Invasive sarcomatoid mesothelioma resulting in spinal cord compression: case report

Our plain-English summary of Invasive sarcomatoid mesothelioma resulting in spinal cord compression: case report, by M. Farthing, T. Shanmugalingam, E.A. Dean, et al (BJR Case Reports, 2018).

The study

• Authors: M. Farthing, T. Shanmugalingam, E.A. Dean, D. Muthukumar
• Journal: BJR Case Reports
• Published: 2018;4(2):20170068
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesothelioma is more likely to metastasize by local invasion, and metastases to the nervous system are rare. There are currently 10 reported cases of spinal cord compression as a result of mesothelioma. We report a 74-year-old patient with sarcomatoid mesothelioma that spreads across the dura into the spinal cord at T4/T5 level. This case report illustrates an unusual presentation of spinal cord compression by mesothelioma. It details the presenting symptoms, examinations and management of the patient and provides an overview of other potential metastatic sites of mesothelioma.

In plain English

This case report described a 74-year-old man with sarcomatoid mesothelioma, treated at Colchester Hospital, UK. He had a history of significant occupational asbestos exposure as a carpenter. He was diagnosed in 2013 after CT showed pleural thickening in the left lower lobe, and cisplatin/pemetrexed chemotherapy stabilized the disease. He was later admitted with 2 months of back pain, weak legs, and faecal and urinary incontinence. MRI showed a 6.7 cm by 5.5 cm extension of the pleural mass. It had infiltrated the vertebral bodies, causing complete collapse at the T4/T5 level and severe narrowing of the spinal canal. Comparing earlier CT scans, the authors judged the mass an extension of the biopsied mesothelioma, and they considered spread from his earlier prostate cancer unlikely. He was treated with dexamethasone and was briefly able to stand with aid. He then declined and died about 4 weeks after admission, before palliative radiotherapy. The authors concluded that spinal involvement should be ruled out when a patient with pleural malignant mesothelioma presents with worsening neurological symptoms and MRI findings likely reporting an abnormal thoracic spinal cord lesion.

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 (a single patient)
• Who was studied: One 74-year-old man, described by authors from the oncology service at Colchester Hospital University Foundation Trust, Essex, UK. He was diagnosed with mesothelioma in 2013 and had a past history of locally advanced prostate cancer treated in 2006.
• Exposure: Significant occupational asbestos exposure while working as a carpenter. Fiber type and dose are not stated.
• Main results:
  • Lobulated pleural thickening in the left lower lobe was found on routine CT imaging in 2013. After one failed and then one successful biopsy, the patient was diagnosed with sarcomatoid mesothelioma.
  • He received six cycles of cisplatin/pemetrexed and the disease remained fairly stable. After progression in mid-2016, a further six cycles again stabilized the disease.
  • On admission he had back pain that had begun 2 months earlier, worsening mobility and weak legs, with faecal and urinary incontinence.
  • MRI showed an extension of a pleural mass measuring 6.7 cm by 5.5 cm.
  • The mass had infiltrated the vertebral bodies, causing complete collapse at the T4/T5 level with intraspinal extensions and severe narrowing of the spinal canal.
  • Spinal cord compression from invasive mesothelioma was considered the most likely diagnosis. Compared with previous CT images, the mass was clearly an extension of the previously biopsied mass.
  • Spread from his earlier prostate cancer was considered as a possible diagnosis but judged unlikely: that disease had gone into remission in 2006, and his prostate-specific antigen level had not risen.
  • After he started dexamethasone there was initial improvement, and he could stand with aid 4 to 5 days later.
  • He then declined and died roughly 4 weeks after admission, before receiving palliative radiotherapy to the spinal cord.
• The authors' conclusion: The authors concluded that spinal involvement needs to be ruled out if a patient with pleural malignant mesothelioma presents with worsening neurological symptoms and MRI findings that likely report an abnormal lesion in the thoracic spinal cord.

Topics

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Mesothelioma, Metastasis.

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