Malignant pleural mesothelioma with spinal fracture – a case report

Background: Malignant mesothelioma is an aggressive tumor of serosal surfaces, such as the pleura and the peritoneum. Local invasion is common involving the adjacent organs. Distant metastasis is rare.
Case Report: We present an interesting case report of a 60-year-old lady with malignant pleural mesothelioma with vertebral collapse, which initially thought to be a metastasis turned out to be vertebral infarction due to compromise in blood supply to the vertebra as a result of contiguous spread of the mesothelioma. This lady presented with low back ache, nontraumatic in origin without neurological symptoms. CT and MR scan revealed significant changes in T12 vertebra with vertebral collapse. Surgical intervention was necessary to obtain pain relief and to get bone sample for biopsy to confirm diagnosis. Histopathological examination of bone specimens revealed samples of bone containing normal haematopoietic tissue together with fragments of partly degenerative necrotic tissue. No morphologically or immunohistochemically viable tumour was identified.
Conclusions: Analysing the various possible causes for vertebral collapse from literature, CT/MRI scan and biopsy report, we identified that the pleural mesothelioma had spread in contiguity, encircled the spine near the thoraco-lumbar junction and interfered with the vascular supply of the vertebral body leading to collapse of the T12 vertebra.

Keywords: malignant mesothelioma, Back Pain, vertebral collapse , spinal stabilisation