Haemorrhagic Brain Metastasis From Malignant Pleural Mesothelioma: A Rare Case

Our plain-English summary of Haemorrhagic Brain Metastasis From Malignant Pleural Mesothelioma: A Rare Case, by C. Furtado, S. Srivastava, S. Nayak, et al (Curēus, 2022).

The study

• Authors: C. Furtado, S. Srivastava, S. Nayak, C. Jadun, Z. Hashim
• Journal: Curēus
• Published: 2022;14(10):e30345
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) typically has a short median survival of only a few months from diagnosis, with death usually due to thoracic disease. This has led to the belief in the past that mesothelioma rarely has distant metastasis, with cerebral metastasis accounting for only 3%. The multiple cases of brain metastasis from MPM recorded so far were discovered after death at autopsy. This report describes a rare case of known malignant mesothelioma with distant haemorrhagic metastasis to the brain, reviews current literature about its metastatic potential to the brain and discusses prognosis and management. We also review the imaging evaluation in known MPM patients with suspected intracranial involvement and describe typical imaging findings of parenchymal brain metastasis on computed tomography (CT) and magnetic resonance imaging (MRI).

Copyright © 2022, Furtado et al.

In plain English

This article was a case report describing one patient, with a brief discussion of earlier reports. A 67-year-old woman already known to have malignant pleural mesothelioma of the biphasic subtype came to the emergency department with weakness in both legs, unsteadiness and a recent loss of consciousness. Her chemotherapy (carboplatin and pemetrexed) had been stopped after five cycles because of toxicity and poor performance status, and her disease had progressed. A head CT scan showed two lesions with surrounding swelling. MRI showed masses in the left parietal area of the brain and the left cerebellum that contained blood, reflecting bleeding (haemorrhagic) metastases. Staging scans found no other primary tumour, so the lesions were diagnosed as spread from the mesothelioma. She declined aggressive treatment, received palliative radiation therapy and dexamethasone, and died eight months later. The article did not describe any asbestos exposure. The authors concluded that haemorrhagic brain metastases should be considered in mesothelioma patients with neurological symptoms. They also concluded that mesothelioma should be considered when such a metastasis is the first sign of disease.

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, with a brief discussion of published literature
• Who was studied: One 67-year-old female patient with known malignant pleural mesothelioma of the biphasic histologic subtype, seen in an emergency department with bilateral lower limb weakness, unsteadiness and a recent loss of consciousness
• Exposure: Not reported: the article does not describe asbestos or any other exposure for this patient
• Main results:
  • The patient's mesothelioma was of the biphasic histologic subtype
  • She had received five cycles of carboplatin and pemetrexed chemotherapy, which was discontinued due to toxicity and poor performance status
  • Plain CT of the head showed two hyperdense lesions, one above and one below the tentorium, with surrounding oedema
  • MRI showed intra-axial mass lesions in the left parietal region and the posterior fossa cerebellar hemisphere, with findings reflecting their haemorrhagic nature
  • Staging CT of chest, abdomen and pelvis showed no other primary tumour, and the brain lesions were diagnosed as metastases from the pleural mesothelioma
  • The patient refused aggressive treatment and received palliative radiation therapy and dexamethasone to reduce swelling around the tumour
  • The patient died eight months later
• The authors' conclusion: The authors concluded that haemorrhagic brain metastases should be considered among the possible diagnoses in patients with known mesothelioma who develop neurological symptoms. They also concluded that mesothelioma should be considered when a brain metastasis with bleeding inside the tumour is the first presentation.

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Median Overall Survival, Mesothelioma, Autopsy, Prognosis.

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