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Cerebral Metastasis of a Malignant Pleural Mesothelioma: A Case Report and Review of the Literature.

Chari A, Kolias AG, Allinson K, Santarius T - Cureus (2015)

Bottom Line: Despite a good surgical outcome with symptomatic recovery, the patient died of cardiopulmonary compromise five months postoperatively.CNS metastases may occur via three distinct mechanisms, namely perineural spread, leptomeningeal carcinomatosis and, most commonly, haematogenous spread leading to parenchymal deposits.However, the overall survival remains poor.

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Affiliation: Neurosurgery, Imperial College London & Imperial College NHS Trust.

ABSTRACT

Background: Malignant pleural mesothelioma (MPM) is an aggressive malignant neoplasm that was thought to be a localised disease with limited metastatic capability. However, recent post-mortem studies have identified metastases to the central nervous system (CNS) in about 3% of cases.

Case description: We present the case of a 65-year-old with a solitary supratentorial metastatic deposit of MPM treated with surgical resection and adjuvant whole brain radiotherapy. Despite a good surgical outcome with symptomatic recovery, the patient died of cardiopulmonary compromise five months postoperatively.

Conclusions: Although rare, CNS metastasis of MPM is a condition that neurosurgeons should be aware of. CNS metastases may occur via three distinct mechanisms, namely perineural spread, leptomeningeal carcinomatosis and, most commonly, haematogenous spread leading to parenchymal deposits. Surgical resection of these deposits can lead to symptomatic improvement, and together with radiotherapy, to local disease control. However, the overall survival remains poor.

No MeSH data available.


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Postoperative MR images confirming gross total resection.A/B: Post-gadolinium T1-weighted images showing some hyperintense material in the cavity that does not enhance compared to pre-contrast sequence; C: T2-weighted image
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FIG2: Postoperative MR images confirming gross total resection.A/B: Post-gadolinium T1-weighted images showing some hyperintense material in the cavity that does not enhance compared to pre-contrast sequence; C: T2-weighted image

Mentions: A 65-year-old left-handed gentleman presented to the emergency department with a focal seizure involving the left upper limb. His only past medical history of note was a left malignant pleural mesothelioma for which he had completed six cycles of pemetrexed and cisplatin chemotherapy one year previously. It had shown excellent partial radiological response and was now under surveillance with stable appearances on follow-up computed tomography (CT) scans. Neurological examination revealed isolated left upper limb weakness (4/5 on MRC scale) and an unsteady gait. CT and magnetic resonance (MR) imaging revealed a heterogeneously enhancing intrinsic lesion centred around the right pre-central gyrus measuring 22 mm x 30 mm x 20 mm with extensive surrounding oedema (Figure 1), highly suspicious of a solitary metastasis. Staging CT revealed stable lung disease in the thorax and no evidence of any new primary cancer. The patient was commenced on high dose dexamethasone and phenytoin, and surgical resection was planned. Preoperative neurological examination showed progression of his left hemiparesis to hemiplegia. He underwent gross total resection, confirmed on postoperative MR imaging (Figure 2). Light microscopy and immunohistochemistry of the excised lesion confirmed the suspected diagnosis of metastatic mesothelioma (Figure 3).


Cerebral Metastasis of a Malignant Pleural Mesothelioma: A Case Report and Review of the Literature.

Chari A, Kolias AG, Allinson K, Santarius T - Cureus (2015)

Postoperative MR images confirming gross total resection.A/B: Post-gadolinium T1-weighted images showing some hyperintense material in the cavity that does not enhance compared to pre-contrast sequence; C: T2-weighted image
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494585&req=5

FIG2: Postoperative MR images confirming gross total resection.A/B: Post-gadolinium T1-weighted images showing some hyperintense material in the cavity that does not enhance compared to pre-contrast sequence; C: T2-weighted image
Mentions: A 65-year-old left-handed gentleman presented to the emergency department with a focal seizure involving the left upper limb. His only past medical history of note was a left malignant pleural mesothelioma for which he had completed six cycles of pemetrexed and cisplatin chemotherapy one year previously. It had shown excellent partial radiological response and was now under surveillance with stable appearances on follow-up computed tomography (CT) scans. Neurological examination revealed isolated left upper limb weakness (4/5 on MRC scale) and an unsteady gait. CT and magnetic resonance (MR) imaging revealed a heterogeneously enhancing intrinsic lesion centred around the right pre-central gyrus measuring 22 mm x 30 mm x 20 mm with extensive surrounding oedema (Figure 1), highly suspicious of a solitary metastasis. Staging CT revealed stable lung disease in the thorax and no evidence of any new primary cancer. The patient was commenced on high dose dexamethasone and phenytoin, and surgical resection was planned. Preoperative neurological examination showed progression of his left hemiparesis to hemiplegia. He underwent gross total resection, confirmed on postoperative MR imaging (Figure 2). Light microscopy and immunohistochemistry of the excised lesion confirmed the suspected diagnosis of metastatic mesothelioma (Figure 3).

Bottom Line: Despite a good surgical outcome with symptomatic recovery, the patient died of cardiopulmonary compromise five months postoperatively.CNS metastases may occur via three distinct mechanisms, namely perineural spread, leptomeningeal carcinomatosis and, most commonly, haematogenous spread leading to parenchymal deposits.However, the overall survival remains poor.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neurosurgery, Imperial College London & Imperial College NHS Trust.

ABSTRACT

Background: Malignant pleural mesothelioma (MPM) is an aggressive malignant neoplasm that was thought to be a localised disease with limited metastatic capability. However, recent post-mortem studies have identified metastases to the central nervous system (CNS) in about 3% of cases.

Case description: We present the case of a 65-year-old with a solitary supratentorial metastatic deposit of MPM treated with surgical resection and adjuvant whole brain radiotherapy. Despite a good surgical outcome with symptomatic recovery, the patient died of cardiopulmonary compromise five months postoperatively.

Conclusions: Although rare, CNS metastasis of MPM is a condition that neurosurgeons should be aware of. CNS metastases may occur via three distinct mechanisms, namely perineural spread, leptomeningeal carcinomatosis and, most commonly, haematogenous spread leading to parenchymal deposits. Surgical resection of these deposits can lead to symptomatic improvement, and together with radiotherapy, to local disease control. However, the overall survival remains poor.

No MeSH data available.


Related in: MedlinePlus