RESUMEN
We previously reported that a novel haemoglobin-platelet index (HPI) based on anaemia and thrombocytopenia was useful to predict the prognosis of patients with diffuse large B-cell lymphoma not otherwise specified (DLBCL NOS). Here, we analyse the utility of HPI in a new validation cohort with DLBCL NOS (n = 94). As a result, we confirm that HPI was effective for differentiating progression-free survival (PFS) and overall survival in this validation cohort. So, we further compare the utility of HPI with previously reported prognostic markers such as the National Comprehensive Center Network-International Prognostic Index (NCCN-IPI), Glasgow prognostic score (GPS), and platelet-albumin (PA) score, using a larger number of 160 patients consisting of the derivation cohort (n = 66) and a validation cohort (n = 94). As a result, the patients with a higher HPI score had significantly worse outcomes, and HPI predicted the prognosis of DLBCL NOS independently of NCCN-IPI. HPI was more sensitive than GPS and almost the same as PA score in predicting PFS. Moreover, the patients whose lymphoma cells were positive for interleukin-6 (IL-6) (75/111 cases) judged by immunohistochemical staining had significantly lower haemoglobin levels and platelet counts than IL-6-negative cases (36/111 cases), suggesting the involvement of IL-6 produced by lymphoma cells in anaemia and thrombocytopenia in DLBCL NOS patients.
Asunto(s)
Anemia , Linfoma de Células B Grandes Difuso , Trombocitopenia , Anemia/etiología , Protocolos de Quimioterapia Combinada Antineoplásica , Hemoglobinas , Humanos , Interleucina-6 , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Pronóstico , Estudios Retrospectivos , Rituximab/uso terapéutico , Trombocitopenia/etiologíaRESUMEN
Despite duodenal-type follicular lymphoma (DTFL) being morphologically, immunophenotypically and genetically indistinguishable from nodal FL (nFL), this entity typically shows a significantly better prognosis. Here, we analysed the tumour immune microenvironments of diagnostic specimens from patients with DTFL (n = 30), limited-stage FL (LSFL; n = 19) and advanced-stage FL (ASFL; n = 31). The mean number of CD8+ tumour-infiltrating lymphocytes (TILs) in the neoplastic follicles was higher in DTFL (1,827/mm2 ) than in LSFL (1,150/mm2 ) and ASFL (1,188/mm2 ) (P = 0·002, P = 0·002, respectively). In addition, CD8+ PD1- T cells with non-exhausting phenotype were more abundant in the peripheral blood (PB) of DTFL than in LSFL and ASFL, indicating that DTFL may exhibit a better and longer-lasting T cell-mediated immune response. Moreover, whereas FOXP3+ CTLA-4+ effector regulatory T cells (eTregs) were rarely observed in the neoplastic follicles of DTFL (mean: 12/mm2 ), they were more abundant in LSFL (78/mm2 ) and ASFL (109/mm2 ) (P = 2·80 × 10-5 , P = 4·74 × 10-8 , respectively), and the numbers of eTregs correlated inversely with those of CD8+ TILs (r = -0267; P = 0·018). Furthermore, DTFL showed significantly fewer circulating FOXP3hi CD45RA- CD25hi eTregs (0·146%) than ASFL (0·497%) and healthy controls (0·639%) (P = 0·0003, P = 6·79 × 10-7 , respectively). These results suggest that the augmented anti-tumour immune reactions may contribute to a better prognosis on DTFL.
