Cerebral Metastasis of a Malignant Pleural Mesothelioma: A Case Report and Review of the Literature

Our plain-English summary of Cerebral Metastasis of a Malignant Pleural Mesothelioma: A Case Report and Review of the Literature, by A. Chari, A.G. Kolias, K. Allinson, et al (Curēus, 2015).

The study

• Authors: A. Chari, A.G. Kolias, K. Allinson, T. Santarius
• Journal: Curēus
• Published: 2015;7(1):e241
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive malignant neoplasm that was thought to be a localised disease with limited metastatic capability. However, recent post-mortem studies have identified metastases to the central nervous system (CNS) in about 3% of cases.

Case Description: We present the case of a 65-year-old with a solitary supratentorial metastatic deposit of MPM treated with surgical resection and adjuvant whole brain radiotherapy. Despite a good surgical outcome with symptomatic recovery, the patient died of cardiopulmonary compromise five months postoperatively.

Conclusions: Although rare, CNS metastasis of MPM is a condition that neurosurgeons should be aware of. CNS metastases may occur via three distinct mechanisms, namely perineural spread, leptomeningeal carcinomatosis and, most commonly, haematogenous spread leading to parenchymal deposits. Surgical resection of these deposits can lead to symptomatic improvement, and together with radiotherapy, to local disease control. However, the overall survival remains poor.

In plain English

This article was a case report of one patient plus a literature review. A 65-year-old man with left malignant pleural mesothelioma, treated with chemotherapy a year earlier, came to the emergency department with a seizure affecting his left arm. Scans showed a single brain lesion measuring 22 mm x 30 mm x 20 mm. Surgeons removed it completely, and tissue tests confirmed spread of mesothelioma to the brain. He went home three days after surgery, walked without a frame by day 10, and received 20 Gy of whole brain radiotherapy in five fractions. He died of cardiopulmonary compromise from his mesothelioma five months later. The report does not describe his asbestos exposure. The authors searched the MEDLINE database and tabulated nine earlier case reports of treated brain metastases from this cancer; treatments varied widely and survival was poor. The authors concluded that surgery for a single symptomatic brain metastasis can improve symptoms and, with radiotherapy, control the disease locally, but overall survival remains poor.

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 of a single patient combined with a literature review of the MEDLINE database
• Who was studied: One 65-year-old left-handed man with left malignant pleural mesothelioma who had completed six cycles of pemetrexed and cisplatin chemotherapy one year earlier. He presented with a focal seizure involving the left upper limb. The location and dates of care are not stated.
• Exposure: The article does not describe any asbestos exposure for this patient. The introduction states generally that asbestos exposure is the main cause of malignant pleural mesothelioma.
• Main results:
  • In this patient, imaging showed a single lesion centred on the right pre-central gyrus of the brain, measuring 22 mm x 30 mm x 20 mm.
  • The patient underwent gross total resection (complete surgical removal), confirmed on postoperative MR imaging.
  • Histology of the removed lesion confirmed metastatic mesothelioma.
  • The patient was discharged on postoperative day three. By day 10 he could walk without a frame, and he then received 20 Gy of whole brain radiotherapy in five fractions.
  • The patient died of cardiopulmonary compromise from his mesothelioma five months later.
  • In the literature review, the authors tabulated nine earlier case reports of actively managed cerebral metastases of malignant pleural mesothelioma. Treatments varied widely. Reported survival ranged from 10 days to 36 months, and was unknown in three cases. The authors described overall survival as poor.
• The authors' conclusion: The authors concluded that surgical removal of a symptomatic solitary brain metastasis can improve symptoms and, together with radiotherapy, achieve local disease control, but overall survival remains poor.

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Neoplasm, Surgical Resection, Overall Survival.

Related studies

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• Donut sign: a unique radiological sign of cerebral metastasis in malignant mesothelioma — O. Adeyinka, A. Dower, et al. (2022)
• Sarcomatoid malignant mesothelioma presenting with intramedullary spinal cord metastasis: a case report and literature review — J. Yamamoto, K. Ueta, et al. (2014)
• Squamous cell carcinoma of the tongue with cardiac metastasis on 18F-FDG PET/CT: A case report and literature review — P. Delabie, D. Evrard, et al. (2021)
• Meningeal metastasis of a malignant peritoneal mesothelioma: A case report and literature review — Y. Jiang, Z. Mei, et al. (2019)
• Intramedullary Metastasis to the Cervical Spinal Cord from Malignant Pleural Mesothelioma: Review of the Literature and Case Reports — F. Kalfas, C. Scudieri (2020)

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