Perineural spread of malignant mesothelioma resulting in an intradural spinal cord mass: case report.
J Neurooncol. 2007 Jan;81(2):185-9. Epub 2006 Jul 19.
Hillard VH, Liu JK, Kwok A, Schmidt MH.
Department of Neurosurgery, University of Utah School of Medicine, 30 North 1900 East, Suite 3B409, Salt Lake City, UT 84132, USA.
Spinal cord involvement by perineural spread of malignant mesothelioma is rare. We report a case of malignant mesothelioma that spread locally to invade the bony spine with both extradural and intradural perineural spread into the spinal canal that resulted in spinal cord compression. A 61-year-old man with a history of malignant mesothelioma presented with progressive leg weakness and right-sided arm weakness. Magnetic resonance imaging showed an enhancing lesion in the apex of the right lung with extension through the C7-T1 foramina with right hemicord enhancement. The patient underwent a C7-T1 laminectomy and right-sided C7-T1 and T1-T2 foraminotomies for neural decompression and biopsy of the lesion. Intraoperatively, tumor extended epidurally, and intradural perineural tumor spread along the C8 and T1 nerve roots into the spinal cord. Because it adhered to the spinal cord, no dissectible plane could be identified that would allow for safe total removal of the tumor. The epidural portion of the tumor, the adjacent involved bone, and the T1 nerve root were resected. Pathologic examination revealed malignant mesothelioma with bony invasion and perineural spread along the T1 nerve root. After decompression of the spinal cord, the patient had moderate improvement of his hand and leg function. Perineural spread of malignant mesothelioma resulting in spinal cord compression is an unusual clinical presentation. Intimate involvement of the spinal cord may prohibit aggressive tumor resection.
Results of treatment of 33 patients with peritoneal mesothelioma.
Br J Surg 2000 Nov;87(11):1587-93
Sebbag G, Yan H, Shmookler BM, Chang D, Sugarbaker PH.
Washington Cancer Institute, DC 20010, USA.
BACKGROUND: Peritoneal mesothelioma is a rare peritoneal malignancy, representing approximately one-third of all mesotheliomas. It is regarded as a universally fatal cancer with few treatment options.
METHODS: Records of 33 patients with peritoneal mesothelioma were reviewed retrospectively. Demographic, clinical and quantitative prognostic indicators were evaluated and analysed statistically using survival as endpoint. Patients were treated by a uniform strategy involving cytoreductive surgery with peritonectomy procedures and perioperative intraperitoneal chemotherapy (cisplatin, doxorubicin).
RESULTS: There were ten women and 23 men; mean age was 53.0 years. Asbestos exposure was recorded in five patients and a family history of cancer in 13. Presentation was mainly abdominal distension and pain. Median survival was 31.0 months; overall projected survival at 3 years was 56 per cent. The most significant positive predictive factors of survival were: female sex (P= 0.003), low prior surgical score (P=0.002), completeness of cytoreduction (P=0.0002) and second-look surgery (P=0.019). The morbidity rate for this combined treatment was 33 per cent and the perioperative mortality rate was 3 per cent.
CONCLUSION: Although peritoneal mesothelioma is rare, progress in its management has occurred. Survival has been extended and selection factors by which patients may be allocated to aggressive management strategies have been defined.
Primary malignant gonadal mesotheliomas and asbestos
Histopathology 2000 Aug;37(2):150-9
Attanoos RL, Gibbs AR
Department of Histopathology, University Hospital of Wales and Llandough Hospital, Cardiff, Wales, UK.
AIMS: The clinicopathological, immunohistochemical and aetiological aspects, with respect to asbestos, of seven primary gonadal mesotheliomas (three intratesticular, four ovarian) are described and compared. These tumours are extremely rare, poorly described and the knowledge of their natural history is very limited.
METHODS AND RESULTS: The cases were collated from the UK Health and Safety Executive Mesothelioma Register over a 24-year period (1968-91). Primary mesotheliomas of the tunica vaginalis and ovary comprised 0. 09% (10 cases) and 0.03% (three cases) of mesothelioma deaths, respectively. No primary intratesticular (non-tunica vaginalis) malignant mesotheliomas have been described. In this study, we present seven (three intratesticular, four ovarian) primary malignant gonadal mesotheliomas. In both genders the tumours show a similar age distribution (with median onset in the sixth decade), a similar association with asbestos (in approximately 50% cases), a diverse histological spectrum (with predominantly tubulopapillary epithelial subtype tumours) and an immunophenotype that is comparable with malignant pleural and peritoneal mesothelioma. The clinical course appears variable (mean, 26 months; range, 9-50 months). All tumours in the study presented as localized masses and their prognosis appeared more favourable than that of diffuse pleural and peritoneal cases.
CONCLUSIONS: An awareness of the existence of these rare forms of malignant mesothelioma is important to prevent misdiagnosis. Immunohistochemistry has an important role in confirmation of the diagnosis. The accurate diagnosis of primary gonadal mesothelioma has potentially important medicolegal compensation considerations as a significant proportion of these cases are associated with asbestos.
Malignant pleural mesothelioma presenting as spontaneous pneumothorax: a case series and review
Am J Ind Med 2000 Aug;38(2):219-23
Alkhuja S, Miller A, Mastellone AJ, Markowitz S
Division of Pulmonary Medicine, Department of Medicine, Catholic Medical Center of Brooklyn and Queens, Jamaica, NY, USA. [email protected]
BACKGROUND: Malignant pleural mesothelioma (MPM) is thought to arise from the mesothelial cells that line the pleural cavities. Most patients initially experience the insidious onset of chest pain or shortness of breath, and it rarely presents as spontaneous pneumothorax.
