The Significance of Spinal Cord Compression as the Initial Manifestation of Lymphoma

Abstract

Eighteen patients with spinal cord compression caused by previously undiagnosed lymphoma were treated at our institution between 1976 and 1991. There were 14 male and 4 female patients (mean age, 58.2 years). The absence of bony involvement on radiographic images was a feature in 16 of the cases. All patients underwent laminectomy for decompression and tissue diagnosis, after which 5 underwent radiotherapy, 3 underwent chemotherapy, and 10 underwent combined-modality treatment. The functional outcome was improvement in 8 patients and no change in 10; no patient worsened after surgery. Eleven had advanced disease at diagnosis, while seven had limited disease, including three patients with localized extradural lymphoma. There were 16 cases of non-Hodgkin's lymphoma and 2 of Hodgkin's disease. Two patients had T-cell lymphoma and were among the longest survivors. DNA flow cytometry identified the low-grade tumors as diploid with very low proliferative indices, while the high-grade tumors all had high indices. At a mean observation time of 41.7 months, five patients have died of their disease, and seven remain in complete remission. Survival is markedly better than that reported for other malignant extradural tumors; however, even limited stage lymphoma can behave aggressively. Similarities in age, sex distribution, histological features, and the results of flow cytometry suggest behavior similar to extranodal lymphoma at other sites. Surgery to provide a tissue diagnosis, followed by combined radiotherapy and chemotherapy, is indicated for all cases.

Epidural malignant lymphomas of the spine: collected experiences with epidural malignant lymphomas of the spinal canal and their treatment

“…3,17 Presentation in the cervical segments is rare because cancer appearing in the paracervical areas is usually discovered early. 2 Similar to data found in the literature, among our patients there were one cervical, eight thoracic and four lumbar lymphoma cases. Magnetic resonance is now indispensable in the diagnosis of the malignant diseases of the spine.…”

“…Surgical intervention is recommended for epidural ML when myelocompression is found. 2,11 The analysis of our current retrospective study of the treatment of epidural ML found data comparable to that in the international literature.…”

“…Non-Hodgkin's lymphoma (NHL) is about three times as common as Hodgkin's lymphoma (HL). [1][2][3][4][5] The presentation of ML can be divided into two groups: (1) the primary extranodal, and (2) the advanced, disseminated forms of the disease. Advanced stage is more commonly encountered with epidural presentation and the primary extranodal form is more common in NHL.…”

Spinal Cord Injury Caused by Epidural B-Cell Lymphoma: Report of Two Cases

“…At a mean observation time of 41.7 months, 5 patients died of their disease, and 7 remained in complete remission. Survival was markedly better than that reported for other malignant extradural tumors (10).…”

Primary bone non-hodgkin lymphoma of the cervical spine. case report and review.

“…Neurological findings may include decreased sensory levels, hyperreflexia, paraparesis or paraplegia and bowel or bladder dysfunction (2,9,23). Spinal cord compression has been reported to appear as the first manifestation, but usually back pain tends to precede the onset of myelopathy by a variable period of time (1,18,20). Ramadan (21) reported an incidence of 50% of spinal cord compression in patients with PBL vertebral involvement.…”