Extensive epidural cufflike growth of malignant pleural mesothelioma causing spinal cord compression

Our plain-English summary of Extensive epidural cufflike growth of malignant pleural mesothelioma causing spinal cord compression, by J.M. Gijtenbeek, H.I. Brouwer, R.H. Boerman, et al (The Journal of Thoracic and Cardiovascular Surgery, 2002).

The study

• Authors: J.M. Gijtenbeek, H.I. Brouwer, R.H. Boerman, R.G. Wiggenraad, C.J. Vecht, P.A. Smitt
• Journal: The Journal of Thoracic and Cardiovascular Surgery
• Published: 2002;124(1):200-2
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

The authors described 4 patients with pleural malignant mesothelioma whose tumor grew from a paravertebral mass through the intervertebral foramina into the spinal epidural space, causing signs of spinal cord compression. The patients were seen at Dutch neurology, radiotherapy and neuro-oncology departments. The neurologic complication developed 4 months, and 2, 6 and 7 years, after diagnosis. Patient 1, a 56-year-old woman exposed to asbestos through her husband's working clothes, had been treated for pleural effusion for 7 years. Mesothelioma was found on psoas muscle biopsy, and epidural tumor later extended through the foramen magnum into the skull. Patient 2, a 46-year-old man diagnosed 6 years earlier, had an epidural cuff from T10 to L3 that later reached the foramen magnum despite radiotherapy. Patient 3, a 41-year-old woman, developed cervical cord compression 2 years after diagnosis, and later a cufflike epidural tumor from C2 to the sacrum. Patient 4, a 53-year-old man, had cord compression at T10 four months after diagnosis. All received radiotherapy, with temporary improvement in some, and all died of respiratory failure. Autopsy in 2 cases confirmed widespread cufflike epidural extension. The authors concluded that radicular pain should alert clinicians to possible epidural tumor in patients with known or suspected mesothelioma, and that radiotherapy should be started immediately to preserve neurologic function.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This case series described four patients in the Netherlands with malignant pleural mesothelioma. In each, the tumor grew through the openings between the vertebrae into the space around the spinal cord (the epidural space). The authors described signs of spinal cord compression, though in the fourth patient the neurologic examination was otherwise normal and compression was seen on MRI. They were a 56-year-old woman, 46-year-old man, 41-year-old woman and 53-year-old man. Only the first patient's asbestos exposure was described: through her husband's working clothes; no fiber type was named. The spinal complication appeared 4 months and 2, 6 and 7 years after diagnosis. Scans in three patients showed epidural tumor along many spinal levels, a 'cufflike' pattern the authors reported was confirmed at autopsy in two. Radiotherapy relieved pain or weakness for a time in some patients. All four died of respiratory failure. The authors wrote that the reason for the extensive spread was unclear but may relate to the relatively protracted course of disease. They also wrote that radiating nerve-root pain should alert clinicians to possible epidural tumor.

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 series (four case reports)
• Who was studied: 4 patients with pleural malignant mesothelioma and spinal epidural tumor growth: women aged 56 and 41, men aged 46 and 53. The authors were based in Nijmegen, Arnhem, The Hague and Rotterdam, The Netherlands. Dates of treatment are not given.
• Exposure: Asbestos exposure is reported only for patient 1, who was exposed through her husband's working clothes. No fiber type or exposure details are given for the other patients.
• Main results:
  • The neurologic complication developed 4 months, 2 years, 6 years and 7 years after diagnosis in the four patients.
  • Patient 1 (56-year-old woman): MRI showed epidural tumor growth at the thoracic and cervical levels, extending into the skull. At autopsy, the tumor extended at all levels through the intervertebral foramina into the spinal canal. She died of respiratory failure.
  • Patient 2 (46-year-old man, diagnosed 6 years earlier): MRI showed an epidural cuff from T10 to L3. Radiotherapy (30 Gy) improved his pain. Five months later, the cuff had extended up to the foramen magnum and was compressing the spinal cord. He died of respiratory failure one month later. No autopsy was performed.
  • Patient 3 (41-year-old woman): radiotherapy for cervical cord compression nearly resolved her weakness. Later, MRI showed a cufflike epidural tumor from C2 to the sacrum. At autopsy, this proved to be partially necrotic malignant mesothelioma surrounding the dura.
  • Patient 4 (53-year-old man, diagnosed 4 months earlier): his neurologic examination was otherwise normal, but MRI showed an epidural cuff at T10 causing spinal cord compression. He died of respiratory failure within 1 month of radiotherapy.
  • The authors reported that the widespread cufflike epidural growth pattern was observed with MRI and confirmed by autopsy in 2 cases.
• The authors' conclusion: The authors concluded that the reason for the extensive spinal extension was unclear but may be related to the relatively protracted course of the disease. They also stated that radicular pain should alert clinicians to possible epidural tumor in patients with known or suspected malignant mesothelioma.

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, Pleural Effusion, Mesothelioma, Biopsy, Autopsy.

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