multimodal treatment, including surgical removal of symptomatic lesions, further metastatic lesions can occur that complicate treatment plans

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Etiology, Lung Cancer, Metastasis, Overall Survival, Bilateral.

Related studies

• Presentation of malignant pleural mesothelioma with cerebral metastases — W.M. McNaughton, M.E. Broughton, et al. (1990)
• Sarcomatous mesothelioma of the pleura with cerebral metastases — C. Nielsen, I.M. Hansen (1990)
• Cerebral Metastasis of a Malignant Pleural Mesothelioma: A Case Report and Review of the Literature — A. Chari, A.G. Kolias, et al. (2015)
• Cerebral metastasis from malignant pleural mesothelioma — M. El Molla, C. Gragnaniello, et al. (2013)
• Cerebral air embolism after indwelling pleural catheter insertion in a chronic hydropneumothorax secondary to epithelioid mesothelioma — D.M.C. Jayawardena, R.K. Panchal, et al. (2021)
• Donut sign: a unique radiological sign of cerebral metastasis in malignant mesothelioma — O. Adeyinka, A. Dower, et al. (2022)

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