Lymphoma and peripheral neuropathy: A clinical review

Abstract

Lymphoma occasionally affects the peripheral nervous system. When it does, the diagnosis can be elusive since many patients present without known lymphoma. Most peripheral nerve complications are due to non-Hodgkin's lymphoma (NHL), which infiltrates nerves causing axonal damage. This disorder can affect nerve roots and cranial nerves, often associated with lymphomatous meningitis. NHL may also infiltrate peripheral nerves and cause plexopathy, mononeuropathy, or generalized neuropathy. These neuropathies may resemble an asymmetric mononeuropathy multiplex or a generalized disorder such as chronic inflammatory demyelinating polyradiculoneuropathy. When NHL infiltrates diffusely, the term neurolymphomatosis is used. Hodgkin's lymphoma (HL), by contrast, rarely infiltrates nerves. More often, HL causes immunological disorders of the peripheral nervous system such as inflammatory plexopathy or Guillain-Barré syndrome. Other rare lymphomas such as intravascular lymphoma and Waldenstrom's macroglobulinemia can also affect peripheral nerves in specific ways. In addition, other malignant and nonmalignant lymphoproliferative disorders enter into the differential diagnosis of lymphomatous neuropathy. This review discusses the multiple peripheral nerve presentations of lymphoma from the clinician's point of view and provides a guide to the evaluation and diagnosis of these uncommon, challenging disorders.

Atypical presentation of Non-Hodgkin Lymphoma (NHL): a case report

“…Il caso in esame evidenzia le "proteiformi" manifestazioni neurologiche in corso di NHL a cui concorrono diversi meccanismi fisiopatologici [2]. Infatti, se possiamo attribuire sintomi clinici degli arti inferiori a una plessopatia bilaterale causata da un diretto danno infiltrante, la sofferenza del sistema nervoso periferico agli arti superiori rimane di non unica interpretazione.…”

CD5-Positive Diffuse Large B Cell Lymphoma Infiltrating the Central Nervous System Presenting Guillain-Barr^|^eacute;-Like Syndrome after Chemotherapy

“…When encountering GBS-like symptoms during chemotherapy for lymphoma, certain causes are usually considered, such as drug administration, especially vincristine 9,10 and methotrexate, 11 immune responses, [12][13][14] and paraneoplastic syndrome-like mechanisms without central nervous system invasion. [15][16][17] We reviewed non-Hodgkin's lymphomas coexisting with Guillain-Barré (-like) syndrome in the past 10 years (Table 3). Most cases developed GBS after chemotherapy and the administration of rituximab, and were responsive to treatment with intravenous immunoglobulin.…”

Clinical Reasoning: A 47-year-old woman with left shoulder pain after a fall

“…3 A later study described 10 cases with nervous system involvement out of 7,000 autopsies on patients with lymphoma. 4,5 Most lymphomatous invasions are difficult to diagnose. In a study over a 16-year period, only 30% of patients were identified within the first 8 years of symptoms.…”

“…Non-Hodgkin lymphoma (NHL) is classified as B-cell or T-cell type, with B-cell types being more common. 4 NHL uncommonly causes peripheral and CNS complications. NHL can infiltrate cranial nerves, roots, plexi, and peripheral nerves from a regional focus or hematogenously.…”