Asunto(s)
Linfocitos T CD8-positivos/inmunología , Neoplasias Duodenales/inmunología , Linfocitos Infiltrantes de Tumor/inmunología , Linfoma Folicular/inmunología , Linfocitos T Reguladores/inmunología , Microambiente Tumoral/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Linfocitos T CD8-positivos/patología , Neoplasias Duodenales/patología , Femenino , Humanos , Linfocitos Infiltrantes de Tumor/patología , Linfoma Folicular/patología , Masculino , Persona de Mediana Edad , Linfocitos T Reguladores/patologíaRESUMEN
The international prognostic index (IPI) is a broadly utilized clinical tool to aid in predicting the prognosis of patients with aggressive non-Hodgkin's lymphomas (NHL). However, since this score was developed before the development of rituximab, and the introduction of combined rituximab plus CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) (R-CHOP) therapy for NHL has dramatically improved clinical outcomes, the IPI may be inadequate to assess prognosis in the R-CHOP era. In the present study, we assessed the utility of hemoglobin (Hb) level and platelet count to predict prognosis in diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS), the largest category of aggressive NHL. A total of 89 patients newly diagnosed with nodal DLBCL, NOS and treated with R-CHOP therapy were included. The blood count results at diagnosis were statistically analyzed. Available biopsy specimens were immunostained for interleukin (IL)-6. Hb levels lower than 120 g/L (p = 0.0133) and platelet counts lower than 135 × 109/L (p = 0.0233) were associated with worse overall survival (OS). Based on those levels as cutoff values, a hemoglobin-platelet (HP) index was calculated by assigning 1 point for an Hb level or a platelet count lower than the cutoff. The patients were divided into three groups based on the HP index: high, with a score of 2 (n = 8); intermediate, with a score of 1 (n = 39); and low, with a score of 0 (n = 42). A higher HP index was associated with worse OS (p = 0.0055). Patients with IL-6-positive tumors had significantly lower Hb levels than those with IL-6-negative tumors (p = 0.0264), suggesting that abnormal production of IL-6 by lymphoma cells is associated with anemia. On the other hand, there was no association between the platelet counts and the IL-6 expression in the lymphoma cells. In a multivariate analysis, the HP index predicted OS rate independently of the IPI. Since the HP index is based on inexpensive and broadly available laboratory values, we believe that this index will have great utility in clinical practice, and the addition of this index to IPI could more precisely predict prognosis.
Asunto(s)
Hemoglobinas , Linfoma de Células B Grandes Difuso/sangre , Linfoma de Células B Grandes Difuso/mortalidad , Recuento de Plaquetas , Anciano , Anciano de 80 o más Años , Anemia/sangre , Anemia/etiología , Anticuerpos Monoclonales de Origen Murino/efectos adversos , Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores , Ciclofosfamida/efectos adversos , Ciclofosfamida/uso terapéutico , Citocinas/sangre , Doxorrubicina/efectos adversos , Doxorrubicina/uso terapéutico , Femenino , Humanos , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Prednisona/efectos adversos , Prednisona/uso terapéutico , Pronóstico , Modelos de Riesgos Proporcionales , Rituximab , Trombocitopenia/sangre , Trombocitopenia/etiología , Vincristina/efectos adversos , Vincristina/uso terapéuticoRESUMEN
(Objectives) We evaluated the safety and efficacy of continuous administration of antithrombotic drugs during transurethral resection of bladder tumors (TURBT). (Methods) We performed a retrospective review of 351 TURBT procedures performed at our institute from April 2011 to October 2015. Among these, antithrombotic drugs were continued in 31 TURBT cases throughout their perioperative period (continuation group), antithrombotic drugs were discontinued in 26 TURBT cases (discontinuation group), and bridging anticoagulation therapy with heparin after interruption of antithrombotic drugs was performed in 4 TURBT cases (heparin bridging group). The safety and efficacy of continuous administration of antithrombotic drugs during TURBT was evaluated by comparing the rate of perioperative complications, median operative time, duration of hematuria, urethral catheter placement, duration of stay after surgery, and by comparing the duration of stay among the three groups. (Results) The median operative time was 40.0 min in the continuation group, 39.0 min in the discontinuation group, and 31.0 min in the heparin bridging group with no significant differences. There were no significant differences in the median duration of hematuria (1.00 days vs. 1.00 days vs. 1.00 days), urethral catheter placement (3.00 days vs. 2.50 days vs. 2.00 days), or stay after TURBT (4.00 days vs. 3.50 days vs. 3.00 days) among the continuation, discontinuation, and heparin bridging groups. The median duration of stay was 6.00 days in the continuation group, 7.00 days in the discontinuation group, and 16.0 days in the heparin bridging group with significant differences between the continuation group vs. the heparin bridging group and the discontinuation group vs. the heparin bridging group. The rate of complications was 6 (19.4%) in the continuation group and 3 (11.5%) in the discontinuation group with no significant differences. However, a serious complication, cerebral infarction leading to hemiplegia, occurred in the discontinuation group. (Conclusion) Continuous administration of antithrombotic drugs during TURBT is considered to be safe and useful because it may prevent serious thromboembolism without adversely affecting the perioperative course.
