Primary spinal epidural lymphomas

Cugati, Goutham; Singh, Manish Kumar; Pande, Anil; Ramamurthi, Ravi; Balasubramanyam, Mahalakshmi; Sethi, Sumer Kumar; Singh, Ajai

doi:10.4103/0974-8237.85307

Cited by 50 publications

(53 citation statements)

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“…MRI appearance was isointense on T1-weighted images and iso-to hyperintense on T2-weighted images, with marked contrast enhancement; occasionally, MRI demonstrates an extraforaminal component. 5 The proper management of patients with primary epidural NHL is not yet certain, 2 and several studies suggest that patients with features of spinal cord compression require to be treated with surgery for the purpose of both tissue diagnosis and decompression. 3 Generally, acute paresis and/or loss of bladder/bowel control require emergency decompression of the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

“…3 Radiation therapy doses of at least 25 Gy and chemotherapeutic agents such as cyclophosphamide, vincristine, and prednisone have been recommended. 5 The prognosis for functional recovery in patients with spinal cord compression due to epidural NHL is relatively better than that of patients with metastatic carcinoma. 2 It is reported in many series that nonambulant patients with spinal cord compression have only a 10 to 30% chance of becoming ambulant after therapy; however, earlier diagnosis and treatment are associated with improved functional outcome.…”

Section: Discussionmentioning

confidence: 99%

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2017

J Neurol Surg Rep

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IntroductionPrimary spinal cord tumors are one of the rarest categories of tumors, representing approximately 4 to 16% of all tumors arising from the central nervous system (CNS). 1 An epidural location for lymphoma is observed in 0.1 to 6.5% of the cases.We describe the diagnostic and management of a 45-yearold man who presented an anterior spinal syndrome secondary to an epidural lesion, which had a histological confirmation of a diffuse large B-cell lymphoma (DLBCL). Case PresentationA 45-year-old man presented with a new onset of highintensity thoracic pain limiting his movements; a month later he was accompanied by decrease in the strength of the left pelvic limb. After 2 months, he started with weakness of both lower limbs and impaired urinary sphincter control.The neurologic examination demonstrated a minor motor impairment of lower limbs and reflexes were hyperactive. He presented a sensory level of hypoesthesia and loss of thermalgesia at T5. Anal sphincter tone was without damage, negative Hoffman, Trömner and Babinski's sign.Magnetic resonance images showed a paravertebral mass hypointense on T1 and T2 with homogeneous enhancement, which produced medullar compression at T3 (►Figs. 1 and 2).The patient was taken into surgery, where we performed a neural decompression by posterior way and biopsy of the extradural spinal lesion. Intraoperatively, we found a fibrotic, gray-colored, vascularized lesion on the right side above the T3-T4 level (►Fig. 3). Keywords► spinal epidural lymphoma ► epidural ► spinal compression AbstractBackground Primary spinal epidural lymphoma (PSEL) is one of the rarest categories of tumors. Spinal cord compression is an uncommon primary manifestation and requires to be treated with surgery for the purpose of diagnosis and decompression. Case Presentation A 45-year-old man presented with a new onset thoracic pain and progress to an anterior spinal syndrome with hypoesthesia and loss of thermalgesia. Magnetic resonance image showed a paravertebral mass that produces medullary compression at T3. The patient was taken up to surgery, where the pathology examination showed a diffuse large B-cell lymphoma. Conclusions PSEL is a pathological entity, which must be considered on a middle-aged man who began with radicular compression, and the treatment of choice is decompression and biopsy. The specific management has not been established yet, but the literature suggests chemotherapy and radiotherapy; however, the outcome is unclear.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Untitled

2017

J Neurol Surg Rep

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“…Limfomi u 0,1 -6,5 % slučajeva imaju epiduralnu lokalizaciju 24 . Zastupljeniji je Hodgkinov limfom.…”

Section: Limfomiunclassified

“…Primarni epiduralni limfom još je rjeđi, a označa-va epiduralnu lokalizaciju kao jedinu prisutnu u trenutku postavljanja dijagnoze. Najčešće sijelo limfoma je u torakalnoj kralježnici, a potom u lumbalnoj te najrjeđe u cervikalnoj, a mogući je razlog bogati venski pleksus torakalne kralježnice 24 . Ipak, u slučaju sumnje na limfom treba učiniti pregled MR-om čitave kralježnice i mozga 24 .…”

