A case of delayed recurrence of pleural mesothelioma with intradural invasion

Background: Pleural mesothelioma (PM) is a tumor of the pleural epithelium with a poor prognosis. Asbestos exposure is closely related to its occurrence. To date, there have been 13 reports of PM with intradural invasion. Case Description: A 73-year-old male was admitted with rapid progression of back pain and paraparesis. At age 67, he was diagnosed with PM (epithelial type) and underwent chemotherapy and a left thoracotomy for tumor resection. At present, the magnetic resonance newly showed T7-T9 spinal cord compressed due to an intradural tumor. Originating from the left pleura and invading the spinal canal through the intervertebral foramina, the lesion was subtotally resected. Histology confirmed that the intradural tumor lesion was a PM (biphasic type) that had transformed into a malignant tumor. Postoperatively, the patient’s paraparesis improved. Despite the administration of adjuvant chemotherapy, the tumor showed regrowth 5 months later; further treatment was purely palliative care. Conclusion: In general, patients with PM have a poor prognosis. However, those with some favorable factors (i.e., epithelioid subtype, female sex, and early clinical stage) may survive for up to 5-years.