A unique case of malignant pleural mesothelioma presenting with highly aggressive multiple brain metastases after a long disease-free period
Malignant pleural mesothelioma (MPM) is an uncommon, aggressive malignant neoplasm derived from the mesothelial cells of pleura or peritoneum characterized by poor outcome. Mesothelioma is thought to metastasize locally only via direct invasion and not have distant spread. Distant metastases are discovered mostly on post-mortem examination. However, recent post-mortem studies have identified metastases to the central nervous system (CNS) in about 3% of cases. A 55 year old patient presented with agressive multiple brain metastases after 4 years from the initial diagnosis. Palliative cranial radiotherapy was given because of unresectability of the lesions. The patient died 3 months after completion of radiotherapy. Distant metastase patern is not predictable in this disease, thus attention should be paid on the high-risk factors at initial presentation to prevent systemic relapses. Multimodality therapies have been produced longer survival times in this disease; clinicians should perform careful screening for brain metastasis in MPM, especially in patients with risk factors including younger age, advanced stage and non-epithelioid features.
pleural mesothelioma; brain metastasis; brain radiotherapy;
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