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J Thorac Cardiovasc Surg 2002;124:200-202
© 2002 The American Association for Thoracic Surgery

Brief Communications

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

Johanna M. M. Gijtenbee, MDa, H. I. Piccardt Brouwer, MDa, Rudolf H. Boerman, MD, PhDb, Ruurd G. Wiggenraad, MDc, Charles J. Vecht, MD, PhDd, Peter A. E. Sillevis Smitt, MD, PhDe Nijmegen, Arnhem, The Hague, and Rotterdam, The Netherlands

From the Department of Neurology, University Medical Center, Nijmegen,a the Department of Neurology, Rijnstate Hospital, Arnhem,b the Departments of Radiotherapyc and Neurology,d Medical Center Haaglanden, The Hague, and the Department of Neuro-Oncology, Dr Daniel den Hoed Cancer Center/University Hospital, Rotterdam,e The Netherlands.

Received for publication Dec 14, 2001. Accepted for publication Jan 8, 2002. Address for reprints: Johanna M. M. Gijtenbeek, MD, Department of Neurology, University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.

The first 20% of the full text of this article appears below.

Despite multimodal therapy, the prognosis of pleural malignant mesothelioma remains dismal, with a median survival of less than 1 year.Go Go 1,2 The disease usually progresses locally by direct extension into the pulmonary parenchyma, the chest wall, and mediastinum, and most patients ultimately die of respiratory failure.Go Go 2,3 Hematologic 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 . . . [Full Text of this Article]






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