A unique case of malignant pleural mesothelioma presenting with highly aggressive multiple brain metastases after a long disease-free period
Abstract
Malignant
pleural mesothelioma (MPM) is an uncommon, aggressive malignant neoplasm
derived from the mesothelial cells of pleura or peritoneum characterized by
poor outcome. Mesothelioma is thought to metastasize locally only via
direct invasion and not have distant spread. Distant metastases are
discovered mostly on post-mortem examination. However, recent post-mortem
studies have identified metastases to the central nervous system
(CNS) in about 3% of cases. A 55 year old patient presented with agressive multiple
brain metastases after 4 years from the initial diagnosis. Palliative cranial
radiotherapy was given because of unresectability of the lesions. The patient
died 3 months after completion of radiotherapy. Distant metastase patern is not
predictable in this disease, thus attention should be paid on the high-risk
factors at initial presentation to prevent systemic relapses. Multimodality
therapies have been produced longer survival times in this disease; clinicians
should perform careful screening for brain metastasis in MPM, especially in
patients with risk factors including younger age, advanced stage and
non-epithelioid features.
References
- 1. Roggli VL, Sharma A, Butnor KJ, et al. Malignant mesothelioma and occupational exposure to asbestos: a clinicopathological correlation of 1445 cases. Ultrastruct Pathol 2002; 26: 55-65.
- 2. Wolf AS, Richards WG, Tilleman TR, et al. Characteristics of malignant pleural mesothelioma in women. Ann Thorac Surg 2010; 90: 949-56.
- 3. Rusch VW, Giroux D, Kennedy C, et al. Initial Analysis of the International Association For the Study of Lung Cancer Mesothelioma Database. J Thorac Oncol 2012; 7: 1631.
- 4. Antman KH, Blum RH, Greenberger JS, et al. Multimodality therapy for malignant mesothelioma based on a study of natural history. Am J Med1980; 68: 356-62.
- 5. Law MR, Hodson ME, Heard BE. Malignant mesothelioma of the pleura: relation between histological type and clinical behaviour. Thorax1982; 37: 810-15.
- 6. Falconieri G, Grandi G, DiBonito L, et al. Intracranial metastases from malignant pleural mesothelioma. Report of three autopsy cases and review of the literature. Arch Pathol Lab Med 1991; 115: 591-5.
- 7. Davies MJ, Ahmedzai S, Arsiwala SS, et al. Intracranial metastases from malignant pleural mesothelioma. Scand J Thorac Cardiovasc Surg1995; 29: 97-9.
- 8. Mansfield AS, Symanowski JT, Peikert T. Systematic review of response rates of sarcomatoid malignant pleural mesotheliomas in clinical trials. Lung Cancer 2014;86: 133-6. doi: 10.1016/j.lungcan.2014.08.017
- 9. Finn RS, Brims FJ, Gandhi A, Olsen N, Musk AW, Maskell NA, Lee YC. Postmortem findings of malignant pleural mesothelioma: a two-center study of 318 patients. Chest 2012; 142: 1267-73.
- 10. Yamagishi T, Fujimoto N, Miyamoto Y, et al. Brain metastases in malignant pleural mesothelioma. Clin Exp Metastasis 2015 DOI 10.1007/ s10585-015-9772-8
- 11. Kitai R, Kabuto M, Kawano H, Uno H, Kobayashi H, Kubota T: Brain metastasis from malignant mesothelioma--Case report. Neurol Med Chir (Tokyo). 1995, 35: 172-4.
- 12. Wroński M, Burt M: Cerebral metastases in pleural mesothelioma: Case report and review of the literature. J Neurooncol 1993, 17: 21-6.
- 13. Mah E, Bittar RG, Davis GA: Cerebral metastases in malignant mesothelioma: Case report and literature review. J Clin Neurosci 2004; 11: 917-8.
- 14. Ishikawa T, Wanifuchi H, Abe K, Kato K, Watanabe A, Okada Y: Brain metastasis in malignant pleural mesothelioma presenting as intratumoral hemorrhage. Neurol Med Chir (Tokyo) 2010; 50: 1027-30.
Agresif multipl beyin metastazları ile uzun süre hastalıksız izlem sonrası başvuran ender bir malign plevral mezotelyoma olgusu
Abstract
Malign plevral mezotelyoma (MPM) nadir görülen plevra ya da
peritondaki mezotelyal hücrelerden köken alan, kötü prognozlu, nadir ve agresif bir malign neoplazidir.
