Cerebral metastasis from malignant pleural mesothelioma

Our plain-English summary of Cerebral metastasis from malignant pleural mesothelioma, by M. El Molla, C. Gragnaniello, D. Al-Khawaja, et al (Journal of Surgical Case Reports, 2013).

The study

• Authors: M. El Molla, C. Gragnaniello, D. Al-Khawaja, C. Chiribao-Negri, B. Eftekhar
• Journal: Journal of Surgical Case Reports
• Published: 2013;2013(9)
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma is an uncommon, highly invasive tumor derived from the mesothelial cells of pleura or peritoneum characterized by poor outcome. Mesothelioma was thought to metastasize locally only via direct invasion and not have distant spread. Distant metastases were discovered mostly on post-mortem examination. The authors present a case of 62-year-old man with pleural mesothelioma and brain metastasis.

Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2013.

In plain English

This was a case report from Nepean Hospital in Sydney, Australia, about one 62-year-old man with malignant pleural mesothelioma that spread to the brain. He had 12 months of shortness of breath and right-sided chest pain. A chest X-ray showed a right pleural plaque that later caused a pleural effusion, and a pleural biopsy confirmed mesothelioma. He reported asbestos exposure from 20 years of work in aluminum and margarine factories. The article does not name a fiber type. He declined chemotherapy and radiotherapy. Eighteen months after first presenting, he developed worsening left-sided weakness and lost the left half of his field of vision. An MRI showed a 43 by 43 by 47 mm mass in the right occipitoparietal region, which surgeons removed entirely through a craniotomy. Tissue tests showed metastatic malignant mesothelioma. His weakness improved markedly and his vision partly, and at 6 weeks he was still improving. The authors concluded that mesothelioma can spread to distant sites such as the brain and that surgery can improve survival and quality of life.

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 62-year-old man with malignant pleural mesothelioma, treated in the Department of Neurosurgery at Nepean Hospital, Sydney, Australia (dates of care not given)
• Exposure: Asbestos exposure reported by the patient from 20 years of work in aluminum and margarine factories. No fiber type or dose is given.
• Main results:
  • The patient first had 12 months of shortness of breath and right-sided chest pain. A right pleural plaque and then a right pleural effusion were seen, and pleural biopsy confirmed mesothelioma.
  • He declined chemotherapy and radiotherapy but had regular follow-up with an oncologist.
  • Eighteen months after his first presentation he developed progressive left-sided weakness and left-sided homonymous hemianopia (loss of the left half of the visual field). MRI showed an extra-axial right occipitoparietal enhancing mass (43 by 43 by 47 mm) with surrounding swelling.
  • The brain mass was removed entirely through a right occipital craniotomy.
  • Histopathology of the brain mass showed metastatic malignant mesothelioma, a large cell-epithelioid malignancy. The cells expressed the same markers as the earlier pleural biopsy.
  • After surgery his left-sided weakness improved significantly and his hemianopia improved somewhat. At 6-week follow-up he was still improving.
• The authors' conclusion: The authors concluded that mesothelioma can have distant metastasis (here, to the brain) and that surgery can improve both survival and quality of life. They stated that, to their knowledge, this was the third report of a symptomatic brain metastasis from malignant mesothelioma that was surgically removed by craniotomy with a diagnosis made before death.

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Mesothelioma, Mesothelial Cells, Pleura, Peritoneum, Autopsy.

Related studies

• Cerebral Metastasis of a Malignant Pleural Mesothelioma: A Case Report and Review of the Literature — A. Chari, A.G. Kolias, et al. (2015)
• Donut sign: a unique radiological sign of cerebral metastasis in malignant mesothelioma — O. Adeyinka, A. Dower, et al. (2022)
• 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 metastases of malignant mesothelioma — A. Bathini, D.M. Kusyk, et al. (2022)
• 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)

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