Section: Limfomiunclassified

“…Ipak, u slučaju sumnje na limfom treba učiniti pregled MR-om čitave kralježnice i mozga 24 . Limfomi se najčešće prezentiraju homogenim izointenzivnim signalom na T1 mjerenim slikama, izointenzivnim do hiperintenzivnim na T2 mjerenim slikama i to intenzivnijeg signala od masti, a postkontrastno se na T1 mjerenim slikama bogato imbibiraju 24 (slika 14).…”

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Magnetic resonance imaging of the spinal epidural space

2017

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Sažetak. Spinalni epiduralni prostor smješten je između dure mater i vertebralne kolumne i proteže se od foramen magnuma do nivoa S2/S3 spinalnog kanala. Podijeljen je u prednji i stražnji odjeljak. Zbog izvrsnog razlučivanja mekih tkiva, magnetska rezonancija metoda je izbora za otkrivanje i karakterizaciju patoloških promjena spinalnog epiduralnog prostora koje su etiološki različitog podrijetla. Mnoge lezije proizlaze iz samog epiduralnog prostora ili se šire iz okolnih struktura, a ovaj je prostor često sijelo metastatskih depozita. Zbog mogućnosti širenja patoloških procesa prema korijenima spinalnih živaca ili leđnoj moždini, lezije epiduralnog prostora mogu se prezentirati simptomima radikulopatije ili mijelopatije.Ključne riječi: epiduralni prostor; oslikavanje magnetskom rezonancijom; spinalni kanal Abstract. The spinal epidural space is located between the spinal dura mater and the vertebral column and extends from the foramen magnum to the sacral canal at the level of S2/S3. It is divided into anterior and posterior compartment. Due to its excellent soft tissue contrast magnetic resonance imaging is the gold standard for imaging and diagnosis of pathological processes of the spinal epidural space which differ in etiology. Many processes origin in the spinal epidural space or extend from adjacent structures and epidural space is a frequent location for metastatic processes. Due to the possibility of spreadingof the pathological processes along spinal nerves and the spinal cord, they may present with symptoms of radiculopathy or myelopathy.

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Primary spinal epidural non‐Hodgkin's diffuse large B‐cell lymphoma: A case report

Pokhrel

Prasad

Paudel

et al. 2020

Clinical Case Reports

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A 24-year-old man presented with radiating back pain and progressive neurological deficit. MRI revealed a spinal epidural tumor at thoracolumbar junction. He underwent decompression and excisional biopsy. Histopathology and immunohistochemistry identified it as diffuse large B-cell lymphoma. He received chemotherapy and is asymptomatic at 1-year follow-up. Primary spinal epidural lymphomas (PSELs) comprise a group of tumors, which are present only in the spinal epidural space, with a histopathological picture of lymphoma and negative diagnostic workup for lymphoma at other sites. 1 The epidural location of lymphomas, both Hodgkin's and non-Hodgkin's, is infrequent and challenging to diagnose. About 24%-48% of non-Hodgkin's lymphomas (NHLs) were found to have an extranodal origin. 2,3 However, PSEL accounts for only 0.9% of all extranodal NHLs. 4 There are many cell types of NHLs. Primary spinal epidural DLBCL is the most common form which accounts for only 1.8% all diffuse large B-cell lymphomas. 5 It is easily missed and maybe misdiagnosed leading to a lack of timely intervention and unhindered tumor progression. This report describes the clinical features, imaging characteristics, and histopathological features of the rare case of primary spinal epidural diffuse large B-cell lymphoma (DLBCL). To the best of our knowledge, this is the first reported case of primary spinal epidural DLBCL from Nepal. It also emphasizes the importance of a multidisciplinary approach for the successful treatment of this disease. 2 | CASE REPORT A 24-year-old man presented with a 3-month history of low back pain associated with the burning sensation of bilateral lower limbs. For the last 12 days, he was unable to walk due to gradually progressive weakness in bilateral lower limbs. These symptoms were not accompanied by fever, headache, and night sweats. He could not recall any history of trauma in the past. His past medical and surgical history was not significant. On examination, there was a localized tenderness over the thoracolumbar region. Lower limb motor power varied across muscle groups: hip flexors (2/5 bilaterally), knee extensors (2/5 bilaterally), ankle dorsiflexors (2/5 bilaterally), long toe

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Primary spinal epidural lymphomas

Cited by 50 publications

References 53 publications

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Magnetic resonance imaging of the spinal epidural space

Primary spinal epidural non‐Hodgkin's diffuse large B‐cell lymphoma: A case report

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