Banu OZTURK, Erkan KAYİKCİOGLU, Furkan Bertug CETİN, Asim Armagan AYDİN, Mustafa YİLDİZ

Agresif multipl beyin metastazları ile uzun süre hastalıksız izlem sonrası başvuran ender bir malign plevral mezotelyoma olgusu

Malign plevral mezotelyoma (MPM) nadir görülen plevra ya da peritondaki mezotelyal hücrelerden köken alan, kötü prognozlu, nadir ve agresif bir malign neoplazidir. Mezotelyomanın sadece lokal direkt invazyon yolu ile lokal olarak metastaz yaptığı; uzak yayılım yapmadığı düşünülmektedir. Uzak metastazlar post mortem incelemeler sonucu ortaya çıkmaya başlamıştır. Son zamanlarda yapılan post mortem çalışmalarda %3 vakada santral sinir sistemi metastazları bildirilmiştir. 55 yaşında hasta ilk tanısından 4 yıl sonra çoklu agresif beyin metastazları ile başvurdu. Rezeksiyona uygun olmayan lezyonlar nedeniyle palyatif kraniyal radyoterapi verildi. Radyoterapinin tamamlanmasından 3 ay sonra hasta kaybedildi. Bu hastalıkta uzak metastaz paterni öngörülebilir olmadığı için, sistemik relapsları önlemede ilk tanı esnasında yüksek risk faktörlerine dikkat edilmelidir. Multimodal tedaviler bu hastalıkta daha uzun sağkalım sağlayabilmektedir. Klinisyenler MPM'de özellikle erken yaş, ileri evre ve epiteloid dışı özellikleri bulunan hastalarda beyin metastazı için dikkatli tarama yapmalıdırlar.

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.

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