Mezotelyomanın sadece lokal direkt invazyon yolu ile lokal olarak metastaz
yaptığı; uzak yayılım yapmadığı düşünülmektedir. Uzak metastazlar post mortem
incelemeler sonucu ortaya çıkmaya başlamıştır. Son zamanlarda yapılan post
mortem çalışmalarda %3 vakada santral sinir sistemi metastazları
bildirilmiştir. 55 yaşında hasta ilk tanısından 4 yıl sonra çoklu agresif beyin
metastazları ile başvurdu. Rezeksiyona uygun olmayan lezyonlar nedeniyle palyatif kraniyal radyoterapi verildi.
Radyoterapinin tamamlanmasından 3 ay sonra hasta kaybedildi. Bu hastalıkta uzak
metastaz paterni öngörülebilir olmadığı için,
sistemik relapsları önlemede ilk tanı esnasında yüksek risk faktörlerine
dikkat edilmelidir. Multimodal tedaviler bu hastalıkta daha uzun sağkalım
sağlayabilmektedir. Klinisyenler MPM’de özellikle erken yaş, ileri evre ve epiteloid dışı özellikleri bulunan hastalarda beyin metastazı için dikkatli tarama
yapmalıdırlar.
References
- 1. Roggli VL, Sharma A, Butnor KJ, et al. Malignant mesothelioma and occupational exposure to asbestos: a clinicopathological correlation of 1445 cases. Ultrastruct Pathol 2002; 26: 55-65.
- 2. Wolf AS, Richards WG, Tilleman TR, et al. Characteristics of malignant pleural mesothelioma in women. Ann Thorac Surg 2010; 90: 949-56.
- 3. Rusch VW, Giroux D, Kennedy C, et al. Initial Analysis of the International Association For the Study of Lung Cancer Mesothelioma Database. J Thorac Oncol 2012; 7: 1631.
- 4. Antman KH, Blum RH, Greenberger JS, et al. Multimodality therapy for malignant mesothelioma based on a study of natural history. Am J Med1980; 68: 356-62.
- 5. Law MR, Hodson ME, Heard BE. Malignant mesothelioma of the pleura: relation between histological type and clinical behaviour. Thorax1982; 37: 810-15.
- 6. Falconieri G, Grandi G, DiBonito L, et al. Intracranial metastases from malignant pleural mesothelioma. Report of three autopsy cases and review of the literature. Arch Pathol Lab Med 1991; 115: 591-5.
- 7. Davies MJ, Ahmedzai S, Arsiwala SS, et al. Intracranial metastases from malignant pleural mesothelioma. Scand J Thorac Cardiovasc Surg1995; 29: 97-9.
- 8. Mansfield AS, Symanowski JT, Peikert T. Systematic review of response rates of sarcomatoid malignant pleural mesotheliomas in clinical trials. Lung Cancer 2014;86: 133-6. doi: 10.1016/j.lungcan.2014.08.017
- 9. Finn RS, Brims FJ, Gandhi A, Olsen N, Musk AW, Maskell NA, Lee YC. Postmortem findings of malignant pleural mesothelioma: a two-center study of 318 patients. Chest 2012; 142: 1267-73.
- 10. Yamagishi T, Fujimoto N, Miyamoto Y, et al. Brain metastases in malignant pleural mesothelioma. Clin Exp Metastasis 2015 DOI 10.1007/ s10585-015-9772-8
- 11. Kitai R, Kabuto M, Kawano H, Uno H, Kobayashi H, Kubota T: Brain metastasis from malignant mesothelioma--Case report. Neurol Med Chir (Tokyo). 1995, 35: 172-4.
- 12. Wroński M, Burt M: Cerebral metastases in pleural mesothelioma: Case report and review of the literature. J Neurooncol 1993, 17: 21-6.
- 13. Mah E, Bittar RG, Davis GA: Cerebral metastases in malignant mesothelioma: Case report and literature review. J Clin Neurosci 2004; 11: 917-8.
- 14. Ishikawa T, Wanifuchi H, Abe K, Kato K, Watanabe A, Okada Y: Brain metastasis in malignant pleural mesothelioma presenting as intratumoral hemorrhage. Neurol Med Chir (Tokyo) 2010; 50: 1027-30.
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Case Reports |
| Authors | |
| Publication Date | September 19, 2017 |
| Acceptance Date | May 27, 2017 |
| Published in Issue | Year 2017Volume: 39 Issue: 3 |