Neurolymphomatosis: A surreal presentation of lymphoma

Abstract

Background:Neurolymphomatosis is a neurologic complication poorly recognized by neurologists and oncologists and presents usually several months after successful treatment of systemic lymphoma. Other disorders that must be differentiated from these entities include peripheral-nerve or nerve root compression and paraneoplastic neuropathy.Aim:To describe the unusual occurrence of neurolymphomatosis in a patient of B-cell lymphoma.Method:Diagnosis was made by demonstration of enhancement of nerve roots on Magnetic Resonance Imaging of the brachial, lumbosacral plexus, peripheral nerves or by increased hyper-metabolic activity along the course of affected nerves on fluorodeoxyglucose positron emission tomography (FDG-PET).Results and Conclusion:MRI and PET-CT are imaging modalities of choice for evaluation of patients with lymphoma and suspected neural involvement. Treatment of neurolymphomatosis consists of focal radiotherapy and high-dose methotrexate therapy.

Primary Central Nervous System Lymphoma with Peripheral Nerve Involvement: Case Report

“…NL is diagnosed by the demonstration of enhancement of nerve roots on MRI of the brachial, lumbosacral plexus, peripheral nerves, or by increased hypermetabolic activity along the course of affected nerves on FDG-PET [2]. Treatment of NL consists of focal radiotherapy and chemotherapy [2]. In our case, NL developed and worsened during chemotherapy with high-dose MTX.…”

“…The lymphomatous infiltration of a nerve root (the cranial or peripheral nerve or multiple nerves) is known as NL or neurolymphomatosis [2]. It is a rare neurologic complication of lymphoma that is poorly recognized by clinicians [2].…”

“…Bourque et al reported a case of NL in the brachial plexus [6]. Khandelwal et al presented a case of NL in the left C4 and C5-C8, and L4-L5 and S1-S2 [2]. Broen et al [1], Sasaki et al [3], and Marquardt et al [7] reported cases of NL in the cauda equina or lumbosacral root/plexus.…”

“…Gd-enhanced MRI and FDG-PET are the imaging modalities of choice for evaluation of patients with lymphoma and suspected neural involvement [2]. NL is diagnosed by the demonstration of enhancement of nerve roots on MRI of the brachial, lumbosacral plexus, peripheral nerves, or by increased hypermetabolic activity along the course of affected nerves on FDG-PET [2]. Treatment of NL consists of focal radiotherapy and chemotherapy [2].…”

“…Only 1% of primary CNS NHL emerges in the spinal cord. A syndrome of lymphoma and leukemic infiltration of the cranial or peripheral nerves is called neurolymphomatosis (NL) [2-3]. It is a rare clinical entity, with an incidence of 0.2% in all NHL patients [3].…”