Autopsy Proven Peripheral Nervous System Neurolymphomatosis Despite Negative Bilateral Sural Nerve Biopsy

Ramirez‐Zamora, Adolfo; Morales-Vidal, Sarkis; Chawla, Jasvinder; Biller, José

doi:10.3389/fneur.2013.00197

Cited by 11 publications

(14 citation statements)

References 15 publications

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“…About 90% of cases of neurolymphomatosis are DLBCL (1). Similar to previous cases of neurolymphomatosis in the cauda equina (4), the present case also showed asymmetrical polyneuropathy without pain (Figure B-E). Gd-enhanced MRI and FDG-PET are useful for detecting small or insidious malignancies, but the diagnosis is still difficult in some cases (5).…”

Section: Discussionsupporting

confidence: 90%

Neurolymphomatosis in the Cauda Equina Diagnosed by an Open Biopsy

et al. 2018

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Neurolymphomatosis is a rare form of extranodal malignant lymphoma defined as the infiltration of malignant lymphocytes into the central or peripheral nerve. We herein report a case of neurolymphomatosis in the cauda equina diagnosed by an open surgical biopsy. He presented with muscle weakness, atrophy, numbness and hypoesthesia in the bilateral lower extremities with the accumulation of fluoro-2-deoxyglucose (FDG) in the bilateral cauda equina. Cerebrospinal fluid cytology (three times) and flow cytometry (two times) and biopsies of the left sural nerve, bone marrow, paranasal sinus and left testis were all negative for malignancy, so finally we performed a surgical open biopsy of the cauda equina by laminectomy and diagnosed him with diffuse large B-cell lymphoma in the cauda equina. He was successfully treated with the disappearance of the FDG accumulation for a long time. The present case suggested that an early open biopsy of the cauda equina may be considered for cases of suspected neurolymphomatosis in the cauda equina for a good outcome.

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Section: Discussionsupporting

confidence: 90%

Neurolymphomatosis in the Cauda Equina Diagnosed by an Open Biopsy

et al. 2018

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“…In one study where diagnostic uncertainty persisted, nerve biopsy (often guided by imaging findings) was performed with 88% sensitivity for neurolymphomatosis 9 . The imperfect sensitivity of nerve biopsy owes to the usually patchy distribution of malignant cells 39 . In some patients with hematological malignancies that are latent or in remission, nerve biopsy may be the only way to link the malignancy with the neuropathy 40 .…”

Section: Methodsmentioning

confidence: 99%

“… 9 The imperfect sensitivity of nerve biopsy owes to the usually patchy distribution of malignant cells. 39 In some patients with hematological malignancies that are latent or in remission, nerve biopsy may be the only way to link the malignancy with the neuropathy. 40 Polymerase chain reaction (PCR) of the lymphoid infiltrate in nerve biopsies can prove monoclonality and help to distinguish between malignant and inflammatory infiltrates.…”

Section: Methodsmentioning

confidence: 99%

Nerve biopsy: Current indications and decision tools

et al. 2021

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After initial investigation of patients presenting with symptoms suggestive of neuropathy, a clinical decision is made for a minority of patients to undergo further assessment with nerve biopsy. Many nerve biopsies do not demonstrate a definitive pathological diagnosis and there is considerable cost and morbidity associated with the procedure. This highlights the need for appropriate selection of patients, nerves and neuropathology techniques. Additionally, concomitant muscle and skin biopsies may improve the diagnostic yield in some cases. Several advances have been made in diagnostics in recent years, particularly in genomics. The indications for nerve biopsy have consequently changed over time. This review explores the current indications for nerve biopsies and some of the issues surrounding its use. Also included are comments on alternative diagnostic modalities that may help to supplant or reduce the use of nerve biopsy as a diagnostic test. These primarily include extraneural biopsy and neuroimaging techniques such as magnetic resonance neurography and nerve ultrasound. Finally, we propose an algorithm to assist in deciding when to perform nerve biopsies.

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“…However, it is invasive and false negative results occur due to sampling errors. Ramirez-Zamora [ 9 ] reported 1 case of NL with negative nerve biopsy that was later confirmed by autopsy. NL is easily misdiagnosed or missed due to its rarity and complex clinical manifestations.…”

Section: Discussionmentioning

confidence: 99%

Peripheral neurolymphomatosis with tracheal asphyxia: a case report and literature review

et al. 2015

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BackgroundNeurolymphomatosis (NL) is an extremely rare disease and tracheal asphyxia due to NL has not been previously reported.Case PresentationA 54-year-old Chinese woman with a history of diffuse large B-cell lymphoma in her first complete remission developed peripheral neuropathy and tracheal asphyxia. Neurolymphomatosis involving the right brachial plexus and the right vagus nerve was demonstrated by PET/CT, but not by MRI. She underwent urgent tracheotomy and impact chemotherapy using rituximab combined with high dose methotrexate and involved field radiotherapy. She achieved a second complete remission.ConclusionPET/CT plays valuable role in differentiating NL from other neuropathies in patients with lymphoma. Complete remission can be achieved in NL due to large B-cell lymphoma.

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Autopsy Proven Peripheral Nervous System Neurolymphomatosis Despite Negative Bilateral Sural Nerve Biopsy

Cited by 11 publications

References 15 publications

Neurolymphomatosis in the Cauda Equina Diagnosed by an Open Biopsy

Neurolymphomatosis in the Cauda Equina Diagnosed by an Open Biopsy

Nerve biopsy: Current indications and decision tools

Peripheral neurolymphomatosis with tracheal asphyxia: a case report and literature review

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