Malignant Pleural Mesothelioma with Bone Marrow Metastases

Our plain-English summary of Malignant Pleural Mesothelioma with Bone Marrow Metastases, by H. Ihara, N. Harada, N. Shimada, et al (Internal Medicine, 2018).

The study

• Authors: H. Ihara, N. Harada, N. Shimada, K. Kanamori, T. Hayashi, T. Uekusa, K. Takahashi
• Journal: Internal Medicine
• Published: 2018;57(17):2541-2545
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 64-year-old man with the bone marrow metastasis due to malignant pleural mesothelioma (MPM) was diagnosed with anemia, leukoerythroblastosis, thrombocytopenia, and lower back pain. A bone marrow biopsy demonstrated infiltrative malignant mesothelioma lesions in the bone marrow. The patient died within 15 days of the detection of the bone marrow involvement. Physicians should consider performing a bone marrow biopsy to diagnose bone marrow metastasis and treat patients with palliative chemotherapy at an earlier phase of the disease. To our knowledge, this is the first report of an MPM patient having bone marrow metastasis with anemia, leukoerythroblastosis, and thrombocytopenia.

In plain English

This case report from Japan described one patient, a 64-year-old man with malignant pleural mesothelioma (epithelial type) that spread to the bone marrow. He had worked in drug manufacturing at a pharmaceutical company. The authors wrote that he may not have been exposed to asbestos or another mineral fiber. He received four cycles of cisplatin plus pemetrexed and showed a partial response, but the disease later progressed. In hospital he developed anemia, low platelets (thrombocytopenia), immature blood cells in the blood (leukoerythroblastic changes) and severe lower back pain. A bone marrow biopsy on day 19 showed the marrow replaced by tumor. Spine MRI showed metastases at multiple bone sites with spinal cord compression. He lost the use of his legs and died on day 32 of hospitalization, within 15 days of the bone marrow finding. The authors called this the fourth reported case of mesothelioma in the bone marrow. They concluded that a bone marrow biopsy should be considered so that palliative chemotherapy can start earlier. They noted that tissue findings differed between the pleura and the bone marrow.

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 (single patient)
• Who was studied: One 64-year-old man with malignant pleural mesothelioma, referred for chemotherapy to a hospital in Japan (Juntendo University); no dates given
• Exposure: No asbestos exposure was documented. He worked as a drug manufacturer and manager in a pharmaceutical company. The authors stated he may have had low-level exposure to chemical substances without asbestos, and may not have been exposed to asbestos or another mineral fiber.
• Main results:
  • The patient's pleural tumor was diagnosed as malignant pleural mesothelioma, epithelial type, clinical stage cT4N3M0 (Stage IV)
  • After talc pleurodesis, he received four cycles of cisplatin plus pemetrexed and showed a partial response; a new lesion in the right pleura later appeared
  • On day 17 of hospitalization his hemoglobin was 7.9 g/dL and leukoerythroblastic changes were seen in the peripheral blood
  • A bone marrow biopsy on day 19 showed the marrow replaced by a diffuse tumor infiltrate, and he was diagnosed with mesothelioma with bone marrow infiltration
  • Spine MRI showed metastases in the thoracic spine, lumbar spine and sacral vertebra, with spinal cord compression at the eleventh and twelfth thoracic vertebrae (Th11 and Th12)
  • Despite palliative radiotherapy (24 Gy in six fractions), he developed paraplegia of the lower extremities on day 23
  • On day 31 of hospitalization he had persistent severe back pain, anemia and thrombocytopenia
  • He died on day 32 of hospitalization, within 15 days of detection of bone marrow involvement
• The authors' conclusion: The authors concluded that the prognosis of mesothelioma with bone marrow metastasis, with or without palliative chemotherapy, is uncertain. They also concluded that a bone marrow biopsy should be considered to aid diagnosis and allow palliative chemotherapy at an earlier phase of the disease.
• Limitations the authors state:
  • The pathological findings differed between the pleura and the bone marrow. The authors suggested differences in staining methods and specimen handling as a possible cause.
  • The survival evidence the authors cite for this condition comes only from gastric cancer patients, so the prognosis for mesothelioma is uncertain

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, Metastasis, Biopsy, Mesothelioma, Palliative Care, Chemotherapy.

Related studies

• Local control of bone metastases treated with external beam radiotherapy in recent years: a multicenter retrospective study — K. Makita, Y. Hamamoto, et al. (2021)
• Clinical Significance of Bone Metastases in Pleural Mesothelioma — M. Miyake, K. Kuribayashi, et al. (2025)
• Bony metastases in desmoplastic pleural mesothelioma — T. Machin, E.T. Mashiyama, et al. (1988)
• Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors. Mesothelioma — A.A. Sandberg, J.A. Bridge (2001)
• Expression of E-cadherin in bone and soft tissue sarcomas: a possible role in epithelial differentiation — H. Sato, T. Hasegawa, et al. (1999)
• Diffuse pleural mesothelioma with distant bone metastasis. A case report — R.N. Laurini (1974)

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