We report a 45 year old male with right sided pleural mesothelioma who received neoadjuvant chemotherapy prior to a right extrapleural pneumonectomy followed by adjuvant chemotherapy. The patient became tumor free and remained in remission for 19 months following which he developed a lymphangitic spread over the contralateral lung. His diagnosis was confirmed by a bronchoscopic transbronchial biopsy of the left lung. The patient died from progressive respiratory failure over a period of three

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... nths. Such a relapse with an aggressive and fatal lymphangitic spread is rarely seen and reported in malignant pleural mesothelioma. Discussion and review of the literature are provided. Mesothelioma is still considered, worldwide, a rare cancer of the serosal membranes. It typically involves the pleural cavity but other reported sites include the peritoneum, pericardium and Tunica vaginalis of the testis. The usual progression of the mesothelioma is coalescence of multiple, small nodules into large masses that invade, entrap and destroy the affected organ by direct extension and invasion. We report an unusual case of relapsing mesothelioma, recurring in an aggressive and fatal form, after 19 months of remission.