Sarcomatoid malignant mesothelioma presenting with intramedullary spinal cord metastasis: a case report and literature review

Our plain-English summary of Sarcomatoid malignant mesothelioma presenting with intramedullary spinal cord metastasis: a case report and literature review, by J. Yamamoto, K. Ueta, M. Takenaka, et al (Global Spine Journal, 2014).

The study

• Authors: J. Yamamoto, K. Ueta, M. Takenaka, M. Takahashi, S. Nishizawa
• Journal: Global Spine Journal
• Published: 2014;4(2):115-20
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Study Design Case report. Objective Malignant mesothelioma (MM) is an uncommon tumor of the pleural epithelium with a predilection for local spread into adjacent tissues. The sarcomatoid type accounts for ∼10% of MM cases and is associated with poorer survival than the epithelioid, desmoplastic, and biphasic types. MM commonly presents with involvement of the vertebral body or epidural space. However, intradural spinal extension of MM is extremely rare. Only eight cases of intradural spinal extension have been reported. We report this rare case and discuss the clinical manifestations of intradural spinal extension of MM with literature review. Methods This report describes the case of a 62-year-old man with Brown-Séquard syndrome and radiculopathy of the left C5 nerve root detected during treatment for pleural sarcomatoid MM. Magnetic resonance imaging (MRI) showed an intramedullary lesion at the C3 level and a small nodule at the left C5 nerve root with cervical canal stenosis. Results The patient underwent surgery, and intramedullary metastasis of sarcomatoid MM was diagnosed. Subsequently, radiotherapy was administered, resulting in temporary improvement of the patient's condition. Thereafter, his condition gradually deteriorated, and follow-up MRI showed a more extensive residual C3 intramedullary lesion. Thus, a second surgery was performed after chemotherapy, but the patient died 5 months after the initial diagnosis. Conclusion We present this rare case, and emphasize intramedullary spinal cord metastasis of MM as differential diagnosis in primary cord lesion.

In plain English

This article was a case report with a short review of earlier published cases. It described a 62-year-old man whose pleural malignant mesothelioma, found to be the sarcomatoid type, spread inside his spinal cord at the C3 level of the neck. The article does not mention asbestos or any other exposure for this patient. He developed weakness and loss of sensation, called Brown-Séquard syndrome. MRI showed a lesion inside the cord and a small nodule on the left C5 nerve root, with no connection to the chest tumor. Surgery confirmed sarcomatoid mesothelioma in the cord and briefly restored his ability to walk. He worsened despite radiotherapy, chemotherapy and a second operation. He became paralyzed in all four limbs and died 5 months after the first spinal surgery. The authors reported that only eight earlier cases of mesothelioma spreading inside the spinal covering had been published. The authors concluded that spread of mesothelioma into the spinal cord should be considered when doctors see an apparent primary spinal cord lesion, particularly with the sarcomatous type and high tumor activity on PET scanning.

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 one patient, with a review of previously published cases of mesothelioma spreading inside the spinal dura
• Who was studied: One 62-year-old man with pleural sarcomatoid malignant mesothelioma, seen by the authors' neurosurgery department (University of Occupational and Environmental Health, Kitakyushu, Japan)
• Exposure: Not described: the article does not report asbestos or any other exposure for this patient
• Main results:
  • A chest wall biopsy first suggested biphasic mesothelioma. The specimen from later chest surgery showed sarcomatoid mesothelioma.
  • PET-CT showed high tumor activity in the pleural tumor (SUVmax 19.9) and no abnormality within the spinal canal at that time
  • MRI showed a lesion inside the spinal cord at C3 with no continuity to the lung tumor. The lesion showed the 'rim sign' pattern of enhancement.
  • The spinal cord tumor removed at the first surgery was sarcomatoid mesothelioma matching the pleural tumor, with a Ki-67 labeling index of 20%. After surgery the patient was able to walk again.
  • The patient worsened despite radiotherapy and chemotherapy, and the C3 lesion grew. The tumor removed at a second surgery was still sarcomatoid mesothelioma, with the Ki-67 labeling index increased to 40%.
  • The patient developed tetraplegia 2 weeks after the second surgery and died 5 months after the first spinal surgery
  • In the literature review, the authors found only eight earlier reported cases of mesothelioma spreading inside the spinal dura. In most of those, spread was thought to occur directly along nerves from the pleural tumor.
• The authors' conclusion: The authors concluded that spread of mesothelioma into the spinal cord should be considered when a primary spinal cord lesion is found, particularly with the sarcomatous type and a high SUVmax on PET

Topics

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Mesothelioma, Metastasis, Epithelium, Epithelioid, Desmoplastic Mesothelioma, Biphasic Mesothelioma, Chemotherapy.

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