Neurolymphomatosis of the median nerve, optic nerve, L4 spinal nerve root and cauda equina in patients with B-cell malignancies: a case series

Abstract

Background Neurolymphomatosis is rare. Neoplastic lymphocytes are seen to invade nerves (cranial or peripheral), nerve roots or other related structures in patients with hematological malignancy. It is a separate entity from central nervous system lymphoma. Neurolymphomatosis has most commonly been described in association with B-cell non-Hodgkin lymphoma. Neurolymphomatosis in the context of Burkitt lymphoma and the post-renal transplant setting has not been described before. Case reports We report for the first time in the Arabian Gulf countries and nearby Arab states four cases of neurolymphomatosis (one Asian, and the other 3 are from Arabic nationals) occurring between 2012 and 2017 involving the median nerve, optic nerve, nerve root and cauda equina in patients with Burkitt lymphoma, Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia and diffuse large B-cell lymphoma. Conclusions Neurolymphomatosis is rare and can be difficult to diagnose by biopsy but reliably confirmed by a combined imaging approach. Prior treatment with high-dose dexamethasone might suppress 18F-fluorodeoxyglucose (FDG) activity and decrease the sensitivity of positron emission tomography/computed tomography (PET/CT). The prognosis is generally poor but using high-dose methotrexate as well as high-dose chemotherapy and autologous stem cell transplantation may be an effective way to treat neurolymphomatosis.

A rare case report of neurolymphomatosis with NK-T-cell lymphoma

“…7 The prognosis is usually poor but high-dose methotrexate as well as highdose chemotherapy and autologous stem cell transplant may be an effective way to treat NL. 7 There are few case reports demonstrating effectiveness of bendamustin in neurolymphomatosis. 6…”

The Surgical Histopathology of the Filum Terminale: Findings from a Large Series of Patients with Tethered Cord Syndrome

“…or inflammatory process. Malignant lymphoid proliferations have been rarely described within the region of the cauda equina [ 38 , 39 ], and in such cases, further hematological and oncological workup and MRI imaging of the neuroaxis may be warranted. Even though, in our case, no indication of a hematologic condition was found, we propose that the findings of inflammation and lymphocyte proliferation in the surgical specimen found in patients with TCS may warrant further workup as done in this patient.…”