Brain metastasis in malignant pleural mesothelioma

Our plain-English summary of Brain metastasis in malignant pleural mesothelioma, by A. Kawai, Y. Nagasaka, M. Muraki, et al (Internal Medicine, 1997).

The study

• Authors: A. Kawai, Y. Nagasaka, M. Muraki, M. Fukuoka, T. Satou, M. Kimura, S. Hashimoto
• Journal: Internal Medicine
• Published: 1997;36(8):591-4
• Type of article: Case report, Review
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 55-year-old male who had a remote history of occupational asbestos exposure consulted us because of chest pain. Chest X-ray revealed diffuse pleural thickening and pleural effusion on the right. A diagnosis of malignant mesothelioma, biphasic type was made by needle pleural biopsy. Fourteen months later, the patient died of brain metastasis. At autopsy, malignant mesothelioma of the pleura with metastasis to the brain and bilateral adrenal glands was observed. Brain metastases proven by autopsy are rare in cases of malignant mesothelioma. The ferruginous body count in the lung tissue was 16 per gram of wet weight.

In plain English

This case report described one 55-year-old man at Kinki University Hospital in Japan. From age 20 to 23 he had worked in a factory fixing jute bags for reuse, and many of those bags had been used to carry imported asbestos. A needle biopsy showed biphasic malignant pleural mesothelioma, a tumor with both epithelial and sarcomatous cells, on the right side. Later he became disoriented and unconscious. A brain scan suggested the cancer had spread to the brain, and doctors diagnosed SIADH, a disorder of the body's salt and water balance. He died fourteen months after diagnosis. Autopsy confirmed pleural mesothelioma that had spread to the brain and both adrenal glands. His lungs held 16 ferruginous bodies per gram of wet lung tissue, which the authors said was not enough to assess the occupational exposure. The authors also reviewed published reports and counted 19 autopsy-proven cases of brain spread, including this one. In the 16 cases they tabulated, 75% were sarcomatous. The authors suggested that sarcomatous tumors may be more likely to spread to the brain.

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 a review of published autopsy-proven cases
• Who was studied: one 55-year-old man at Kinki University Hospital, Osaka, Japan. His symptoms began in August 1994, and he was readmitted in December 1995. The literature review tabulated 16 cases, including the present one.
• Exposure: fixing jute bags for reuse, many of which had carried imported asbestos (fiber type not stated), from age 20 to 23
• Main results:
  • Needle biopsy of the right pleura showed biphasic malignant mesothelioma, a mixture of epithelial and sarcomatous components
  • On readmission the patient became disoriented and unconscious. Brain CT led to a tentative diagnosis of brain metastasis, and a clinical diagnosis of SIADH was made
  • The patient died of brain metastasis fourteen months after diagnosis
  • At autopsy, mesothelioma of the pleura had spread to the brain and to both adrenal glands
  • The brain and adrenal lesions matched the primary tumor, but the sarcomatous component was more prominent
  • The patient's lung tissue contained 16 ferruginous bodies per gram of wet tissue
  • The literature search found 19 autopsy-proven cases of brain metastasis in malignant mesothelioma, including the present case
  • Among the 16 tabulated cases, the sarcomatous type made up 75%
  • Among the 16 tabulated cases, a history of occupational asbestos exposure was reported in 92%
• The authors' conclusion: The authors suggested that sarcomatous mesothelioma may be more likely to spread to the brain. They also assumed that this patient's SIADH was a consequence of the brain metastasis.
• Limitations the authors state:
  • The ferruginous body count was too low to assess the occupational asbestos exposure, so the authors could not confirm it
  • Three previously listed proven cases were left out of the review: one report could not be accessed, and two lacked details

Topics

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

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Asbestos Exposure, Chest X-Ray, Diffuse Pleural Thickening, Pleural Effusion, Malignant Mesothelioma, Biphasic Mesothelioma.

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• Simian virus 40 transformation, malignant mesothelioma and brain tumors — F. Qi, M. Carbone, et al. (2011)
• Malignant mesothelioma with brain metastases — J.A. Kaye, A.M. Wang, et al. (1986)

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