Lymphoma-related resolving paraneoplastic myelopathy with MRI correlation

Abstract

We present here a case of paraneoplastic myelopathy with significant cord abnormality documented on MRI. Following treatment of the patient's underlying haematological malignancy, there was marked improvement both symptomatically and on follow-up MR imaging. This has rarely been described in the literature in relation to lymphoma or with imaging correlation.

Acute inflammatory myelopathies

“…Subsequently, cases of otherwise unexplained necrotizing myelopathy were associated with a wide variety of malignancies, including prostate cancer (Nonne, 1903;Whiteley et al, 1979;Gray et al, 1980), lung cancer (Nonne, 1919;D'Antona, 1926;L'hermitte and Bussière de Robert, 1941;Mancall and Rosales, 1964;Ojeda, 1984;Glantz et al, 1994;Lins et al, 2003), leg sarcoma (Feindel, 1921), squamous cell skin cancer (Moersch and Kernohan, 1934), stomach cancer (Juba, 1938), thyroid cancer (Jaffe and Freeman, 1943;Kuroda et al, 1993), non-Hodgkin's lymphoma (Williams et al, 1962;Richter and Moore, 1968;Nishida and Ziegler, 1973;Whiteley et al, 1979;Gray et al, 1980;Grignani et al, 1992;Drach et al, 1996;Anderson and Borsaru, 2008), breast cancer (Mancall and Rosales, 1964;Sieben et al, 1981;Ojeda, 1984;Mueller et al, 2008), ovarian cancer (Case records of the Massachusetts General Hospital, 1976), leukemia (Reznik, 1979;Grisold et al, 1980;Gieron et al, 1987), Hodgkin's lymphoma (Lester et al, 1979;Dansey et al, 1988;Hughes et al, 1992), renal cell carcinoma (Handforth et al, 1983;Wilson et al, 1983), hepatocellular carcinoma (Misumi et al, 1988), multiple myeloma …”

“…That the underlying pathology is immune-mediated comes from the observation that treatment with immune suppression may stabilize and even improve the neurologic deficit (Dansey et al, 1988;Grignani et al, 1992;Hughes et al, 1992;Glantz et al, 1994;Drach et al, 1996;Anderson and Borsaru, 2008;Mueller et al, 2008). Furthermore, in some cases intrathecal synthesis of gammaglobulins, a common laboratory abnormality found in MS and other paraneoplastic syndromes, was present (Dansey et al, 1988;Hughes et al, 1992;Kuroda et al, 1993;Anderson and Borsaru, 2008).…”

“…Furthermore, in some cases intrathecal synthesis of gammaglobulins, a common laboratory abnormality found in MS and other paraneoplastic syndromes, was present (Dansey et al, 1988;Hughes et al, 1992;Kuroda et al, 1993;Anderson and Borsaru, 2008). Activated T-helper cells were found in one case (Kuroda et al, 1993) and antioligodendroglial antibodies were identified in another (Lins et al, 2003), although the antigenic target was not identified.…”

“…The cervical spine MRI showed extensive T2 signal abnormality in the upper cervical cord. Additional cases in which spinal cord MRI was performed typically showed spinal cord swelling with multisegmental T2-hyperintensity and corresponding patchy contrast enhancement (Glantz et al, 1994;Drach et al, 1996;Anderson and Borsaru, 2008;Mueller et al, 2008;Urai et al, 2009). These MRI changes are similar to the longitudinally extensive lesions characteristically observed during AM in NMO (Wingerchuk et al, 1999).…”

“…In the last 20 years there have been several cases reports suggesting stabilization or improvement in neurologic function following immune suppression and treatment of the underlying malignancy (Dansey et al, 1988;Grignani et al, 1992;Hughes et al, 1992;Glantz et al, 1994;Drach et al, 1996;Anderson and Borsaru, 2008;Mueller et al, 2008;Urai et al, 2009). Furthermore, spinal cord MRI signal changes may improve or resolve with immune suppression (Glantz et al, 1994;Drach et al, 1996;Anderson and Borsaru, 2008;Mueller et al, 2008). Nevertheless, relentless neurologic decline occurs in some patients despite treatment (Storey and McKelvie, 1991;Kuroda et al, 1993;Glantz et al, 1994).…”