Asunto(s)
Cistectomía/métodos , Fibrinolíticos/administración & dosificación , Atención Perioperativa , Complicaciones Posoperatorias/prevención & control , Seguridad , Trombosis/prevención & control , Uretra , Neoplasias de la Vejiga Urinaria/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Hematuria/epidemiología , Humanos , Tiempo de Internación , Masculino , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Trombosis/epidemiología , Resultado del Tratamiento , Cateterismo Urinario/estadística & datos numéricosAsunto(s)
25-Hidroxivitamina D3 1-alfa-Hidroxilasa/metabolismo , Citocinas/metabolismo , Mediadores de Inflamación/metabolismo , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/metabolismo , 25-Hidroxivitamina D3 1-alfa-Hidroxilasa/sangre , Anciano , Biopsia , Citocinas/sangre , Humanos , Inmunohistoquímica , Mediadores de Inflamación/sangre , Masculino , Tomografía Computarizada por Rayos XAsunto(s)
Citocinas/biosíntesis , Infecciones por Virus de Epstein-Barr/complicaciones , Herpesvirus Humano 4/aislamiento & purificación , Linfohistiocitosis Hemofagocítica/etiología , Linfoma de Células B Grandes Difuso/complicaciones , Células Madre Neoplásicas/virología , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Médula Ósea/patología , Ciclofosfamida/administración & dosificación , Citocinas/análisis , Doxorrubicina/administración & dosificación , Infecciones por Virus de Epstein-Barr/metabolismo , Resultado Fatal , Femenino , Humanos , Ganglios Linfáticos/patología , Linfohistiocitosis Hemofagocítica/patología , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/metabolismo , Linfoma de Células B Grandes Difuso/virología , Persona de Mediana Edad , Células Madre Neoplásicas/química , Células Madre Neoplásicas/patología , Prednisona/administración & dosificación , ARN Viral/análisis , Rituximab/administración & dosificación , Vincristina/administración & dosificaciónAsunto(s)
Anemia Hemolítica Autoinmune , Neoplasias de Cabeza y Cuello , Interleucina-17/metabolismo , Linfoma de Células T , Proteínas de Neoplasias/metabolismo , Trombocitopenia , Anciano , Anemia Hemolítica Autoinmune/metabolismo , Anemia Hemolítica Autoinmune/patología , Neoplasias de Cabeza y Cuello/metabolismo , Neoplasias de Cabeza y Cuello/patología , Humanos , Linfoma de Células T/metabolismo , Linfoma de Células T/patología , Masculino , Trombocitopenia/metabolismo , Trombocitopenia/patologíaAsunto(s)
Neoplasias de Cabeza y Cuello , Interleucina-6/metabolismo , Linfoma de Células T , Proteínas de Neoplasias/metabolismo , Vasopresinas/metabolismo , Anciano de 80 o más Años , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/metabolismo , Humanos , Inmunohistoquímica , Linfoma de Células T/diagnóstico por imagen , Linfoma de Células T/metabolismoAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Antígeno CTLA-4/metabolismo , Leucemia-Linfoma de Células T del Adulto , Resistencia a la Meticilina , Proteínas de Neoplasias/metabolismo , Infecciones Estafilocócicas , Staphylococcus epidermidis , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Ciclofosfamida/administración & dosificación , Ciclofosfamida/efectos adversos , Doxorrubicina/administración & dosificación , Doxorrubicina/efectos adversos , Resultado Fatal , Humanos , Leucemia-Linfoma de Células T del Adulto/tratamiento farmacológico , Leucemia-Linfoma de Células T del Adulto/metabolismo , Leucemia-Linfoma de Células T del Adulto/microbiología , Leucemia-Linfoma de Células T del Adulto/patología , Masculino , Prednisona/administración & dosificación , Prednisona/efectos adversos , Infecciones Estafilocócicas/inducido químicamente , Infecciones Estafilocócicas/metabolismo , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/patología , Vincristina/administración & dosificación , Vincristina/efectos adversosAsunto(s)
