Department of Neurosurgery, First Hospital of Jilin University, Changchun, China.
Operating Room, First Hospital of Jilin University, Changchun, China.
World Neurosurg. 2018 Jun;114:211-216. doi: 10.1016/j.wneu.2018.03.124. Epub 2018 Mar 26.
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; the pericardium and the tunica vaginalis are infrequently involved, and malignant mesothelioma in the spinal canal is extremely rare. Here we report a case of primary spinal malignant mesothelioma. We also report the results of a literature search conducted in PubMed with specific key terms, inclusion criteria, and exclusion criteria, with a comparison of elected case studies and case series, and statistical analysis as appropriate.
A 35-year-old man presented with a 3-month history of swelling and pain in the left lower extremity. Neurologic examination revealed a loss of sensation below the L5 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 yielded normal results. The patient refused adjuvant radiotherapy or chemotherapy. Positron emission tomography-computed tomography performed at 3 months postoperatively showed no abnormality. At 8 months postoperatively, the patient developed back pain and difficulty with defecation; MRI demonstrated tumor recurrence. During a second operation, invasion of the vertebra and cauda equina was noted. A subtotal resection was achieved, and the pain was partially alleviated. Two months later, the patient succumbed to a traffic accident.
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, but the overall prognosis is poor.
恶性间皮瘤是一种源自间皮细胞的侵袭性和快速致命的肿瘤。最常见的起源部位是胸膜和腹膜腔；心包和鞘膜腔很少受累，椎管内恶性间皮瘤极为罕见。在此，我们报告一例原发性脊柱恶性间皮瘤。我们还报告了在 PubMed 上使用特定关键词、纳入和排除标准进行文献检索的结果，对选定的病例研究和病例系列进行了比较，并进行了适当的统计分析。
一名 35 岁男性，因左下肢肿胀和疼痛 3 个月就诊。神经系统检查显示 L5 皮节以下感觉丧失。磁共振成像（MRI）显示 L4-5 水平有一肿块。怀疑为神经鞘瘤，并进行了手术切除。组织病理学检查结果符合肉瘤样恶性间皮瘤。胸部和全腹部计算机断层扫描结果正常。患者拒绝接受辅助放疗或化疗。术后 3 个月行正电子发射断层扫描-计算机断层扫描未见异常。术后 8 个月，患者出现背痛和排便困难；MRI 显示肿瘤复发。第二次手术时发现肿瘤侵犯椎体和马尾。进行了次全切除术，疼痛部分缓解。两个月后，患者死于交通事故。
脊柱恶性间皮瘤是一种极为罕见但侵袭性很强的实体瘤。术前识别具有挑战性，明确诊断依赖于组织病理学证据。手术切除有助于缓解症状，但总体预后较差。
