Pleural malignant mesothelioma causing cord infiltration through the nerve root. Case report

Our plain-English summary of Pleural malignant mesothelioma causing cord infiltration through the nerve root. Case report, by H. Okura, Y. Suga, O. Akiyama, et al (Neurologia Medico-chirurgica, 2009).

The study

• Authors: H. Okura, Y. Suga, O. Akiyama, K. Kudo, S. Tsutsumi, Y. Abe, Y. Yasumoto, M. Ito, H. Izumi, K. Shiomi
• Journal: Neurologia Medico-chirurgica
• Published: 2009;49(4):167-71
• Type of article: Case report
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 61-year-old man presented with a rare pleural malignant mesothelioma of the spine manifesting as progressive weakness of the bilateral lower extremities, numbness in the body and both legs, and dysfunction of the bladder and bowel. He had previous occupational exposure to asbestos while working at a car repair shop and had undergone right panpleuropneumonectomy under a diagnosis of sarcomatous type mesothelioma in the right pleural space. Magnetic resonance imaging of the spine with gadolinium showed an enhanced intramedullary tumor at the T4 level. Operative findings disclosed the clouded and swollen right posterior nerve root, and the pial surface was covered by clouded arachnoid-like membrane. The removed part of the T4 posterior nerve root and intramedullary tumor revealed malignant mesothelioma with invasion spreading along the posterior nerve root. He died of respiratory failure 3 months after the diagnosis. This case shows that spinal metastasis must be considered if a patient with pleural malignant mesothelioma shows neurological worsening and neuroimaging shows an abnormal lesion in the thoracic spinal cord. However, the patient's neurological condition is very difficult to improve in the presence of spinal cord infiltration.

In plain English

This case report from Japan described a 61-year-old man who worked at a car repair shop handling brakes and clutches from 1963 to 1970. The authors recorded this as occupational exposure to asbestos. In 2007 he had surgery (right panpleuropneumonectomy) for sarcomatous type mesothelioma in the right pleural space. His right leg weakened progressively from late August 2007. His left leg became numb and weak from early October, along with bladder and bowel dysfunction. MRI showed a mass inside the spinal cord at the T4 level. At surgery, tissue from the right T4 posterior nerve root and the tumor in the cord showed malignant mesothelioma spreading along the nerve root. The nerve root was completely replaced by tumor. His leg movement did not recover, and he died of respiratory failure 3 months after the diagnosis. The authors concluded that spread to the spine must be considered when a patient with pleural malignant mesothelioma worsens neurologically and imaging shows a lesion in the thoracic spinal cord. They noted that the exact pattern of spread along the nerve root was difficult to determine.

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
• Who was studied: One 61-year-old man with pleural malignant mesothelioma, treated at Juntendo Urayasu Hospital, Japan, in 2007
• Exposure: Occupational asbestos exposure while working at a car repair shop dealing with brakes and clutches, 1963 to 1970; fiber type not stated
• Main results:
  • The patient underwent right panpleuropneumonectomy in March 2007 for sarcomatous type mesothelioma in the right pleural space
  • Progressive weakness of the right leg began in late August 2007. Numbness and weakness of the left leg began in early October, with bladder and bowel dysfunction at the same time.
  • On admission he had sensory disturbance, paraparesis, and bladder and bowel dysfunction
  • MRI showed an enhanced mass inside the spinal cord at the T4 level
  • The removed T4 posterior nerve root and the tumor inside the cord showed malignant mesothelioma spreading along the posterior nerve root
  • Under the microscope, the T4 nerve root was diffusely infiltrated and completely replaced by tumor
  • After surgery he had no motor function in either leg, and he died of respiratory failure 3 months after the diagnosis
• The authors' conclusion: The authors concluded that spinal metastasis must be considered if a patient with pleural malignant mesothelioma shows neurological worsening and imaging shows an abnormal lesion in the thoracic spinal cord. They added that neurological condition is very difficult to improve once the spinal cord is infiltrated.
• Limitations the authors state:
  • The authors stated that the pattern by which the tumor extended along the nerve root was difficult to determine

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Bilateral, Occupational Exposure, Mesothelioma, Metastasis.

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• Malignant mesothelioma with bone metastases — W.F. Cheng, A.W. Berkman (1990)
• Intradural intramedullary spinal cord metastasis due to mesothelioma — M.C. Chamberlain, K.D. Eaton, et al. (2010)
• Malignant mesothelioma of testicular tunica vaginalis — K. Abe, N. Kato, et al. (2002)
• Spinal cord ischemia resulting in paraplegia following extrapleural pneumonectomy — K. Ural, K. Jakob, et al. (2014)
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