Multiple skeletal muscle metastases from malignant pleural mesothelioma

Our plain-English summary of Multiple skeletal muscle metastases from malignant pleural mesothelioma, by W. Grellner, M. Staak (Pathology, Research and Practice, 1995).

The study

• Authors: W. Grellner, M. Staak
• Journal: Pathology, Research and Practice
• Published: 1995;191(5):456-60; discussion 461-2
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 54-year-old male patient (occupational asbestos exposure over 27 years) died 2 years and 4 months after the diagnosis of malignant pleural mesothelioma of the right side, despite twice undergoing pleurectomy and radiotherapy. The autopsy revealed a locally advanced pleural mesothelioma of both sides involving the pericardium, heart, right diaphragm, liver and peritoneum. Disseminated metastases in numerous lymph nodes and a hematogenous metastatic spread into both lungs, the thyroid gland, peritoneum and skeletal musculature were found. The left temporal muscle and proximal limb skeletal muscles of the right upper arm and both thighs exhibited multiple metastases measuring up to 7 cm in diameter. Microscopically, a biphasic type of mesothelioma was detected. To our knowledge this is the first extensive case report on muscle metastases in malignant mesothelioma. Reviewing the literature, it is thought that in the presented case the long survival time of the patient and his protracted preterminal immobility could have contributed to the unusual formation of multiple skeletal muscle metastases.

In plain English

This was a case report from the Institute of Forensic Medicine, University of Cologne, Germany. It described a man who had been exposed to asbestos for 27 years while working as an engineer in shipyards and power stations. The fiber type was not stated. At age 52 he came to doctors with breathlessness and chest pain and was diagnosed with malignant pleural mesothelioma of the biphasic (mixed) type on the right side. He had surgery twice and radiotherapy. He became immobile in his final months and died at 54, 2 years and 4 months after diagnosis. At autopsy the tumour encased both lungs and had spread to the pericardium and heart, the right diaphragm and liver, the abdomen, and many lymph nodes. Metastases spread through the blood were found in both lungs, the thyroid, the peritoneum and skeletal muscles of the left temple, right upper arm and both thighs. The largest measured up to 7 cm across. Lung tissue held 300-3100 asbestos bodies per cubic centimetre, against a reference value of 9 plus or minus 13 for the average population. The authors suggested that his long survival and prolonged immobility could have contributed to the unusual muscle 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 (single patient, clinical history and autopsy findings)
• Who was studied: One man, 52 years old when he presented with a 1-month history of breathlessness and chest pain. He died at age 54 and was examined at autopsy. The authors were at the Institute of Forensic Medicine, University of Cologne, Germany. Dates of the case are not given.
• Exposure: Occupational asbestos exposure over 27 years as an engineer in shipyards and power stations, ending 5 years before symptoms began. Fiber type not stated. The mesothelioma was acknowledged as an occupational disease.
• Main results:
  • The patient had biphasic malignant pleural mesothelioma of the right side, treated by subtotal pleurectomy and radiotherapy. After a relapse involving both sides 19 months after diagnosis, he had parietal pleurectomy of both sides. He became immobile and died at 54 of respiratory insufficiency and right heart failure, 2 years and 4 months after diagnosis.
  • At autopsy, metastases spread through the blood were found in both lungs, both lobes of the thyroid gland, the peritoneum and the skeletal muscles. The tumour also extended over the pericardium (into the right atrium), the right diaphragm and liver, and the right peritoneal cavity, and spread to numerous lymph node groups.
  • Skeletal muscle metastases were in the left temporal muscle, the right upper arm (deltoid, triceps brachii) and both thighs (quadriceps femoris, adductors). All were in the superficial parts of the muscles and measured up to 7 cm in diameter.
  • Under the microscope, the muscle metastases, like the other tumour sites, were a mixture of epithelial and mesenchymal cells (biphasic mesothelioma) and invaded and destroyed the muscle.
  • Immunohistochemistry showed tumour cells negative for vimentin, which the authors called unusual and suggested may be due to the long disease course, the radiotherapy or artefacts in formalin-fixed tissue.
  • Quantitative analysis of the patient's lung tissue found 300-3100 asbestos bodies per cubic centimetre of lung tissue.
  • The reference value given for the average population was 9 plus or minus 13 asbestos bodies per cubic centimetre of lung tissue.
• The authors' conclusion: The authors concluded that in this case the patient's long survival time and his protracted immobility before death could have contributed to the unusual formation of multiple skeletal muscle metastases.
• Limitations the authors state:
  • The authors state it is not known whether metastases had been detected during the patient's clinical course.

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, Asbestos Exposure, Autopsy, Pericardium, Diaphragm, Peritoneum, Biphasic Mesothelioma, Mesothelioma.

Related studies

• A comparative evaluation of intrathoracic latissimus dorsi and serratus anterior muscle transposition — M.K. Widmer, T. Krueger, et al. (2000)
• Diagnostic use of muscle markers in the cytologic evaluation of serous fluids — A.M. Afify, B.M. Al-Khafaji, et al. (2002)
• The role of muscle flap in preventing bronchus stump insufficiency after pneumonectomy for malignant pleural mesothelioma in high-risk patients — M. Beshay, G. Carboni, et al. (2008)
• Peritoneal malignant mesothelioma with multiple distant skin metastases — N.G. Ordóñez, J.L. Smith (1983)
• Multiple distant metastases in a case of malignant pleural mesothelioma — K.C. Tertemiz, A. Ozgen Alpaydin, et al. (2014)
• Multiple intracranial metastases from postoperative giant sarcomatoid malignant pleural mesothelioma: A case report and literature review — D. Tian, H. Wen, et al. (2018)

Browse more research in Pathology, Research and Practice, or return to medical research.