Malignant pleural mesothelioma with lacrimal gland metastasis

Our plain-English summary of Malignant pleural mesothelioma with lacrimal gland metastasis, by H. Hanafi, R.M. Verdijk, D. Paridaens (Acta Ophthalmologica, 2016).

The study

• Authors: H. Hanafi, R.M. Verdijk, D. Paridaens
• Journal: Acta Ophthalmologica
• Published: 2016;94(8):836-838
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: To describe a rare clinical case of biopsy-proven metastatic mesothelioma of the lacrimal gland which responded well to chemo and radiation therapy.

Methods: Interventional case report.

Results: A 55-year-old woman with an untreated malignant biopsy-proven pleural mesothelioma presented with right proptosis, diplopia and hypoglobus. Magnetic resonance imaging showed an aggressive lacrimal gland tumour with bony erosion. A biopsy concluded a diagnosis of metastatic mesothelioma of the lacrimal gland. Her lacrimal and lung tumours showed a marked regression following palliative chemo (carboplatin) and radiation therapy.

Conclusions: Malignant pleural mesothelioma may metastasize to the orbit, including the lacrimal gland. A combined chemo and radiation therapy may reduce the size of the metastatic and primary tumour.

© 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

In plain English

This case report from Rotterdam, the Netherlands, describes one patient. A 55-year-old woman had biopsy-proven malignant pleural mesothelioma since December 2013 and had refused all treatment offered. She then developed a growing mass in her right eye socket and double vision. An MRI scan showed a mass arising from the right lacrimal (tear) gland, eroding the bone of the orbital roof and extending inside the skull. A biopsy showed epithelioid mesothelioma that had spread to the gland, and a national mesothelioma panel agreed. She then had six cycles of carboplatin chemotherapy and five fractions of radiation to the eye socket. By May 2015 the bulging and lowered position of the eye had resolved, though some restriction of upward movement remained. She had survived 6 months, with the further course to be seen. She had no history of occupational asbestos exposure, but earlier exposure at home could not be ruled out. The authors concluded that spread of the disease should be considered when the lacrimal gland enlarges in patients with malignant pleural mesothelioma, although this is rare.

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: interventional case report (one patient)
• Who was studied: one 55-year-old woman with biopsy-proven malignant pleural mesothelioma diagnosed in December 2013. She was referred to The Rotterdam Eye Hospital, the Netherlands, examined in December 2014 and reviewed in May 2015.
• Exposure: The article studied no asbestos exposure. The patient had no history of occupational exposure to asbestos or other risk factors, but the authors say earlier exposure at home could not be ruled out. The treatment given was carboplatin chemotherapy and orbital radiation therapy.
• Main results:
  • The patient had refused all medical treatment offered for her pleural mesothelioma before the eye symptoms appeared.
  • MRI showed a mass arising from the right lacrimal gland, eroding the orbital roof and extending inside the skull.
  • Biopsy cells stained positive for calretinin, WT-1 and podoplanin, compatible with epithelioid mesothelioma. The national mesothelioma panel in the Netherlands agreed with the diagnosis.
  • Staging showed growth of the pleural lesions but no other sites of spread.
  • After six cycles of carboplatin chemotherapy and five fractions of orbital radiation therapy, the patient showed a dramatic improvement. The article's abstract says both the lacrimal and lung tumours regressed markedly.
  • At review in May 2015, vision in both eyes was unchanged. The proptosis and hypoglobus had totally resolved, but a residual restriction of right upward eye movement remained.
  • A new finding at follow-up was diffuse pigmentary retinal changes in the right eye.
  • The patient had survived 6 months at the time of writing.
• The authors' conclusion: The authors concluded that metastatic disease should be considered when the lacrimal gland is enlarged in patients with (a history of) malignant pleural mesothelioma, although it is rare. They also stated that, to their knowledge, a lacrimal gland metastasis from pleural mesothelioma had not been reported before.
• Limitations the authors state:
  • Follow-up was short. The authors note that the further course of the disease was still to be seen at 6 months.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Metastasis, Biopsy, Mesothelioma, Palliative Care, Carboplatin.

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