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Abstract

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.