HISTORY
A 57-year-old smoker of 60 cigarettes a day until 5 years, occupational exposure to asbestos for 28 years, diagnosed 10 months ago epithelial malignant pleural mesothelioma, affecting the left paravertebral region from D6-D7 to D10. 
Two months after the diagnosis has numbness and loss of strength in both lower limbs, which progresses to complete paraparesis with urinary retention. MRI is performed, which revealed a left paravertebral expansion process at the level of D6 to D9 , which infiltrates ribs, left margin of the vertebral bodies above and compresses the spinal cord at D7-D8 metameric back forward.
Is ruled out surgery, beginning treatment with radiotherapy and chemotherapy. It exitus 5 months later, performing autopsy examination.
PATHOLOGY
Grossly, there was a significant thickening of the pleura of the left lung at the expense of multiple neoplastic nodules whitish confluent and elastic, that infiltrate the lung parenchyma by continuity left pericardial fat, fat periesofágica, aortic arch and spine , bulging into the spinal canal at the level of D7 and D8. Metastatic nodules were identified in the right lower lung lobe, mediastinal lymph nodes and both adrenal glands.
The aortic arch appears wrapped by the injury, and acceded to it, making it impossible to separate out .
On histologic examination, tumor cells consists of cuboidal appearance, with intense cellular pleomorphism and nuclear atypia intense and abundant atypical mitotic figures, which are arranged in an irregular pattern of tubulo-papillary structures and small nests of cells tumor arranged randomly. There are large areas of necrotic and hemorrhagic inside the tumor.
In the immunohistochemical study, tumor cells show positivity for EMA, vimentin and cytokeratin (high molecular weight cytokeratin 1,10,5,14) to be negative for CEA, Ber EP-4 and Leu M-1 ( CD-15), in turn, are also negative staining with PAS. Perls staining with occasional ferruginous bodies were identified in the lung parenchyma adjacent to the tumor.
Microscopic examination of individual metastatic nodules, they all show a similar histological appearance to the primary tumor. In the structures adjacent to the primary lesion, which appeared macroscopically infiltrated by contiguity, this invasion is confirmed on histology. Thus, the tumor infiltrates the vertebrae, and breaks the vertebral bone lamellae .
Although the tumor infiltrates the spinal meningeal coverings, the infiltration of vertebral bone tissue allows protrude into the spinal canal and cause and clinical manifestations of spinal cord compression. The aorta that appeared macroscopically encompassed by the injury and adhered to it, shown in the histological invasion of its outer layers, appearing tumor nests infiltrating the whole thickness of adventitia .
DISCUSSION
Diffuse malignant pleural mesothelioma has several different histologic patterns, from which the epithelium is the most common, followed by mixed and sarcomatous, which is the most unusual and which carries a worse prognosis (1).
The distinction between mesothelioma and adenocarcinoma remains the main difficulty in the differential diagnosis of this entity. The immunohistochemical pattern present our case we can include it in mesothelioma, according to the reviewed literature on the subject (2-7). Tumors affecting the spinal canal may be primary or metastatic, and are classified as extra or epidural and intradural, and the latter as an extra or intramedullary. Most neoplastic lesions at this level are epidurals (50%) (8), of which the most frequent metastatic carcinomas (especially breast, prostate, lung, thyroid and kidney), followed by lymphoma and multiple myeloma. In intradural tumors (40%), the most common are meningiomas and neurofibromas. In terms of intramedullary tumors (10%), ependymomas are most common at this location (60-70% of intramedullary tumors in adults).
The special feature is the case described the infiltration of the spine with clinical evidence of spinal cord injury, which we have seen only two cases in an extensive literature review (9-11).
This is of great interest both for the pathologist to the clinician, and for including malignant mesothelioma in neoplasms to consider in the differential diagnosis in a case of malignant spinal cord compression.
On the other hand, has been reported in a mesothelioma covers or surrounds the abdominal aorta (12-13), but we found in the literature reviewed no description of the aortic arch Frankish invasion by malignant mesothelioma.