Ciclina D3/metabolismo , Hipercalcemia/metabolismo , Linfoma de Células del Manto/metabolismo , Proteína Relacionada con la Hormona Paratiroidea/metabolismo , Anciano de 80 o más Años , Femenino , Humanos , Hipercalcemia/complicaciones , Hipercalcemia/patología , Linfoma de Células del Manto/complicaciones , Linfoma de Células del Manto/patologíaAsunto(s)
Neoplasias de Cabeza y Cuello , Leucemia-Linfoma de Células T del Adulto , Anciano , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/metabolismo , Neoplasias de Cabeza y Cuello/patología , Humanos , Leucemia-Linfoma de Células T del Adulto/diagnóstico por imagen , Leucemia-Linfoma de Células T del Adulto/metabolismo , Leucemia-Linfoma de Células T del Adulto/patología , MasculinoAsunto(s)
Citocinas/genética , Expresión Génica , Linfadenopatía Inmunoblástica/diagnóstico , Linfadenopatía Inmunoblástica/genética , Linfoma de Células T/diagnóstico , Linfoma de Células T/genética , Receptores CCR4/genética , Anciano , Humanos , Inmunohistoquímica , Inmunofenotipificación , Ganglios Linfáticos/metabolismo , Ganglios Linfáticos/patología , Linfocitos Infiltrantes de Tumor/metabolismo , Linfocitos Infiltrantes de Tumor/patología , Masculino , Células Plasmáticas/metabolismo , Células Plasmáticas/patología , Tomografía de Emisión de Positrones , Piel/patologíaRESUMEN
BACKGROUND: Clear cell sarcoma (CCS) and malignant melanoma share overlapping immunohistochemistry with regard to the melanocytic markers HMB45, S100, and Melan-A. However, the translocation t(12; 22)(q13; q12) is specific to CCS. Therefore, although these neoplasms are closely related, they are now considered to be distinct entities. However, the translocation is apparently detectable only in 50%-70% of CCS cases. Therefore, the absence of a detectable EWS/AFT1 rearrangement may occasionally lead to erroneous exclusion of a translocation-negative CCS. Therefore, histological assessment is essential for the correct diagnosis of CCS. Primary CCS of the bone is exceedingly rare. Only a few cases of primary CCS arising in the ulna, metatarsals, ribs, radius, sacrum, and humerus have been reported, and primary CCS arising in the pubic bone has not been reported till date. CASE PRESENTATION: We present the case of an 81-year-old man with primary CCS of the pubic bone. Histological examination of the pubic bone revealed monomorphic small-sized cells arranged predominantly as a diffuse sheet with round, hyperchromatic nuclei and inconspicuous nucleoli. The cells had scant cytoplasm, and the biopsy findings indicated small round cell tumor (SRCT). Immunohistochemical staining revealed the tumor cells to be positive for HMB45, S100, and Melan-A but negative for cytokeratin (AE1/AE3) and epithelial membrane antigen. To the best of our knowledge, this is the first case report of primary CCS of the pubic bone resembling SRCT. This ambiguous appearance underscores the difficulties encountered during the histological diagnosis of this rare variant of CCS. CONCLUSION: Awareness of primary CCS of the bone is clinically important for accurate diagnosis and management when the tumor is located in unusual locations such as the pubic bone and when the translocation t(12; 22)(q13; q12) is absent.
