Hodgkin's lymphoma with leptomeningeal involvement

Abstract

A 31-year-old male patient with Hodgkin's lymphoma (Hl) and leptomeningeal involvement presented to at Hematology departments of Atatürk University . The patient developed dizziness, limb weakness, involuntary contractions of the hands and feet, incontinence, headache, fever, nausea, and vomiting following the first cycle of treatment with the ABVd protocol (adriamycin 25 mg m ⎯2, bleomycin 10 mg m ⎯2, vinblastin 6 mg m ⎯2 , and dacarbazine 375 mg m ⎯2 on d 1 and 15 of a 28-d cycle). magnetic resonance imaging (mRı) showed that there were regions with infiltration in particularly the thoracic vertebrae (T3, T4, T9, and T10-T12). ın the lumbar region leptomeningeal involvement beginning at the end of the medulla spinalis that gave rise to a separation of nerves in the cauda equine was observed. Contrast agent uptake was observed, especially at the dural sac, with edema in the nerve roots.Key Words: leptomeningeal involvement, Hodgkin's lymphoma Özet Otuz bir yaşında leptomeningeal tutulumu olan Hodgkin's lenfoma (Hl)'lı erkek hasta sunuldu. Hastada, ABVd (Adriamycin 25 mg/m2, bleomycin 10 mg/m2, vinblastine 6 mg/m2, dacarbazine 375 mg/m2 on days 1 and 15 of a 28-day cycle) tedavisinin ilk siklusundan sonra baş dönmesi, ekstremitelerde güçsüzlük, el ve ayaklarda istemsiz kasılma, inkontinans, baş ağrısı, ateş, bulantı ve kusma gelişti. magnetic resonance imaging (mRı)'da özellikle torakal vertebralarda (T3, T4, T9, T10-T12), infiltrasyon ile uyumlu alanlar görüldü. lomber bölgede medulla spinalisin son kısmından başlayan, kauda equinadaki sinirlerde ayrılmaya sebep olan leptomeningeal tutulum görüldü. Sinir köklerinde ödem ile birlikte özellikle dural kesede kontrast madde tutulumu görüldü.Anahtar Sözcükler: leptomeningeal tutulum, Hodgkin lenfoma

Leptomeningeal Metastases of the Spine: A Systematic Review

“…This likely owes to the fact that CSF circulation is slower in the cauda equina and the basilar cisterns, which represent the two regions mostly affected by leptomeningeal seeding (66, 67). Finally, the concurrent presence of intracranial LMs may also lead to a wide range of additional poorly-localized symptoms, such as headache and/or cranial nerve palsies, following CSF obstruction and increase in intracranial pressure (28,30,61). Hence, the complex clinical presentation of patients with suspected secondary spine LMs highlights the importance to obtain MRI T1-contrasted scans and CSF cytology to assist the diagnostic workflow (15).…”

“…Similarly to intracranial cases, radiotherapy for spine LMs has the ability to reduce lesions' volumes and facilitate the CSF flow, relieving compression-related symptoms and improving the distribution of intrathecal agents when needed (12). In some patients with diffuse and multifocal LMs, radiation protocols targeting the whole spine axis or extending to the brain axis have been implemented for prolonging local tumor control (28,46,49,55). These protocols should be carefully discussed in multidisciplinary teams, weighting the expected clinical benefits in such patients with dismal prognoses to the high risks of severe radiation-induced complications.…”

Magnetic Resonance of Ferritin Crystalline Particles in Tumor Tissue

“…The amount of ferritin characterizes the intensity of the tumor process and its malignant potential [24]. The ferritin level in blood serum is considered to be an indicator of the treatment prognosis [23,25] and it is believed that the high level of ferritin correlates with a poorer prognosis for the patient. It is supposed [26] that a better prognostic factor may be not the ferritin level but the amount of iron in the ferritin core.…”