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      Malignant Pleural Mesothelioma with Bone Marrow Metastases

      case-report

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          Abstract

          A 64-year-old man with the bone marrow metastasis due to malignant pleural mesothelioma (MPM) was diagnosed with anemia, leukoerythroblastosis, thrombocytopenia, and lower back pain. A bone marrow biopsy demonstrated infiltrative malignant mesothelioma lesions in the bone marrow. The patient died within 15 days of the detection of the bone marrow involvement. Physicians should consider performing a bone marrow biopsy to diagnose bone marrow metastasis and treat patients with palliative chemotherapy at an earlier phase of the disease. To our knowledge, this is the first report of an MPM patient having bone marrow metastasis with anemia, leukoerythroblastosis, and thrombocytopenia.

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          A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group.

          V W Rusch (1995)
          Investigation of the behavior and treatment of the diffuse malignant pleural mesothelioma (MPM) is hindered by the lack of an accurate universally accepted staging system. To address this problem, the International Mesothelioma Interest Group (IMIG) has developed a new TNM-based staging system. The staging system was developed at a consensus meeting of IMIG members involved in clinical research in MPM, including the originators of previously proposed staging systems. The new staging system is based on the analysis of emerging information about the impact of T and N status on survival. In contrast to five previous staging systems, the T descriptors designated as T1, T2, T3, and T4, provide precise anatomic definitions of the local extent of the primary tumor. The N descriptors, designated as N0, N1, N2, and N3, are virtually identical to those used in the International Lung Cancer Staging System. The stage groupings recognize new data about the better prognosis of T1 and N0 tumors and classify those tumors into stages I and II. The adverse impact of nodal metastases on survival noted in some recent surgical series warrants placing node-positive tumors in stage III. Locally advanced unresectable (T4) tumors and extrathoracic disease (N3 or M1) are classified as stage IV. This proposed staging system reconciles and updates several earlier systems, and can provide the framework for analyzing the results of prospective clinical trials aimed at improving the currently dismal prognosis of MPM.
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            Clinical Outcome of Gastric Cancer Patients with Bone Marrow Metastases

            Hyo Kim, Seong Yoon Yi, Hyun Jung Jun … (2008)
            Background: Gastric cancer with bone marrow metastases is known to pursue a rapidly deteriorating clinical course. We conducted a retrospective analysis to evaluate clinical manifestations and prognosis of gastric cancer patients with bone marrow metastases. Methods: Between September 1994 and February 2006, 39 gastric cancer patients with pathologically confirmed bone marrow dissemination were selected. Results: The majority of the patients showed younger age, poorly differentiated adenocarcinoma or signet ring cell carcinoma, thrombocytopenia, anemia, elevated lactate dehydrogenase and alkaline phosphatase. Poor prognostic factors for survival were serum sodium ≤133 mmol/l [relative risk (RR) 4.57; 95% CI 1.99–10.52; p < 0.001], the presence of lung metastasis (RR 3.47; 95% CI 1.48–8.15; p = 0.007) and the presence of peritoneal seeding (RR 2.17; 95% CI 1.06–4.43; p = 0.036). Median survival durations after bone marrow metastases for patients without any adverse factors (n = 19, 48.7%) and those with 1–3 adverse factors (n = 20, 51.3%) were 67 and 23 days, respectively (p = 0.013). Patients without any adverse factors did benefit from palliative chemotherapy (p = 0.048). Conclusion: We suggest that gastric cancer patients with bone marrow metastases should receive more tailored therapies according to different risk factors in order to enhance survival.
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              Postmortem Findings of Malignant Pleural Mesothelioma

              Rhian S. Finn, Fraser J.H. Brims, Arjun Gandhi … (2012)
              Malignant pleural mesothelioma (MPM) is an incurable cancer with a rising incidence. MPM is often perceived as a locally invasive cancer, and the exact cause of death is poorly understood.This two-center study describes the anatomic features of patients with MPM at postmortem.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Intern Med
                Journal ID (iso-abbrev): Intern. Med
                Title: Internal Medicine
                Publisher: The Japanese Society of Internal Medicine
                ISSN (Print): 0918-2918
                ISSN (Electronic): 1349-7235
                Publication date (Electronic): 30 March 2018
                Publication date (Print): 1 September 2018
                Volume: 57
                Issue: 17
                Pages: 2541-2545
                Affiliations
                [1 ]Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
                [2 ]Research Institute for Diseases of Old Ages, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
                [3 ]Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
                [4 ]Department of Pathology, Labour Health and Welfare Organization Kanto Rosai Hospital, Japan.
                Author notes

                Correspondence to Dr.　Norihiro Harada, nor@ 123456juntendo.ac.jp

                Article
                DOI: 10.2169/internalmedicine.9246-17
                PMC ID: 6172530
                PubMed ID: 29607973
                SO-VID: 8f988404-7245-4b8a-a4b4-ca6aadafdd47
                Copyright © Copyright © 2018 by The Japanese Society of Internal Medicine
                License:

                The Internal Medicine is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit ( https://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 26 March 2017
                Date accepted : 24 January 2018
                Categories
                Subject: Case Report

                Keywords: bone marrow metastasis,malignant pleural mesothelioma,anemia,leukoerythroblastosis,thrombocytopenia
                Data availability:
                Keywords: bone marrow metastasis, malignant pleural mesothelioma, anemia, leukoerythroblastosis, thrombocytopenia

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