Brown-Séquard Syndrome in a Desmoplastic Malignant Mesothelioma Patient: A Rare Complication

Our plain-English summary of Brown-Séquard Syndrome in a Desmoplastic Malignant Mesothelioma Patient: A Rare Complication, by M. Ralki, A. Serrien, J. Lambert, et al (Clinical Lung Cancer, 2021).

The study

• Authors: M. Ralki, A. Serrien, J. Lambert, M. Leys, K. Nackaerts
• Journal: Clinical Lung Cancer
• Published: 2021;22(4):e552-e554
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is a case report of one patient from Belgian hospitals. A 66-year-old man had malignant mesothelioma in the upper right pleural cavity. The tumor was of the desmoplastic subtype and invaded the brachial plexus. The article does not mention asbestos exposure. The tumor was considered inoperable, and he was treated with chemotherapy and immunotherapy drugs in the BEAT-meso clinical trial. Five months after diagnosis he was hospitalized with right leg weakness and balance problems. Examination showed Brown-Séquard syndrome. Scans showed local tumor spread at spinal level T1-T2 and a right-sided spinal metastasis at level C7-T1. The trial treatment was stopped for radiotherapy and steroids; his neurologic condition later worsened, and he received best supportive care. The authors said imaging could not prove how the tumor reached the spinal cord. They suggested spread through a widened blood vessel as a possibility. The local spread did not extend into the spinal canal around the cord. The authors concluded that spinal cord metastasis should be considered as a cause of neurologic complaints in mesothelioma patients, especially when examination suggests spinal cord 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)
• Who was studied: One 66-year-old man with desmoplastic malignant mesothelioma in the upper (apical) part of the right pleural cavity, invading the brachial plexus. He was treated in the BEAT-meso trial. The authors are from KU Leuven University Hospitals Leuven and AZ Groeninge Hospital, Kortrijk, Belgium. Dates of care are not given.
• Main results:
  • Five months after his mesothelioma diagnosis, the patient was hospitalized with weakness (paresis) of the right leg and difficulty keeping his balance. Clinically he had Brown-Séquard syndrome.
  • Spinal cord imaging showed local spread of the mesothelioma at level T1-T2 and a right-sided spinal metastasis at level C7-T1.
  • Electrodiagnostic studies also showed a severe polyneuropathy in this patient.
  • The trial treatment was stopped. Radiotherapy was given to the primary tumor (25 Gy) and to the spinal metastasis (20 Gy), with steroids.
  • In the following months the patient's neurologic status deteriorated, and he received best supportive care.
  • The authors suggested that the tumor may have spread to the spinal cord metastasis through the blood, via a pathologically widened blood vessel seen on imaging.
  • Imaging showed local spread of the mesothelioma into the right intervertebral foramen at level T1-T2. This spread did not extend into the space inside the spinal canal outside the cord. The authors suggested that the patient's earlier foraminotomy (neck surgery) possibly contributed to the local spread.
• The authors' conclusion: The authors concluded that spinal cord metastasis should be considered as a cause of neurologic complaints in patients with mesothelioma, especially when clinical examination suggests spinal cord pathology. They stated that blood-borne spinal cord metastasis is rare and had not been reported before in desmoplastic mesothelioma.
• Limitations the authors state:
  • The authors stated that the route by which the mesothelioma spread to the spinal cord could not be proven with imaging in this case.

Topics

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

Medical terms in this study, explained in our Lexicon: Desmoplastic Mesothelioma, Malignant Mesothelioma.

Related studies

• Intradural intramedullary spinal cord metastasis due to mesothelioma — M.C. Chamberlain, K.D. Eaton, et al. (2010)
• Malignant mesothelioma invading the spinal canal — D. Cooper (1974)
• Evaluation of the Webler-Brown model for estimating tetrachloroethylene exposure from vinyl-lined asbestos-cement pipes — L.A. Spence, A. Aschengrau, et al. (2008)
• Does occupational exposure to brown coal dust cause a decline in lung function? — C. Finocchiaro, A. Lark, et al. (1997)
• BAP1 Immunohistochemistry and p16 FISH in the Diagnosis of Sarcomatous and Desmoplastic Mesotheliomas — H.C. Hwang, S. Pyott, et al. (2016)
• The diagnosis of desmoplastic malignant mesothelioma and its distinction from fibrous pleurisy: a histologic and immunohistochemical analysis of 31 cases including p53 immunostaining — W.E. Mangano, P.T. Cagle, et al. (1998)

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