Brain metastases in malignant pleural mesothelioma. Case report and review of the literature

Our plain-English summary of Brain metastases in malignant pleural mesothelioma. Case report and review of the literature, by K.S. Sridhar, A.M. Hussein, P. Ganjei, et al (American Journal of Clinical Oncology, 1989).

The study

• Authors: K.S. Sridhar, A.M. Hussein, P. Ganjei, R.J. Thurer, N. Raskin, E.J. Beattie
• Journal: American Journal of Clinical Oncology
• Published: 1989;12(3):222-8
• Type of article: Case report, Review
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Recent advances in pleural malignant mesothelioma include the sequential use of palliative surgery, perioperative radiation therapy, and systemic chemotherapy. Radical treatments may not only palliate but also improve survival in some patients. The latter may be associated with the appearance of metastases in unusual sites including the central nervous system. In malignant mesothelioma, brain metastases were previously reported in 19 patients at autopsy and in only 1 patient antemortem. We detail the clinical presentation in the second patient with pleural malignant mesothelioma thus far reported to develop brain metastases. The difficulties in diagnosis, the role of immunoperoxidase stains in malignant mesothelioma, excellent tolerance of different modalities of treatment, and a review of the literature of brain metastases in mesothelioma are discussed. Based on our report, the possibility of brain metastases should be investigated by careful clinical examination prior to a radical treatment in patients with progressive refractory mesothelioma.

In plain English

This article was a case report with a review of published reports of brain metastases in malignant pleural mesothelioma. The patient was a 65-year-old woman who, 25 years earlier, had worked with asbestos tiles for about 1 month. The article did not name a fiber type. A needle sample from her chest was first read as adenocarcinoma, but an extensive workup found no primary cancer. Surgery with special stains then confirmed malignant mesothelioma. She had no symptoms for 8 months, then received chemotherapy, including the investigational drug pirarubicin, and a second chest operation. A month after that operation she developed aphasia (a language impairment), and a brain scan showed two lesions the authors described as typical of metastases. She died a month later, and no autopsy was done. The authors cited earlier reports of 19 such patients found at autopsy and one diagnosed before death, and concluded that theirs was the second diagnosed before death. They could not totally exclude spread from another cancer. They suggested a detailed neurological examination before radical treatment.

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 with review of the literature
• Who was studied: one 65-year-old right-handed woman with malignant pleural mesothelioma who presented in June 1985 with a 1-month dry cough; authors were in Miami, Florida and New York
• Exposure: worked with asbestos tiles for about 1 month, 25 years before presentation; no fiber type stated
• Main results:
  • The needle aspiration was initially interpreted as adenocarcinoma, and an extensive workup failed to find a primary carcinoma
  • After surgery (right partial pleurectomy, excision of nodules, right middle lobectomy), staining was strongly positive for keratin and negative for CEA, confirming mesothelial origin
  • The patient had no evidence of mesothelioma for 8 months, until dyspnea and right chest pain developed
  • She received four courses of pirarubicin 35 mg/m² intravenously every 3 weeks, with stable disease on radiologic evaluation
  • After one course of mitomycin-C and cisplatin she had severe but reversible pancytopenia (low blood counts)
  • A month after a second thoracotomy she developed aphasia; brain CT showed two lesions in the left parietal and left occipital cortex, both enhancing with contrast, typical of metastases
  • The patient died 1 month later in hospice care, and autopsy was denied
  • The authors described this as only the second case of brain metastases from mesothelioma reported to be diagnosed before death
  • Literature review: 20 cases of brain metastases had been reported previously, 19 at autopsy and only one diagnosed before death
  • Literature review: no reported cases of brain metastasis associated with peritoneal mesothelioma
• The authors' conclusion: The authors concluded that, because brain metastases in mesothelioma are rare, routine CT or nuclear magnetic brain scans are cost ineffective, and they suggested a detailed neurological examination in patients with pleural malignant mesothelioma before any radical treatment
• Limitations the authors state:
  • No autopsy was available to confirm the brain lesions
  • The authors could not totally exclude brain metastases from another cancer such as bronchogenic (lung) carcinoma

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Malignant Mesothelioma, Palliative Care, Chemotherapy, Autopsy, Mesothelioma.

Related studies

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• Response to chemotherapy of brain metastases from malignant pleural mesothelioma — M. Colleoni, G. Liessi, et al. (1996)
• Meningeal and brain metastases in primary malignant pericardial mesothelioma — U. Bohn, J.L. Gonzalez, et al. (1994)
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• Occupational risk factors for brain cancer in Canada — S.Y. Pan, A.M. Ugnat, et al. (2005)

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