Primary Spinal Malignant Mesothelioma: A Case Report and Literature Review

Our plain-English summary of Primary Spinal Malignant Mesothelioma: A Case Report and Literature Review, by F. Chen, B. Liu, Y. Yu, et al (World Neurosurgery, 2018).

The study

• Authors: F. Chen, B. Liu, Y. Yu, J. Du, D. Chen
• Journal: World Neurosurgery
• Published: 2018;114:211-216
• Type of article: Case report, Review
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant mesotheliomas are aggressive and rapidly fatal neoplasms arising from the mesothelial cells. The most common sites of origin are the pleural and peritoneal cavities; the pericardium and the tunica vaginalis are infrequently involved, and malignant mesothelioma in the spinal canal is extremely rare. Here we report a case of primary spinal malignant mesothelioma. We also report the results of a literature search conducted in PubMed with specific key terms, inclusion criteria, and exclusion criteria, with a comparison of elected case studies and case series, and statistical analysis as appropriate.

Case Description: A 35-year-old man presented with a 3-month history of swelling and pain in the left lower extremity. Neurologic examination revealed a loss of sensation below the L5 dermatome. Magnetic resonance imaging (MRI) showed a mass at the L4-5 level. A diagnosis of schwannoma was suspected, and surgical resection was performed. Histopathological findings were consistent with sarcomatoid malignant mesothelioma. Thoracic and whole-abdomen computed tomography yielded normal results. The patient refused adjuvant radiotherapy or chemotherapy. Positron emission tomography-computed tomography performed at 3 months postoperatively showed no abnormality. At 8 months postoperatively, the patient developed back pain and difficulty with defecation; MRI demonstrated tumor recurrence. During a second operation, invasion of the vertebra and cauda equina was noted. A subtotal resection was achieved, and the pain was partially alleviated. Two months later, the patient succumbed to a traffic accident.

Conclusions: Spinal malignant mesothelioma is an extremely rare but highly aggressive entity. Preoperative identification is challenging, and definitive diagnosis depends on histopathological evidence. Surgical resection can help relieve the symptoms, but the overall prognosis is poor.

Copyright © 2018 Elsevier Inc. All rights reserved.

In plain English

This article reported one patient treated at the First Hospital of Jilin University, China, and reviewed earlier published cases. A 35-year-old man had three months of swelling and pain in his left leg. A scan showed a mass in the lower spine (L4-5), first thought to be a schwannoma. Surgery removed a 3.3×3.0×2.6 cm tumor, which tests identified as sarcomatoid malignant mesothelioma. Chest and abdominal CT scans were normal, and the authors described this as the first known mesothelioma starting in the spine. They wrote that asbestos exposure, simian virus 40 infection and hereditary factors were all absent in this patient. He declined radiotherapy and chemotherapy. The tumor returned eight months later and was only partly removed in a second operation. Two months after that he died in a traffic accident. The review found 21 earlier spinal cases, all spread from pleural or peritoneal mesothelioma, with a 17:4 male-to-female ratio and 17 of 21 in the thoracic spine. The authors concluded the disease is extremely rare but highly aggressive, with a poor overall prognosis.

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 review of previously published cases
• Who was studied: One 35-year-old man treated at the First Hospital of Jilin University, Changchun, China (dates not given), plus 21 previously published cases of spinal metastatic malignant mesothelioma
• Exposure: No asbestos exposure. The authors stated that asbestos exposure, simian virus 40 infection and hereditary factors were all absent in this patient and called the case possibly cryptogenic (of unknown cause). How exposure was assessed is not described.
• Main results:
  • In the patient, MRI showed a mass at the L4-5 level of the lumbar spine involving the left intervertebral foramen. A schwannoma was first suspected.
  • At surgery, the patient had a 3.3×3.0×2.6 cm tumor that was invading the dura mater and the local vertebra and infiltrating the nerve root.
  • Pathology and immunohistochemistry of the patient's tumor gave a diagnosis of sarcomatoid malignant mesothelioma.
  • The patient's chest and whole-abdomen CT scans were normal.
  • The authors described the patient as the first known case of primary spinal malignant mesothelioma.
  • The patient refused adjuvant radiotherapy or chemotherapy. PET-CT 3 months after surgery showed no abnormality.
  • Eight months after surgery the patient's tumor recurred. A second operation achieved only subtotal resection because the vertebra and cauda equina were severely invaded.
  • The patient died in a traffic accident two months after the second operation.
  • The literature review identified 21 earlier cases of spinal metastatic malignant mesothelioma. All previously reported spinal cases had spread from pleural or peritoneal mesotheliomas.
  • In the 21 reviewed cases, ages ranged from 18 to 76 years (mean 56.5 years) and the male-to-female ratio was 17:4.
  • In the 21 reviewed cases, the thoracic spine was most often involved (17 of 21, 81.0%), followed by cervical (2 of 21, 9.5%) and lumbar (2 of 21, 9.5%) segments. Seven cases had intramedullary involvement.
• The authors' conclusion: The authors concluded that spinal malignant mesothelioma is extremely rare but highly aggressive, that identifying it before surgery is hard and diagnosis depends on pathology, and that surgery can help relieve symptoms while the overall prognosis is poor.

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, Neoplasm, Mesothelial Cells, Pericardium, Tunica Vaginalis, Surgical Resection, Sarcomatoid, Chemotherapy.

Related studies

• Strategy for the treatment of patients with spinal neoplasms — P. Kluger, A. Korge, et al. (1997)
• Malignant mesothelioma with bone metastases — W.F. Cheng, A.W. Berkman (1990)
• Malignant mesothelioma of testicular tunica vaginalis — K. Abe, N. Kato, et al. (2002)
• Pleural malignant mesothelioma causing cord infiltration through the nerve root. Case report — H. Okura, Y. Suga, et al. (2009)
• Nervous system metastases from malignant mesothelioma — N.M. Martinez, I.T. Gavrilovic, et al. (2013)
• Primary malignant peritoneal mesothelioma. A report of seven cases and a review of the literature — J.A. Asensio, P. Goldblatt, et al. (1990)

Browse return to medical research.