Perineural spread of malignant mesothelioma with spinal intramedullary involvement

Our plain-English summary of Perineural spread of malignant mesothelioma with spinal intramedullary involvement, by M. Tanwar, C.B. Simone, S. Newman, et al (Clinical Neurology and Neurosurgery, 2014).

The study

• Authors: M. Tanwar, C.B. Simone, S. Newman, K. Cengel, G.H. Yu, E.R. Melhem, S. Mohan
• Journal: Clinical Neurology and Neurosurgery
• Published: 2014;120:116-9
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

The authors, from the University of Pennsylvania in Philadelphia, reported a case of malignant pleural mesothelioma that spread along a nerve into the spinal cord. They also reviewed seven previously reported cases of perineural spread with spinal involvement. A 76-year-old man had left shoulder and chest pain. CT showed multi-lobulated pleural masses throughout the left hemithorax, confirmed as mesothelioma of mixed epithelial and sarcomatoid histology. Because of his age, extensive disease and heart disease, he was not considered for surgery. He received six cycles of pemetrexed and carboplatin, with partial response, then maintenance pemetrexed. After the disease progressed he received radiation therapy to the chest wall. During this treatment he developed worsening weakness and numbness in both legs. Contrast-enhanced MRI showed a 5.8 cm pleural mass invading the paraspinous tissues, ribs and chest wall. Enhancing tissue followed the left 6th intercostal nerve and nerve roots into the spinal cord, with a cord lesion at T5–T6 and cord edema from T4 to T9. CT-guided fine needle aspiration was most consistent with mesothelioma. Steroids and palliative spinal radiation (3500 cGy in 250 cGy fractions) reduced his pain and improved his leg strength and sensation. He then developed urinary retention, worse right leg weakness and a new lesion at L1, treated with a single 800 cGy fraction. He died about 1.7 months after presenting with spinal cord involvement. The authors concluded that this pattern of spread should be considered when mesothelioma patients develop new neurological symptoms, and that contrast-enhanced MRI followed by fine needle aspiration cytology can be used to assess such cases.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a case report with a short review of earlier published cases. It described a 76-year-old man with malignant pleural mesothelioma of mixed epithelial and sarcomatoid type in the left chest. He received six cycles of pemetrexed and carboplatin with a partial response, but the disease later progressed. While receiving radiation to his chest wall, he developed weakness and numbness in both legs. MRI showed tumor tissue following the left 6th intercostal nerve through the T6-7 opening into the spinal canal and into the spinal cord, with cord swelling from T4 to T9. A needle sample was most consistent with mesothelioma. Steroids and palliative radiation (250 cGy daily fractions to 3500 cGy) reduced his pain and improved leg strength and sensation. A new lesion then appeared at the lower end of the cord, and he died about 1.7 months after this presentation. The authors counted seven earlier reported cases of this kind of spread. The article did not describe any asbestos exposure.

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 with review of previously published cases
• Who was studied: one 76-year-old man with malignant pleural mesothelioma of the left chest, treated at the University of Pennsylvania (Philadelphia, USA); the review covered seven previously reported cases
• Main results:
  • The patient's mesothelioma had mixed epithelial and sarcomatoid histology. He received six cycles of pemetrexed and carboplatin with a partial response, followed by maintenance pemetrexed.
  • MRI showed enhancing tumor tissue following the left 6th intercostal nerve through the T6-7 intervertebral opening into the spinal canal and into the spinal cord.
  • MRI showed extensive swelling (edema) of the spinal cord from T4 to T9.
  • CT-guided fine needle aspiration of the mass beside the spine found atypical spindle and epithelioid cells, most consistent with mesothelioma.
  • He received steroids (decadron) and palliative radiation to the thoracic spine in 250 cGy daily fractions to 3500 cGy. His pain was reduced and his leg strength and sensation improved.
  • Shortly after radiation ended, he developed urinary retention and worse right leg weakness. MRI showed a new lesion at the conus medullaris at L1, which was treated with a single 800 cGy fraction.
  • The patient died nearly 1.7 months after presenting with spinal cord involvement.
  • The authors found seven previously reported cases of perineural spread of mesothelioma to the spinal cord.
• The authors' conclusion: The authors concluded that in malignant pleural mesothelioma patients with new neurological symptoms, spread along nerves into the spinal cord should be considered. They concluded that contrast-enhanced MRI followed by confirmation with needle cytology can be used to assess such cases. They noted that the outlook is dismal, so relieving symptoms and preventing neurological decline are critical.

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: Malignant Mesothelioma, Pleural Mesothelioma, Hemithorax, Mesothelioma, Sarcomatoid, Histology, Pemetrexed (Alimta), Carboplatin.

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• Lymphohematogenous spread of asbestos — A. Brown (1974)

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