A Rare Occurrence of Primarily Extranodal Spinal Epidural Lymphoma With Spinal Cord Compression and Invasion to the Thoracic Cavity

Abstract

A 41-year-old man suffered from progressive radiculomyelopathy caused by spinal epidural mass primarily encasing the spinal cord at the cervicothoracic vertebrae that extended into the thoracic cavity through the neural foramen. An urgent decompressive laminectomy and epidural tumor resection were performed to prevent neurological deterioration and effective spinal cord decompression. The histopathologic diagnosis was diffuse large B-cell lymphoma. As first-line treatment for stage II extranodal lymphoma, he received 6 cycles of R-CHOP (rituximab/cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisone) chemotherapy. Consequently, follow-up positron-emission tomography CT and MR images demonstrated a complete metabolic response (Deauville score 1). This rare occurrence of primarily extranodal spinal epidural lymphoma with limited disease will be presented in a literature review.

Aggressive B-Cell Lymphoma with Metastatic Spinal Cord Compression: Treat the Patient, Not the Disease

“…To date, these questions remain unsolved, hindering the development of specific, let alone standard, recommendations. As the result, surgery, RT, and ICT are utilized randomly across a variety of the lymphoma types, grades, and stages, leading to indiscriminate sequencing of the different treatment options (Table 1) [5, 7, 8, 14‒45] and erratic and even contrasting clinical outcomes. Therefore, despite unequivocal benefits, the place of systemic therapy and even its necessity in a general treatment plan remains indeterminate.…”

“…Surgery 2 → (immuno-) chemotherapy3 Perry et al[19] (1993), Khalid et al[23] (2004), Chang et al[7] (2013), Tang et al[24] (2013), Cho et al[25] (2015), Erol et al[26] (2016), Hashi et al[27] (2018), Adhikari et al[28] (2022), Ruiz and Garrido[29] (2023), Seok et al[30] (2023) 3 Surgery 2 → radiation → (immuno-) chemotherapy3 Friedman et al[14] (1976), Rathmell et al [18] (1992), Perry et al [19] (1993), Salvati et al [20] (1996), Monnard et al [21] (2006), Charfi et al [31] (2006), Peng et al [32] (2009), Tang et al [24] (2013), Hashi et al [27] (2018) 4 Surgery 2 → (immuno-) chemotherapy 3 → radiation Eeles et al [5] (1991), Fujino et al [33] (2002), Mally et al [34] (2011), Park et al [35] (2012), Wang et al [36] (2016), Msheik et al [37] (2023) 5 Radiation +/− steroids Mullins et al [38] (1971), Epelbaum et al [39] (1986), McDonald et al [40] (2000), Luo [41] (2005), Rades et al [8] (2016), Hashi et al [27] (2018) 6 Radiation → (immuno-) chemotherapy 3 Friedman et al [14] (1976), Epelbaum et al [39] (1986), Eeles et al [5] (1991), Tsukada et al [42] (1992), Fujino et al [33] (2002), Peng et al [32] (2009), Tang et al [24] (2013) 7 (Immuno-) chemotherapy 3 → radiation Wong et al [43] (1996), Vanneuville et al [44] (2000), McDonald et al [40] (2000), Wada et al [45] (2010), Hashi et al [27] (2018) 8 (Immuno-) chemotherapy 3 Epelbaum et al [39] (1986), Wong et al [43] (1996), Wada et al [45] (2010), Chang et al [7] (2013), Hashi et al [27] (2018)1The first authors' names and the year of publication provide a quick reference to corresponding treatment timelines 2. Indications for the surgery usually include an unknown diagnosis with or without myelopathy 3.…”