Meningeal metastasis of a malignant peritoneal mesothelioma: A case report and literature review

Our plain-English summary of Meningeal metastasis of a malignant peritoneal mesothelioma: A case report and literature review, by Y. Jiang, Z. Mei, H. Cao, et al (Cancer Biology & Therapy, 2019).

The study

• Authors: Y. Jiang, Z. Mei, H. Cao, S. Li, H. Xu, H. Qiu, Y. Liu
• Journal: Cancer Biology & Therapy
• Published: 2019;20(12):1409-1415
• Type of article: Case report, Review
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant peritoneal mesothelioma is a very rare tumor originating from the peritoneal serous mesothelium. Meningeal metastasis of malignant peritoneal is even more rare. Here, we reported a case of a 60-year-old female patient with a history of exposure to asbestos for 10 years who presented with massive peritoneal effusion followed by disorder of consciousness and symptoms of cranial nerve injury. The patient was diagnosed as peritoneal mesothelioma with meningeal metastasis through neurological symptoms, cytological finding of cerebrospinal fluid combined with cranial magnetic resonance imaging (MRI). The patient received systemic chemotherapy and total craniospinal irradiation. The follow up visits showed that the survival time of patient after diagnosis of meningeal metastasis from peritoneal mesothelioma was 5 months. To our knowledge, this is the first case of menigeal metastasis of peritoneal mesothelioma. We hope this particular case may be helpful in providing some experience to the treatment of peritoneal mesothelioma with meningeal metastasis.

In plain English

This case report, with a discussion of published literature, came from Zhongnan Hospital of Wuhan University in China. It described a 60-year-old woman with about 10 years of work exposure to asbestos; the article did not state the fiber type. In early 2017, surgery for massive abdominal fluid showed disseminated peritoneal mesothelioma, and she then received nine cycles of pemetrexed and cisplatin chemotherapy. In December 2018 she returned with back pain. Scans showed the cancer had come back in the abdomen, and a brain MRI showed abnormal signals. She had brief losses of consciousness, blindness and left facial paralysis. Tumor cells were found in her spinal fluid, so she was diagnosed with meningeal metastasis (spread to the membranes around the brain and spinal cord). She received radiation to the brain and spine, and by the end of it the authors reported that her back pain, disorder of consciousness and blindness had improved significantly. She died on May 15, 2019, and the authors reported survival of 5 months after the meningeal metastasis diagnosis. The authors stated that, to their knowledge, this was the first case of its kind.

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 of one patient, with a discussion of published literature
• Who was studied: One 60-year-old woman admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, on February 25, 2017
• Exposure: Career (occupational) exposure to asbestos for about 10 years. Fiber type, products and job are not stated.
• Main results:
  • After exploratory laparotomy and surgery for massive ascites, tissue examination showed disseminated peritoneal mesothelioma
  • The tumor cells had epithelioid cell morphology
  • The patient received nine cycles of pemetrexed plus cisplatin from February 2017 to October 2017. Treatment was well tolerated, and no obvious recurrence or metastasis was found on regular CT and MRI.
  • The patient returned on December 15, 2018 with back pain of 6 days.
  • At return, tumor markers were high: CA 125 452.8 U/mL, CA199 64.09 U/mL and HE4 252.9 pmol/L. At the first admission, CA125 had been 96.4 U/mL (reference range 0 to 35).
  • PET-CT showed recurrence, with peritoneal thickening in the greater omentum, mesentery and pelvic floor. Head MRI showed multiple abnormal signals in the brain sulci and vermis.
  • The patient had two episodes of temporary loss of consciousness and blindness, and a persistent left facial paralysis. Tumor cells were found in the cerebrospinal fluid, and meningeal metastasis from peritoneal mesothelioma was diagnosed.
  • Genetic testing of tumor tissue found six gene mutations (TP53, ARAF, ITGB2, PDGFRB, POLQ, PALB2). No available targeted drugs were identified.
  • The patient received craniospinal irradiation by Tomotherapy, 32.5 Gy in total in 18 fractions, without significant side effects. By the end of radiotherapy, back pain, disorder of consciousness and blindness had improved significantly. Three cycles of temozolomide followed.
  • Disease progressed in April 2019 and the patient died on May 15, 2019. The authors reported survival of 5 months after diagnosis of meningeal metastasis.
• The authors' conclusion: The authors concluded that this was a rare case of peritoneal mesothelioma with meningeal metastasis, to their knowledge the first reported, and that more studies are needed on treatment.

Topics

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

Medical terms in this study, explained in our Lexicon: Metastasis, Peritoneal Mesothelioma, Mesothelium, Chemotherapy.

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