Asunto(s)
Tumor Desmoplásico de Células Pequeñas Redondas/diagnóstico , Hueso Púbico/patología , Sarcoma de Células Claras/diagnóstico , Sarcoma de Células Pequeñas/diagnóstico , Anciano de 80 o más Años , Tumor Desmoplásico de Células Pequeñas Redondas/metabolismo , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Antígeno MART-1/metabolismo , Masculino , Melanoma/diagnóstico , Melanoma/metabolismo , Antígenos Específicos del Melanoma/metabolismo , Hueso Púbico/metabolismo , Proteínas S100/metabolismo , Sarcoma de Células Claras/metabolismo , Sarcoma de Células Pequeñas/metabolismo , Antígeno gp100 del MelanomaAsunto(s)
Citocinas/biosíntesis , Linfoma Anaplásico Cutáneo Primario de Células Grandes/metabolismo , Neoplasias Cutáneas/metabolismo , Piel/metabolismo , Adulto , Biomarcadores de Tumor/biosíntesis , Femenino , Humanos , Inmunohistoquímica , Interferón gamma/biosíntesis , Interleucina-6/biosíntesis , Linfoma Anaplásico Cutáneo Primario de Células Grandes/diagnóstico , Piel/patología , Neoplasias Cutáneas/diagnóstico , Factor de Necrosis Tumoral alfa/biosíntesisRESUMEN
BACKGROUND: Patients with spinal cord injury (SCI) frequently complain of intractable pain that is resistant to conservative treatments. Here, we report the successful application of 1-kHz high-frequency spinal cord stimulation (SCS) in a patient with refractory neuropathic pain secondary to SCI. CASE PRESENTATION: A 69-year-old male diagnosed with SCI (C4 American Spinal Injury Association Impairment Scale A) presented with severe at-level bilateral upper extremity neuropathic pain. Temporary improvement in his symptoms with a nerve block implied peripheral component involvement. The patient received SCS, and though the tip of the leads could not reach the cervical vertebrae, a 1-kHz frequency stimulus relieved the intractable pain. CONCLUSIONS: SCI-related symptoms may include peripheral components; SCS may have a considerable effect on intractable pain. Even when the SCS electrode lead cannot be positioned in the target area, 1-kHz high-frequency SCS may still produce positive effects.
RESUMEN
BACKGROUND: Hyperactive dysfunction syndrome (HDS) refers to a constellation of symptoms developing from cranial nerve overactivity caused by neurovascular compression at the root entry or exit zone near the brainstem. Although the combined features of HDS are seen in the elderly, there are no reports of such cases in adolescents, to date. CASE PRESENTATION: A 17-year-old male was diagnosed with right glossopharyngeal neuralgia and treated with microvascular decompression. He experienced new-onset right facial pain later and was diagnosed with right trigeminal neuralgia, which required prompt radiofrequency thermocoagulation of the right mandibular nerve. Follow-up in the third post-treatment year revealed the absence of symptom recurrence. DISCUSSION: We report the treatment of a rare case of adolescent-onset combined HDS presenting as trigeminal and glossopharyngeal neuralgia. This report highlights the possibility of combined hyperactive dysfunction syndrome in younger age groups. It is crucial to establish a diagnosis early on for prompt management.
