Primary spinal malignant mesothelioma: a case report and literature review.

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Primary spinal malignant mesothelioma: a case report and literature review.

World Neurosurg. 2018 Mar 24;:

Authors: Chen F, Liu B, Yu Y, Du J, Chen D

Abstract
BACKGROUND: Malignant mesotheliomas are aggressive and rapidly-fatal neoplasms arising from the mesothelial cells. The most common sites of origin are the pleural and peritoneal cavities, and additionally, malignant mesotheliomas can also infrequently involve the pericardium and the tunica vaginalis. However, malignant mesothelioma occurring in the spinal canal is extremely rare. Herein, we reported a case with primary spinal malignant mesothelioma.
METHODS: A literature search was using PubMed with specific key terms, inclusion criteria, and exclusion criteria. Selected case studies and case series were then compared and statistical analysis performed where appropriate. A 35-year-old man presented with a 3-month history of swelling and pain in the left lower extremity.
RESULTS: Neurological examination revealed a loss of sensation below the lumbar (L)5 dermatome. Magnetic resonance imaging (MRI) showed a mass at the L4-5 level. A diagnosis of schwannoma was suspected, and surgical resection was performed. Histopathological findings were consistent with sarcomatoid malignant mesothelioma. Thoracic and whole-abdomen computed tomography (CT) was requested, yielding normal results. The patient refused adjuvant radiotherapy or chemotherapy. Positron emission tomography-computed tomography (PET-CT) 3 months postoperatively showed no abnormality. Eight months postoperatively, the patient developed back pain and difficulty in defecation; MRI demonstrated tumor recurrence. A second operation was performed, and intraoperatively we found the vertebra and Cauda equina were invaded. A subtotal resection was achieved, and the pain was alleviated partially. Two months later, the patient succumbed to a traffic accident.
CONCLUSION: Spinal malignant mesothelioma is an extremely rare but highly aggressive entity. Preoperative identification is challenging and definitive diagnosis depends on histopathological evidence. Surgical resection can help relieve the symptoms, whereas the overall prognosis is poor.

PMID: 29588242 [PubMed - as supplied by publisher]

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