Intradural intramedullary spinal cord metastasis due to mesothelioma

Our plain-English summary of Intradural intramedullary spinal cord metastasis due to mesothelioma, by M.C. Chamberlain, K.D. Eaton, J.R. Fink, et al (Journal of Neuro-oncology, 2010).

The study

• Authors: M.C. Chamberlain, K.D. Eaton, J.R. Fink, T. Tredway
• Journal: Journal of Neuro-oncology
• Published: 2010;97(1):133-6
• Type of article: Case report
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Unlabelled: To report the occurrence of intramedullary spinal cord metastases in a patient with a mesothelioma. A case report.

Setting: University medical center. A 67-year old man with mesothelioma developed paraparesis 6-months after diagnostic thoracotomy. MR spine imaging revealed an intramedullary spinal cord metastases. Cyberknife radiotherapy. Intramedullary spinal cord metastases, although rare, is increasingly recognized with spinal cord MRI. Treatment remains unsatisfactory as treatment with surgery or irradiation is only partially effective.

In plain English

This article was a case report about one patient, a 67-year-old man, whose mesothelioma spread into the spinal cord. He first had pain in the right shoulder blade and side of the chest. A chest wall biopsy showed sarcomatoid mesothelioma, staged T3, N0, M0. He had a right thoracotomy with full pleurectomy and decortication, then chest radiotherapy totaling 54.5 Gy. About six months after surgery his right leg weakened and became paralyzed over 3 weeks. Examination showed markedly uneven weakness of the legs. Spinal fluid tested negative for tumor cells. MRI showed a lesion inside the spinal cord at the T1 to T3 level, and tumor growing along the right T4 nerve root, which the authors suggested was the route of spread. Because the area had already been irradiated, cyberknife stereotactic re-radiation was recommended. The article did not report the outcome, and it did not describe any asbestos exposure. The authors concluded that early recognition and treatment of this rare condition allows palliation and survival not unlike brain metastases.

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
• Who was studied: One 67-year-old white man with mesothelioma of the pleura (chest lining), reported by authors at the University of Washington, Seattle; dates of care not given
• Main results:
  • A CT-guided chest wall biopsy showed sarcomatoid mesothelioma
  • Because the ribs were involved, the patient was staged as T3, N0, M0
  • The patient had a right thoracotomy with full pleurectomy and decortication, followed by right chest radiotherapy (total dose 54.5 Gy over 38 days, 28 treatment days)
  • About 6 months after surgery, weakness of the right leg progressed over 3 weeks until the leg was paralyzed
  • Neurological examination showed markedly asymmetric weakness of the legs: only trace movement in the lower right leg and mild weakness in the upper left leg
  • Spinal fluid obtained by lumbar puncture was negative for tumor cells
  • Spine MRI showed a lesion inside the spinal cord (intradural intramedullary) at the T1 to T3 level
  • MRI also showed mesothelioma growing inward along the right T4 nerve root, which the authors suggested was the route by which the tumor reached the spinal cord
  • No compression of the spinal cord from outside the cord (epidural compression) was seen
  • Because the lesion lay within the previously irradiated chest field, re-radiation with cyberknife stereotactic radiotherapy was recommended. No treatment outcome was reported.
• The authors' conclusion: The authors concluded that early clinical recognition and treatment of intramedullary spinal cord metastasis, a rare condition, permits palliation and survival not dissimilar to metastases in the brain tissue

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, Mesothelioma, Thoracotomy.

Related studies

• Malignant mesothelioma invading the spinal canal — D. Cooper (1974)
• Spinal cord ischemia resulting in paraplegia following extrapleural pneumonectomy — K. Ural, K. Jakob, et al. (2014)
• Extensive epidural cufflike growth of malignant pleural mesothelioma causing spinal cord compression — J.M. Gijtenbeek, H.I. Brouwer, et al. (2002)
• Spinal cord ischaemia after radical pleurectomy/decortication operation for mesothelioma — E. Kaba, M.O. Özyurtkan, et al. (2016)
• Perineural spread of malignant mesothelioma with spinal intramedullary involvement — M. Tanwar, C.B. Simone, et al. (2014)
• Pleural malignant mesothelioma causing cord infiltration through the nerve root. Case report — H. Okura, Y. Suga, et al. (2009)

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