Sarcomatoid Malignant Mesothelioma Presenting with Intramedullary Spinal Cord Metastasis: A Case Report and Literature Review

Abstract

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.

Intramedullary metastasis to the cervical spinal cord from malignant pleural mesothelioma: Review of the literature and case reports

“…Intradural mesothelioma is highly uncommon and has been reported in 11 cases, including the present case, so far [12,13,[17][18][19][20][21][22][23][24][25] [Tables 1 and 2]. In two cases, [23,24] the lesion was extramedullary.…”

“…Six articles with cranial or spinal meningeal infiltration of a mesothelioma without intradural tumor were found in literature. [28,30,[34][35][36] Ten reports [Table 1] were retrieved with one case of intradural mesothelioma each, [12,13,[17][18][19][20][21][22][23]25] two of which were in intradural extramedullary location, [23,24] and eight of which showed intramedullary Article published online: 2022-08-16…”

“…growth [12,13,[17][18][19][20][21][22]25] [Table 2]. These eight cases were analyzed and together with the current case, serve as the basis for the discussion of intradural intramedullary metastasis from PMM.…”

Non-traumatic Causes of Brown-sequard Syndrome: A Case Series and Clinical Update With Systematic Review

“…Primary tumors include cavernous hemangioma, schwannoma, meningioma and osteochondroma [19,20]. Secondary metastasis from remote sites includes malignant mesothelioma [21], colonic carcinoma [22], squamous cell carcinoma of the maxillary sinus [23], and gastric adenocarcinoma [24], leading to intramedullary spinal cord metastasis. Spinal canal stenosis with cervical spondylosis and OPLL are forms of degenerative conditions that develop over the years and affect the vertebral column and surrounding ligaments [14].…”

“…Time of surgical intervention plays a vital role and has a great impact on the postoperative outcome; the earlier the intervention, the better the prognoses and postoperative outcomes. Therefore, most non-traumatic injuries have good prognosis after early surgical interventions and patients achieve complete recovery, except for ISCM and calcified CDH that carry moderate to bad prognosis [21,26]. Other surgically treatable non-traumatic causes of BSS that have been reported rarely include neurenteric cyst, cervical synovial cyst, ganglion cyst, spinal arteriovenous fistula, intramedullary abscess, intramedullary tuberculosis, and regional kyphosis (Figure 3).…”