Mesothelioma-mimicking multiple myeloma with dumbbell-type progression.

An 80-year-old man, exposed to asbestos in a dockyard, suffered from progressive paraplegia for two months. His plantar reflexes were bilaterally abnormal and Romberg’s sign was positive. Spine MRI revealed that the thoracic cord was compressed by the mass in the dorsal epidural space (Picture 1). Chest CT was suggestive of mesothelioma with dumbbell-shaped progression spreading from the right pleura over the thoracic vertebral body through the right intervertebral foramen (Picture 2A, B). However, IgG-lambda type monoclonal gammopathy and massive infiltration of welldifferentiated plasmacytes shown on a blood examination and a right pleura biopsy, respectively, confirmed the diagnosis of multiple myeloma (Picture 3). Plasmacytoma, including multiple myeloma, infrequently appears as an epidural spinal tumor, pleural tumor or dumbbell (dumb-bell) tumor penetrating the intervertebral