Sarcomatoid Malignant Mesothelioma Presenting with Intramedullary Spinal Cord Metastasis: A Case Report and Literature Review
14 June 2013
24 October 2013
22 November 2013 (eFirst)
Study Design Case report.
Objective Malignant mesothelioma (MM) is an uncommon tumor of the pleural epithelium with a predilection for local spread into adjacent tissues. The sarcomatoid type accounts for ∼10% of MM cases and is associated with poorer survival than the epithelioid, desmoplastic, and biphasic types. MM commonly presents with involvement of the vertebral body or epidural space. However, intradural spinal extension of MM is extremely rare. Only eight cases of intradural spinal extension have been reported. We report this rare case and discuss the clinical manifestations of intradural spinal extension of MM with literature review.
Methods This report describes the case of a 62-year-old man with Brown-Séquard syndrome and radiculopathy of the left C5 nerve root detected during treatment for pleural sarcomatoid MM. Magnetic resonance imaging (MRI) showed an intramedullary lesion at the C3 level and a small nodule at the left C5 nerve root with cervical canal stenosis.
Results The patient underwent surgery, and intramedullary metastasis of sarcomatoid MM was diagnosed. Subsequently, radiotherapy was administered, resulting in temporary improvement of the patient's condition. Thereafter, his condition gradually deteriorated, and follow-up MRI showed a more extensive residual C3 intramedullary lesion. Thus, a second surgery was performed after chemotherapy, but the patient died 5 months after the initial diagnosis.
Conclusion We present this rare case, and emphasize intramedullary spinal cord metastasis of MM as differential diagnosis in primary cord lesion.
- 1 Robinson BW, Lake RA. Advances in malignant mesothelioma. N Engl J Med 2005; 353 (15) 1591-1603
- 2 Driscoll TR, Baker GJ, Daniels S , et al. Clinical aspects of malignant mesothelioma in Australia. Aust N Z J Med 1993; 23 (1) 19-25
- 3 Boutin C, Schlesser M, Frenay C, Astoul P. Malignant pleural mesothelioma. Eur Respir J 1998; 12 (4) 972-981
- 4 Newlin HE, Morris CG, Amdur RJ, Mendenhall WM. Neurotropic melanoma of the head and neck with clinical perineural invasion. Am J Clin Oncol 2005; 28 (4) 399-402
- 5 Rykken JB, Diehn FE, Hunt CH , et al. Rim and flame signs: postgadolinium MRI findings specific for non-CNS intramedullary spinal cord metastases. AJNR Am J Neuroradiol 2013; 34 (4) 908-915
- 6 Pistolesi M, Rusthoven J. Malignant pleural mesothelioma: update, current management, and newer therapeutic strategies. Chest 2004; 126 (4) 1318-1329
- 7 Ishikawa R, Kikuchi E, Jin M , et al. Desmoplastic malignant mesothelioma of the pleura: autopsy reveals asbestos exposure. Pathol Int 2003; 53 (6) 401-406
- 8 Steel TR, Allibone J, Revesz T, D'Arrigo C, Crockard HA. Intradural neurotropic spread of malignant mesothelioma. Case report and review of the literature. J Neurosurg 1998; 88 (1) 122-125
- 9 Murray JB, Neilly JB, Hadley D, Moran F, McKean M. Diffuse meningeal thickening associated with pleural mesothelioma. Thorax 1990; 45 (1) 70-71
- 10 Cooper D. Malignant mesothelioma invading the spinal canal. Postgrad Med J 1974; 50 (589) 718-723
- 11 Lee AW, Nikitins I, Pozza C, Koblar SA. Pleural mesothelioma with extension into the thoracic spinal cord. Intern Med J 2005; 35 (3) 195-196
- 12 Hillard VH, Liu JK, Kwok A, Schmidt MH. Perineural spread of malignant mesothelioma resulting in an intradural spinal cord mass: case report. J Neurooncol 2007; 81 (2) 185-189
- 13 Payer M, von Briel T. Intradural pleural malignant mesothelioma. Acta Neurochir (Wien) 2007; 149 (10) 1053-1056 , discussion 1056
- 14 Okura H, Suga Y, Akiyama O , et al. Pleural malignant mesothelioma causing cord infiltration through the nerve root. Case report. Neurol Med Chir (Tokyo) 2009; 49 (4) 167-171
- 15 Chamberlain MC, Eaton KD, Fink JR, Tredway T. Intradural intramedullary spinal cord metastasis due to mesothelioma. J Neurooncol 2010; 97 (1) 133-136
- 16 King JA, Tucker JA, Wong SW. Mesothelioma: a study of 22 gases. South Med J 1997; 90 (2) 199-205
- 17 Hulks G, Thomas JS, Waclawski E. Malignant pleural mesothelioma in western Glasgow 1980–6. Thorax 1989; 44 (6) 496-500
- 18 Klebe S, Brownlee NA, Mahar A , et al. Sarcomatoid mesothelioma: a clinical-pathologic correlation of 326 cases. Mod Pathol 2010; 23 (3) 470-479
- 19 Wilson GE, Hasleton PS, Chatterjee AK. Desmoplastic malignant mesothelioma: a review of 17 cases. J Clin Pathol 1992; 45 (4) 295-298
- 20 Lee ST, Ghanem M, Herbertson RA , et al. Prognostic value of 18F-FDG PET/CT in patients with malignant pleural mesothelioma. Mol Imaging Biol 2009; 11 (6) 473-479
- 21 Schiff D, O'Neill BP. Intramedullary spinal cord metastases: clinical features and treatment outcome. Neurology 1996; 47 (4) 906-912