CASE REPORTS: We report four patients who presented in this manner. Three of the patients were exposed to asbestos directly or indirectly at shipyards during World War II; the fourth was exposed as an insulator's wife. Two of our cases were not recognized to have MPM on histologic examination at first thoracotomy and remained asymptomatic for 12 and 22 months, respectively. In none of the patients described herein, was spontaneous pneumothorax the cause of death.
CONCLUSIONS: Since many people were exposed to asbestos during and after World War II, spontaneous pneumothorax in a patient with the possibility of such exposure should raise the suspicion of malignant pleural mesothelioma. Copyright 2000 Wiley-Liss, Inc.
Malignant mesothelioma presenting as pulmonary metastasis ahead of growth of primary tumour
Respirology 1999 Sep;4(3):279-81
Heki U, Fujimura M, Kasahara K, Matsubara F, Matsuda T
Third Department of Internal Medicine, Kanazawa University School of Medicine, Japan.
A 59-year-old woman was admitted to Houju Memorial Hospital, Ishikawa, Japan, because of cough and fever on 30 March 1997. A diagnosis of pneumonia was made and she was given antibiotics. Her symptoms improved but failed to resolve completely on antibiotic therapy. On 9 September 1997, she revisited the hospital because of bodyweight loss and malaise. There was no history of exposure to asbestos. The chest roentgenogram revealed infiltrative shadows with vague and indistinct margins suggesting inflammatory processes, which were more extensive than those investigated on her last visit. One month later, a giant tumour was detected rapidly growing from the mediastinum and open biopsy was performed. The histological examination confirmed that the tumour was a malignant mesothelioma and the intrapulmonary nodules were its metastases. This is a rare case of pulmonary metastasis being present for several months before an appearance of primary mesothelioma.
Malignant mesothelioma of the tunica vaginalis testis: a report of two cases and review of literature.
J Surg Oncol 1999 Apr;70(4):251-4
Gupta NP, Agrawal AK, Sood S, Hemal AK, Nair M
Department of Urology, All India Institute of Medical Sciences, New Delhi. [email protected]
Two cases of rare malignant mesothelioma of tunica vaginalis testis are presented. Both cases were advanced on clinical and radiological studies. One patient was treated with surgical excision followed by chemotherapy and radiotherapy and the other patient was treated with surgery and chemotherapy. Despite aggressive therapy both the patients died within 18 months of treatment. Review of the literature with suggested treatment protocol is presented. The response of malignant mesothelioma to chemotherapy and radiotherapy is poor as indicated by both of our cases. Initial aggressive surgery and adjuvant procedures are necessary soon after diagnosis to achieve long-term survival.
Epithelial mesothelioma with deciduoid features.
Virchows Arch 1999 Mar;434(3):263-6
Orosz Z, Nagy P, Szentirmay Z, Zalatnai A, Hauser P
Center of Diagnostic and Experimental Tumour Pathology, National Institute of Oncology, Budapest, Hungary. [email protected]
A rare case of malignant mesothelioma in a 15-year old girl is described. The patient presented with secondary amenorrhoea and clinical symptoms resembling those of an ovarian cyst. One large and multiple small peritoneal nodules were found at laparoscopy. Histologically the tumour was characterised by an unusual pattern with a tumour, epithelial mesothelioma with deciduoid features, was made. The patient died 11 months after diagnosis. Post-mortem examination revealed extensive extraperitoneal spread.
Video-assisted thoracoscopic excision of a benign cystic mesothelioma of pleura.
Nippon Kyobu Geka Gakkai Zasshi 1998 Aug;46(8):664-6
Haraguchi S, Koizumi K, Kawamoto M, Tanaka S, Tanaka S
Department of Surgery II, National Defense Medical College, Saitama, Japan.
We are reporting on the case of a 44-year-old woman upon which video-assisted thoracoscopic excision of a benign cystic mesothelioma of the pleura was performed. To our knowledge, this is the second report on a case of a benign cystic mesothelioma of the pleura. The cyst in our case was solitary and was easily excised. Microscopic examination revealed that the cyst was lined by a single layer of flattened and cuboidal cells. Immunohistochemical analysis revealed that the cells lining the cyst stained positively for keratin and negatively for factor VIII-related antigen. Benign cystic mesothelioma of the pleura was diagnosed based on histological findings. For seven months her condition has been monitored at our out-patient clinic with no signs of recurrence. However, continued careful observation is required because benign cystic mesothelioma often recurs locally. Local recurrence is thought to be related to incomplete resection of the tumor. Therefore, careful observations and techniques to ensure complete resection of the cyst, are important during video-assisted thoracoscopic surgery.
Malignant mesothelioma of the pleura with a large tumor embolus in the left atrium: an autopsy case.
Intern Med 1998 Jul;37(7):614-7
Ishiyama Y, Hisanaga S, Asada Y, Sumiyoshi A, Eto T
First Department of Internal Medicine, Miyazaki Medical College, Kiyotake.
malignant mesothelioma of the pleura often involves the heart but seldom invades the intracardiac cavity. We report a 78-year-old woman with right pleural mesothelioma who died of heart failure. An autopsy revealed that the tumor was present at the right pleura and invaded the right upper lobe of the lung and the mediastinum. The tumor also extended to the left atrium via the right pulmonary vein and filled the atrial cavity. Repeated transthoracic echocardiography failed to detect the tumor, but magnetic resonance imaging was useful for diagnosis.