Metastatic biphasic pleural mesothelioma presenting with cauda equina syndrome

Our plain-English summary of Metastatic biphasic pleural mesothelioma presenting with cauda equina syndrome, by P. Pranay, V. Serafimov, J. Hall, et al (Radiology Case Reports, 2018).

The study

• Authors: P. Pranay, V. Serafimov, J. Hall, A. Goel, M. Mushtaq
• Journal: Radiology Case Reports
• Published: 2018;13(3):736-739
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Patient with previous asbestos exposure on a watchful wait and watch regime presents acutely with cauda equina syndrome. Radiological imaging confirmed a mass with direct invasion of the spinal cord. Histology confirmed metastatic pleural mesothelioma.

In plain English

This case report described one patient, an 84-year-old male plumber with previously known asbestos exposure. Pleural changes had been watched with serial CT scans from 2010 until 2016. In June 2016 he was admitted after 12 weeks of reduced sensation in his left leg, back pain, reduced sensation opening his bowels, and difficulty walking. A CT scan showed new irregular pleural thickening in the upper left chest extending toward the left nerve root at T2/3, plus new disease in the right lower chest. An MRI showed a 23 mm metastasis inside the spinal cord at T2/T3. He was given high-dose dexamethasone. The neurosurgeons felt that surgery would be more likely to damage the spinal cord. A biopsy confirmed biphasic pleural mesothelioma. After the biopsy result and worsening nerve symptoms in his legs, he agreed to radiotherapy of 20 Grays in 5 fractions. He died shortly afterwards of respiratory failure. The authors concluded that spread of pleural mesothelioma outside the chest is rare, and that the case shows the importance of matching clinical findings with imaging and tissue confirmation.

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 84-year-old male plumber in the UK. He was admitted in June 2016 and had been followed with CT scans since 2010.
• Exposure: Previously known asbestos exposure in a man who worked as a plumber. The fiber type, duration and dose were not reported.
• Main results:
  • The patient was admitted in June 2016 with a 12-week history of reduced sensation in his left leg, back pain, reduced sensation opening his bowels, difficulty walking, and reduced proprioception in his leg.
  • The inpatient CT showed new irregular pleural thickening in the left upper back of the chest, extending toward the left nerve root at T2/3. Earlier CT findings in 2015 had been normal. There was also new disease in the right lower chest with local bone erosion.
  • The MRI of the whole spine showed a 23 mm intramedullary metastasis at T2/T3, swelling of the spinal cord from C6 to T6, and a further deposit in the bone at T8.
  • The patient was started on high-dose dexamethasone. The neurosurgeons judged that surgery would be more likely to damage the spinal cord.
  • The biopsy confirmed biphasic pleural mesothelioma, a tumor made of both epithelioid and spindle cells. The Mib-1 proliferative index was about 30%.
  • The patient first declined palliative radiotherapy, preferring to wait for the biopsy result. After the biopsy result and a worsening of the nerve symptoms in his legs, he agreed to radiotherapy of 20 Grays in 5 fractions.
  • The patient was referred to palliative care because his condition was deteriorating, and died shortly afterwards of respiratory failure.
• The authors' conclusion: The authors concluded that spread of pleural mesothelioma to sites outside the chest is rare. In their view, this case illustrates the importance of matching the clinical picture with imaging and tissue confirmation, which they said leads to early intervention and better quality of life.

Topics

Medical terms in this study, explained in our Lexicon: Biphasic Mesothelioma, Pleural Mesothelioma, Asbestos Exposure, Histology.

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