Primary NK/T-Cell Lymphoma of the Cauda Equina

Abstract

Although primary lymphoma of the cauda equina is extremely rare, the prognosis of this condition is thought to be poor. Early definitive diagnosis with examination of the cerebrospinal fluid followed by combined treatment with radiotherapy and high-dose methotrexate should be considered.

Primary B-cell lymphoma of the cauda equina, successfully treated with high-dose methotrexate plus high-dose cytarabine: a case report with MRI findings

“…Most previous cases were reported to have relapsed and died in the early phase, within several months after the initial diagnosis. Their therapeutic options were not as intensive as our case [1][2][3][4][5][6][7][8][9][10]. So, we performed combination chemotherapy with high-dose Ara-C, in addition to high-dose MTX, followed by radiotherapy to remain the patient in CR without any signs of recurrence.…”

“…Examination of the spinal MRI with intravenous Gd has been shown to be helpful in detecting the extent of the disease lesions of the spinal cord and the thickened cauda equina and nerve roots are clearly demonstrated after the Gd enhancement [1][2][3][4][5][6][7][8][9]. The differential diagnosis of primary intradural tumors at the level of the cauda equina consist first of tumors, such as metastases, neurofibromas, ependymomas, and schwannomas, secondly of infections, including tuberculosis, toxoplasmosis, cryptococcal granulomatas, inflammatory polyradiculoneuropathy, vasculitis, and arachnoiditis, Lastly, Guillain-Barre syndrome, sarcoidosis, and so on [1][2][3][4][5][6][7][8]. In our case, the detection of the thickened cauda equina with markedly increased Gd enhancement on the spinal MRI examination was the main finding, highly for suspicious of the diagnosis of malignant tumors and especially, the patient's 10-day history of rapidly progressive clinical symptoms absolutely required us of the early definitive diagnosis to start the therapy and reverse the patient's muscle weakness as soon as possible, so the examination of the CSF was quickly performed, which demonstrated the appearance of CD20 positive atypical large lymphoma cells, as described above (Fig.…”

“…Furthermore, the rate of primary cauda equina lymphoma was extremely rare and most cases relapse early in the clinical course. So, its optimal treatment strategy has not been established yet and the prognosis is thought to be poor [1][2][3][4][5][6][7][8][9][10].…”

A 78‐Year‐Old Male with a Right Occipital Lesion

“…The "extra-nasal" NKTCL cases do not differ histologically from their nasal counterparts but exhibit a more aggressive clinical behavior (1,4). Although secondary involvement of the central nervous system has been described (6), primary NKTCLs in the CNS are very rare and a handful of previous cases have been reported in detail (2,3,5,7,9). Primary NKTCLs of the CNS affect preferentially the cerebral hemispheres (2, 3, 5, 9) but a single case affecting the cauda equina has been reported (7).…”

Nasal Natural Killer/T-cell Lymphoma with Skin, Eye, and Peroneal Nerve Involvement

“…Nasal-type NKTL presents with transverse myelopathy and third cranial nerve palsy [8,9]. More recently, nasaltype NKTL of the cauda equina has been reported [10]. In the presented patient right-sided peroneal nerve involvement with drop foot was diagnosed on the basis of clinical, MRI, and electromyographic findings.…”