Brain Metastasis of Pleural Mesothelioma after a Subarachnoid Hemorrhage

Our plain-English summary of Brain Metastasis of Pleural Mesothelioma after a Subarachnoid Hemorrhage, by A. Hirooka, A. Tamiya, M. Kanazu, et al (Internal Medicine, 2016).

The study

• Authors: A. Hirooka, A. Tamiya, M. Kanazu, J. Nonaka, T. Yonezawa, K. Asami, S. Atagi
• Journal: Internal Medicine
• Published: 2016;55(7):779-81
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is an uncommon, fatal neoplasm induced by asbestos exposure. Brain metastases from MPM are extremely rare, with most such cases diagnosed only at the time of autopsy. This report describes what we believe to be the first case of MPM metastasizing to the brain after a subarachnoid hemorrhage, as well as the subsequent surgical removal of the brain metastasis.

In plain English

This article is a case report from Japan about one patient. A 57-year-old man was admitted to a neurosurgical hospital in May 2010 with a subarachnoid hemorrhage (bleeding around the brain) and had surgery to repair a ruptured aneurysm. Three months later he was admitted with fluid around the left lung. A biopsy showed biphasic malignant pleural mesothelioma, mainly sarcomatoid. A brain scan found a tumor near the bleeding site in the right occipital lobe. In October 2010 the tumor was completely removed, and laboratory testing showed it had spread from the mesothelioma. He then received two cycles of cisplatin and pemetrexed chemotherapy. He developed loss of appetite and impaired liver function, became completely disabled, did not respond to treatment, and died two months after surgery. The report does not describe his asbestos exposure. The authors proposed that the hemorrhage damaged the barrier protecting the brain and helped mesothelioma cells reach it, and they called this a hypothesis. They noted that tiny metastases may already have been present and that the mechanism remains unclear.

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 (a single patient)
• Who was studied: One 57-year-old man in Japan, first admitted with a subarachnoid hemorrhage in May 2010
• Exposure: The patient's asbestos exposure is not described. The article states only in general terms that malignant pleural mesothelioma is caused by asbestos exposure.
• Main results:
  • Three months after brain surgery for the hemorrhage, a pleural biopsy showed biphasic mesothelioma that was mainly sarcomatoid
  • MRI showed a brain tumor near the hemorrhage-related blood clot in the right occipital lobe
  • The brain tumor was completely removed in October 2010, and testing showed it had spread from the pleural mesothelioma
  • The patient received two cycles of chemotherapy with cisplatin and pemetrexed
  • After chemotherapy his condition worsened. He did not respond to treatment and died two months after surgery, with no recurrence shown.
• The authors' conclusion: The authors hypothesized that the subarachnoid bleeding caused failure of the blood-brain barrier, which promoted spread of the mesothelioma to the brain
• Limitations the authors state:
  • The authors could not rule out that a microscopic brain metastasis was already present before the hemorrhage
  • The authors state that the mechanism of mesothelioma spreading to the brain and spinal cord remains unclear
  • The authors state that further studies would be needed to tell whether the hemorrhage or the surgery itself damaged the blood-brain barrier

Topics

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

Medical terms in this study, explained in our Lexicon: Metastasis, Pleural Mesothelioma, Neoplasm, Asbestos Exposure, Autopsy.

Related studies

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• Brain metastasis in malignant pleural mesothelioma — A. Kawai, Y. Nagasaka, et al. (1997)
• Malignant mesothelioma with brain metastases — J.A. Kaye, A.M. Wang, et al. (1986)
• Assessing Tumor-Infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method from the International Immuno-Oncology Biomarkers Working Group: Part 2: TILs in Melanoma, Gastrointestinal Tract Carcinomas, Non-Small Cell Lung Carcinoma and Mesothelioma, Endometrial and Ovarian Carcinomas, Squamous Cell Carcinoma of the Head and Neck, Genitourinary Carcinomas, and Primary Brain Tumors — S. Hendry, R. Salgado, et al. (2017)
• Simian virus 40 transformation, malignant mesothelioma and brain tumors — F. Qi, M. Carbone, et al. (2011)
• Occupational risk factors for brain cancer in Canada — S.Y. Pan, A.M. Ugnat, et al. (2005)

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