Brain metastasis in malignant pleural mesothelioma presenting as intratumoral hemorrhage

Our plain-English summary of Brain metastasis in malignant pleural mesothelioma presenting as intratumoral hemorrhage, by T. Ishikawa, H. Wanifuchi, K. Abe, et al (Neurologia Medico-chirurgica, 2010).

The study

• Authors: T. Ishikawa, H. Wanifuchi, K. Abe, K. Kato, A. Watanabe, Y. Okada
• Journal: Neurologia Medico-chirurgica
• Published: 2010;50(11):1027-30
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 51-year-old man presented with a rare case of brain metastasis of malignant pleural mesothelioma (MPM) manifesting as intratumoral hemorrhage. He had undergone several treatments such as left pneumonectomy, pleurectomy, chemotherapy with cis-diamminedichloroplatinum and gemcitabine hydrochloride, and irradiation. Five years later, computed tomography revealed right parietal metastasis with intratumoral hemorrhage and the patient was treated by surgery and irradiation. Six months after the surgery, recurrent intratumoral hemorrhage occurred and a second surgery was performed. MPM has a poor prognosis and brain metastasis is rare, but long-term survival has recently improved through the application of multi-modality approaches. Therefore, the number of opportunities for treating MPM metastasis will increase in the near future. Intratumoral hemorrhage may occur in patients with solitary brain metastasis of MPM, so surgery should be considered as a general candidate treatment for metastatic tumors.

In plain English

This article is a case report about one patient, written by neurosurgeons in Saitama, Japan. A 51-year-old man, a non-smoker, had worked in a textile factory for 20 years. The article describes him as having no occupational exposure to asbestos. In November 2003 he was diagnosed with epithelial type malignant pleural mesothelioma. He was treated with removal of the left lung and pleura, chemotherapy and 54 Gy of radiation. A later tumor in the right lung was treated with partial removal of that lung and more chemotherapy, which the article dates to June 2007. In November 2008, after a seizure, a scan showed a 1.5 cm lesion in the right parietal lobe of the brain. It was removed in December 2008 and found to be metastatic mesothelioma with bleeding that also contained sarcomatous patterns. Whole brain radiation followed. A mass reappeared in April 2009, and the patient refused surgery. In June 2009 a 5 cm bleeding lesion was removed. Its sarcomatous component was larger than before. The patient was discharged without recognizable neurological deficit. The authors concluded that surgery should be considered for solitary brain metastasis of this disease.

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 (one patient), with a short table of previously published surgical cases
• Who was studied: One 51-year-old male non-smoker with malignant pleural mesothelioma, admitted in November 2003 to the authors' hospital (Saitamaken Saiseikai Kurihashi Hospital, Kuki, Saitama, Japan) and followed through June 2009
• Exposure: The patient worked in a textile factory for 20 years. The article states he had no occupational exposure to asbestos. In the discussion, the authors noted that a textile factory is a possible place of occupational asbestos exposure, but that no other workers there had been affected by mesothelioma. No fiber type is named for this patient.
• Main results:
  • The patient was diagnosed with epithelial type malignant pleural mesothelioma. He was treated with left pneumonectomy, pleurectomy, two courses of chemotherapy with cisplatin (CDDP) and gemcitabine, and a total of 54 Gy of irradiation.
  • A metastatic tumor in the right lung was later found. The patient had right partial pneumonectomy and four courses of chemotherapy with CDDP and pemetrexed, which the article dates to June 2007.
  • In November 2008, after a generalized convulsion, CT showed a 1.5 cm high density lesion in the right parietal lobe of the brain.
  • The first brain surgery took place in December 2008, according to the figure caption describing the tissue specimens.
  • The brain lesion was completely removed and identified as metastatic mesothelioma with hemorrhage. Besides epithelial cells, it contained a histological variant with sarcomatous patterns. Calretinin and epithelial membrane antigen stains were positive; carcinoembryonic antigen, CD31 and CD34 were negative.
  • After 54 Gy of whole brain irradiation, MR imaging again showed a mass in April 2009, and the patient refused surgery.
  • In June 2009 the patient had sudden headache, nausea and mild left hemiparesis. CT showed a 5 cm lesion with two components, swelling and midline shift.
  • At the second complete removal, the front part of the tumor was a large hematoma (blood clot). The sarcomatous component was much larger than in the first specimen.
  • The authors suspected the bleeding was caused by rupture of abnormal blood vessels in the tumor, based on the tissue findings.
  • After the second operation the patient was discharged without recognizable neurological deficit.
• The authors' conclusion: The authors concluded that bleeding inside the tumor may occur in patients with a solitary brain metastasis of malignant pleural mesothelioma, and that surgery should be considered as a treatment option for such metastases.

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, Pneumonectomy, Chemotherapy, Gemcitabine, Prognosis.

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• Response to chemotherapy of brain metastases from malignant pleural mesothelioma — M. Colleoni, G. Liessi, et al. (1996)
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