Extensive epidural cufflike growth of malignant pleural mesothelioma causing spinal cord compression.

spread may occur in the late stages of the disease, but neurologic complications have only rarely been reported. We describe 4 patients with spinal epidural extension of a paravertebral malignant mesothelioma, resulting in signs of spinal cord compression. The neurologic complication developed 4 months and 2, 6, and 7 years after diagnosis, indicating a remarkably indolent course of malignant mesothelioma in most of these patients. Clinical Summaries PATIENT 1. A 56-year-old woman was referred because of progressive low back pain radiating to the back of her legs. She had been treated for pleural effusion for the previous 7 years, and although a pleural tumor was suspected, repeated pleural biopsies were not diagnostic. She had been exposed to asbestos by way of her husband’s working clothes. Computed tomographic scan of the lumbar spine showed masses in the left intervertebral foramina at L2-L3 and L3-L4, with thickening of the left psoas muscle. A muscle biopsy specimen revealed malignant mesothelioma. Three months later, the patient had uncontrollable pain and weakness in both legs. A computed tomographic scan of the spine (T7-L5) showed paravertebral masses growing into the intervertebral foramina at all levels. After 4 months, intolerable neck pain, progressive leg weakness, and ataxic gait had developed. Magnetic resonance imaging (MRI) showed epidural tumor growth at the thoracic and cervical levels, extending through the foramen magnum into the skull (Figure 1). One week later, the patient’s condition deteriorated, and she died of respiratory failure. At autopsy,