Massive hemorrhagic necrosis of the spinal cord in metastatic cord compression

A fusiform longitudinal hemorrhagic necrosis of the spinal cord is described in a patient with spinal cord compression caused by metastases from an adenocarcinoma of the prostate. The lesion extended from the D3 down to L2 level with maximal involvement of the D7-D8 segments. The shape, location, and distribution of the lesion and its prominent hemorrhagic component corresponded to Jellinger's category of cylindrical liquefaction necrosis, probably due to venous obstruction. The multiple thrombi found in epidural veins supported such a pathogenic mechanism, which although extremely rare has been reported previously in five cases.