title: Pleural malignant mesothelioma causing cord infiltration through the nerve root. Case report.
abstract: A 61-year-old man presented with a rare pleural malignant mesothelioma of the spine manifesting as progressive weakness of the bilateral lower extremities, numbness in the body and both legs, and dysfunction of the bladder and bowel. He had previous occupational exposure to asbestos while working at a car repair shop and had undergone right panpleuropneumonectomy under a diagnosis of sarcomatous type mesothelioma in the right pleural space. Magnetic resonance imaging of the spine with gadolinium showed an enhanced intramedullary tumor at the T4 level. Operative findings disclosed the clouded and swollen right posterior nerve root, and the pial surface was covered by clouded arachnoid-like membrane. The removed part of the T4 posterior nerve root and intramedullary tumor revealed malignant mesothelioma with invasion spreading along the posterior nerve root. He died of respiratory failure 3 months after the diagnosis. This case shows that spinal metastasis must be considered if a patient with pleural malignant mesothelioma shows neurological worsening and neuroimaging shows an abnormal lesion in the thoracic spinal cord. However, the patient's neurological condition is very difficult to improve in the presence of spinal cord infiltration.
authors.affiliation: Department of Neurosurgery, Juntendo Urayasu Hospital, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan. hohkura@juntendo.ac.jp
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Okura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Suga
authors.forename: Osamu
authors.initials: O
authors.lastname: Akiyama
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kudo
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tsutsumi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Abe
authors.forename: Yukimasa
authors.initials: Y
authors.lastname: Yasumoto
authors.forename: Masanori
authors.initials: M
authors.lastname: Ito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Izumi
authors.forename: Kazu
authors.initials: K
authors.lastname: Shiomi
mesh_terms: D001194:Asbestos / Q000009:adverse effects; D018450:Disease Progression; D004781:Environmental Exposure; D017809:Fatal Outcome; D006801:Humans; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008654:Mesothelioma / Q000556:secondary*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology* / Q000503:physiopathology; D010291:Paresis / Q000209:etiology; D010997:Pleural Neoplasms / Q000473:pathology*; D011843:Radiculopathy / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D012131:Respiratory Insufficiency / Q000209:etiology; D013116:Spinal Cord / Q000473:pathology* / Q000503:physiopathology; D013125:Spinal Neoplasms / Q000556:secondary*; D013126:Spinal Nerve Roots / Q000473:pathology* / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000473:pathology; D014549:Urinary Incontinence / Q000209:etiology
chemical_list: D001194:Asbestos