RESUMEN
BACKGROUND Tracheobronchopathia osteochondroplastica (TO) is a rare disorder characterized by cartilaginous or ossified submucosal nodules of unknown etiology that project into the tracheobronchial lumen. TO is often accompanied by endotracheal stenosis from cartilage proliferation and is often detected by difficult endotracheal intubation incidence. CASE REPORT Here we report the case of a patient (67-year-old man) with TO scheduled to undergo robot-assisted total prostatectomy for prostate cancer. The tracheal lumen was especially narrow at an area 1 cm below the glottis, with the smallest lumen diameter being 9 mm. After rapid induction, the bronchoscope passed through the stenosed region, and a 6.5-mm spiral endotracheal tube (ETT) was inserted with bronchoscopic assistance. However, because of resistance, the spiral ETT could not pass through the stenosed area. After changing to a 6.5-mm normal ETT, intubation was successfully performed with gentle rotation. Owing to the rotation, the tip entered and gained access to the gap between nodules. With use of a bronchoscope, we confirmed that the tip of the ETT was advanced 10 cm from the glottis, where the site of maximum stenosis was not covered by the tube cuff, and where the tip did not cross the bifurcation. After surgery, no bleeding or edema was found on bronchoscopy. CONCLUSIONS In patients with TO, it is important to assess the airway condition and prepare for difficult intubation. In this case, tracheal intubation was performed with rotation using a bronchoscope and normal ETT.
Asunto(s)
Broncoscopía/métodos , Intubación Intratraqueal/métodos , Osteocondrodisplasias/diagnóstico , Osteocondrodisplasias/cirugía , Enfermedades de la Tráquea/diagnóstico , Enfermedades de la Tráquea/cirugía , Anciano , Humanos , MasculinoRESUMEN
A 91-year-old woman presented with a rapidly proliferative cutaneous lesion on the left lower limb, which was identified as a primary cutaneous diffuse large B-cell lymphoma (PCLBCL), leg type, on biopsy. The patient also showed complications of hepatomegaly, endocrinopathy, edema, skin change, and polyneuropathy without monoclonal plasma cell proliferative disorder, and was therefore diagnosed with POEMS-like syndrome owing to the lack of monoclonal plasma cell proliferative disorder. Levels of serum vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) were high with the lymphoma cells immunostained positively for VEGF and IL-6. To the best of our knowledge, this is the first case report of PCLBCL, leg type, with POEMS-like syndrome. The findings in this case suggest that the symptoms of POEMS-like syndrome might be caused by the cytokines produced by the lymphoma cells. Furthermore, a wider range of diagnostic criteria associated with the result of abnormal secretion of cytokine may have to be considered for the diagnosis and evaluation of patients with possible POEMS syndrome, as against the present criteria specifying monoclonal plasma cell proliferative disorder as the essential criterion.
Asunto(s)
Interleucina-6/sangre , Linfoma de Células B Grandes Difuso/complicaciones , Proteínas de Neoplasias/sangre , Síndrome POEMS/diagnóstico , Neoplasias Cutáneas/diagnóstico , Factor A de Crecimiento Endotelial Vascular/sangre , Anciano de 80 o más Años , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales de Origen Murino , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/administración & dosificación , Diagnóstico Diferencial , Doxorrubicina/administración & dosificación , Edema/etiología , Femenino , Hepatomegalia/etiología , Humanos , Hiperparatiroidismo Secundario/etiología , Hiperprolactinemia/etiología , Inmunofenotipificación , Pierna , Linfoma de Células B Grandes Difuso/sangre , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Polineuropatías/etiología , Prednisona/administración & dosificación , Rituximab , Vincristina/administración & dosificaciónRESUMEN
BACKGROUND: Patients with malignant pleural mesothelioma (MPM) frequently complain of intractable pain that is resistant to conservative treatments. Although spinal cord stimulation (SCS) may be promising in the alleviation of such devastating pain, the effects of SCS on MPM-associated pain and the appropriate timing of its application remain unknown. CASE PRESENTATION: A 66-year-old man diagnosed with MPM presented with severe neuropathic pain due to rapid progression of the tumor to the intercostal nerves. The patient immediately decided to receive SCS implantation and burst stimulus, which relieved the conservative therapy-resistant pain and improved his sleep and daily activities. CONCLUSION: This report suggests that the execution of SCS as soon as possible may help to alleviate MPM symptoms. Since MPM extends aggressively to the thorax and nerves that cause mixed nociceptive and/or neuropathic pain, appropriate pain management requires the proper assessment of the etiology by an expert in pain management.