Neurosurgical management of intracranial metastatic mesothelioma

Our plain-English summary of Neurosurgical management of intracranial metastatic mesothelioma, by H.J. Westwick, G.H. Jansen, V.F. Da Silva (The Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques, 2013).

The study

• Authors: H.J. Westwick, G.H. Jansen, V.F. Da Silva
• Journal: The Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
• Published: 2013;40(6):878-80
• Read it: PubMed · Publisher

In plain English

This was a case report from The Ottawa Hospital, Canada, with a table of earlier published cases. The patient, a 75-year-old man with right pleural mesothelioma diagnosed a year earlier and treated with carboplatin and pemetrexed, had three weeks of headaches at the back of the head and an unsteady gait. Imaging showed a mass in the right cerebellum and a smaller left temporal lobe lesion consistent with a second metastasis. Surgeons removed the cerebellar tumor, which tests identified as metastatic mesothelioma, mainly of the epithelioid subtype. The patient recovered with no remaining deficits and left hospital six days after surgery with a referral for radiation therapy. At six weeks the neurological symptoms had resolved. The article does not describe the patient's asbestos exposure. The authors found seven earlier reported cases in which neurosurgical intervention was undertaken for mesothelioma that had spread inside the skull, and only one of these survived more than three months after resection. The authors concluded this case was a successful resection, noting that so few cases make outcomes hard to predict.

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 (brief communication) of one patient, with a tabulated review of previously published cases
• Who was studied: One 75-year-old man at The Ottawa Hospital, Canada, with a one-year history of right pleural mesothelioma previously treated with six cycles of carboplatin and pemetrexed
• Exposure: The article does not report this patient's asbestos exposure
• Main results:
  • Besides the right cerebellar mass, MRI showed a smaller enhancing lesion in the left temporal lobe, consistent with a second metastasis
  • The cerebellar tumor was surgically removed and the patient recovered with no residual deficits
  • The removed specimen measured 1.5 cm and was identified as metastatic mesothelioma of mainly epithelioid subtype
  • Immunohistochemistry showed a 70% proliferation rate on the Ki-67 marker. Negative staining for TTF-1, keratin 5, CEA and Ber-EP-4 ruled out a pseudo-mesotheliomatous adenocarcinoma
  • The patient was discharged six days after surgery with referral to radiation therapy
  • At the six-week clinic visit the patient's neurological symptoms had resolved
  • In the authors' literature review there were seven previously reported cases with neurosurgical intervention for symptomatic intracranial metastases. One of these, according to the table, was a biopsy of a paracervical mass. Only one of the seven had a post-resection survival of more than three months
• The authors' conclusion: The authors concluded that this case documents a successful resection of a metastatic mesothelioma of the cerebellum, allowing the patient to return home with symptom resolution, and that it highlights the potential of mesothelioma to spread to the brain
• Limitations the authors state:
  • Because so few cases have been reported, it is difficult to predict outcomes for patients with brain metastases of mesothelioma

Topics

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

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

Related studies

• Multiple intracranial metastases from postoperative giant sarcomatoid malignant pleural mesothelioma: A case report and literature review — D. Tian, H. Wen, et al. (2018)
• Keratins 7 and 20 as diagnostic markers of carcinomas metastatic to the ovary — C.C. Wauters, F. Smedts, et al. (1995)
• First-in-Human, Multicenter, Phase I Dose-Escalation and Expansion Study of Anti-Mesothelin Antibody-Drug Conjugate Anetumab Ravtansine in Advanced or Metastatic Solid Tumors — R. Hassan, G.R. Blumenschein, et al. (2020)
• Value of the mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin, and CD44H in distinguishing epithelioid pleural mesothelioma from adenocarcinoma metastatic to the pleura — P.M. Cury, D.N. Butcher, et al. (2000)
• Long-term pulmonary exposure to multi-walled carbon nanotubes promotes breast cancer metastatic cascades — X. Lu, Y. Zhu, et al. (2019)
• E-cadherin and calretinin: a useful combination of immunochemical markers for differentiation between mesothelioma and metastatic adenocarcinoma — M.P. Leers, M.M. Aarts, et al. (1998)

Browse return to medical research.