Christopher J Winfree1, William J Mack, Michael B Sisti. 1. Department of Neurological Surgery, The Neurological Institute, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
Abstract
BACKGROUND: Malignant pleural mesothelioma is an uncommon malignancy that rarely metastasizes to the central nervous system and even less frequently occurs as a solitary lesion. CASE DESCRIPTION: We present a 71-year-old white female, nonsmoker, with no occupational exposure to asbestos. She presented with a 15-lb. weight loss over several months and persistent right subscapular pain radiating to her anterior chest. Imaging studies revealed a pleural mass, and biopsy confirmed fibrous type malignant pleural mesothelioma. During a metastatic workup, computed tomography (CT) and magnetic resonance imaging (MRI) of the head demonstrated a 1 cm subcortical, contrast-enhancing lesion without surrounding edema in the right posterior cerebellum. Surgical resection of the solitary cerebellar mass revealed fibrous-type metastatic malignant mesothelioma. Postoperatively, the patient received a combined chemotherapy regimen of Adriamycin and Cisplatin and underwent whole brain radiation therapy. CONCLUSIONS: We report the first resection of a solitary cerebellar metastasis of malignant pleural mesothelioma. We also review past cases of intracranial metastasis of this malignancy, its histologic subtypes, outcome, and recent treatment modalities.
BACKGROUND:Malignant pleural mesothelioma is an uncommon malignancy that rarely metastasizes to the central nervous system and even less frequently occurs as a solitary lesion. CASE DESCRIPTION: We present a 71-year-old white female, nonsmoker, with no occupational exposure to asbestos. She presented with a 15-lb. weight loss over several months and persistent right subscapular pain radiating to her anterior chest. Imaging studies revealed a pleural mass, and biopsy confirmed fibrous type malignant pleural mesothelioma. During a metastatic workup, computed tomography (CT) and magnetic resonance imaging (MRI) of the head demonstrated a 1 cm subcortical, contrast-enhancing lesion without surrounding edema in the right posterior cerebellum. Surgical resection of the solitary cerebellar mass revealed fibrous-type metastatic malignant mesothelioma. Postoperatively, the patient received a combined chemotherapy regimen of Adriamycin and Cisplatin and underwent whole brain radiation therapy. CONCLUSIONS: We report the first resection of a solitary cerebellar metastasis of malignant pleural mesothelioma. We also review past cases of intracranial metastasis of this malignancy, its histologic subtypes, outcome, and recent treatment modalities.
Authors: Nestor M Pakasa; Basile Pasquier; Marie-Laure Chambonnière; Alan L Morrison; Abir Khaddage; Anne Gentil Perret; Jean Marc Dumollard; Fabrice G Barral; Michel Péoc'h Journal: Virchows Arch Date: 2005-05-31 Impact factor: 4.064