Primary spinal epidural manifestation of malignant lymphoma

Abstract

The clinical, histological and immunomorphological data in 19 cases of primary spinal epidural manifestation of malignant lymphomas collected between 1974 and 1994 are reported. The age of the patients varied between 11 and 87 years with a mean age of 56.3 years. There was a slight male predominance (11:8). In most cases, the onset of the clinical symptoms was rapid. The preferential tumour localization was the epidural space related to the thoracal vertebral bone. In each case, decompressive laminectomy was performed. The tumours were histologically and immunomorphologically classified as B-cell lymphomas (14 of 19), T-cell lymphomas (3 of 19) and anaplastic plasmacytoma (1 of 19). Except for one case, post-operative staging did not reveal anything other than epidural manifestation of the malignant lymphoma. The vertebral bone, however, was involved in seven cases. Irradiation alone, or in combination with chemotherapy, was performed as additional therapy. The post-operative survival time was variable.

Primary spinal epidural lymphomas

“…A male preponderance of 69%, which was similar to other studies, was observed. Patients clinically present most commonly in the fifth to seventh decade of life[15–18] with more than 80% being older than 40 years. [114–1619] Pediatric patients with PSEL, however, have also been reported.…”

“…This has been attributed to both the greater length of the thoracic spine (compared with the cervical and lumbar) and to an enhanced ability to accommodate bulky disease in the thorax and abdomen. [1131416–1825] The rich venous plexus in the thoracic spine may be the reason for frequent occurrence of lymphomas in this site. [21]…”

“…Of significant note, they found no significant survival implications based on histopathological classification. [18] Few other authors have found high-grade lymphomas occurring less frequently than the intermediate or low-grade lymphomas. [132946]…”

“…[1518] Radiation doses used by various authors varied widely, with ranges between 20 and 60 Gy,[1219] and doses of at least 25 Gy are recommended. [2851] Monnard et al , by their multivariate analysis, have advocated that a dose of at least 36 Gy at 2 Gy per fraction or its equivalent should be considered.…”

Primary Spinal Epidural B-Lymphoblastic Lymphoma

“…Schwechheimer et al found an increased incidence of B-cell high-grade lymphomas in 11 of 19 cases, centroblastic lymphomas being the predominant type. Of signifi cant note, no signifi cant survival implications were based on histopathological classifi cation ( 14 ).…”