Hodgkin Lymphoma revealed by epidural spinal cord compression

Ghedira, Khalil; Matar, Nidhal; Bouali, Sofiene; Zehani, Alia; Boubaker, Adnen; Jemel, Hafedh

doi:10.1080/10790268.2018.1427519

Cited by 7 publications

(12 citation statements)

References 8 publications

(14 reference statements)

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“…Prolonged back pain or discovery of radicular or nerve damage should be immediately investigated for malignant cord compression with tumor extension into the nerve roots [ 3 , 9 ]. As in our reported case, pre-existing neurological abnormalities may initially cover these complaints and lead to diagnostic exclusion of malignancy, particularly in the absence of significant lymphadenopathy and general health decay [ 12 ]. Nonspecific symptomatology led to initial misdiagnoses of pyelonephritis, Guillain-Barrè syndrome and, in another case, Pott’s disease [ 4 , 13 ].…”

Section: Discussionmentioning

confidence: 97%

Spinal cord compression as tumor onset: an unusual case report of Hodgkin lymphoma in a teenager

et al. 2021

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Background Spinal cord compression (SCC) is an uncommon, severe complication of Hodgkin lymphoma (HL), occurring in 0.2% of cases at the onset and in 6% during disease progression. We present a teenager with SCC with clinical onset of HL; her pre-existing neurological abnormalities covered the presence of an epidural mass, which could have misled us. Case presentation A 13-year-old girl presented with a three-month history of lower back pain and degrading ability to walk. She suffered from a chronic gait disorder due to her preterm birth. A magnetic resonance imaging of the spine revealed an epidural mass causing collapse of twelfth thoracic vertebra and thus compression and displacement of the spinal cord. Histological examination with immunohistochemical analysis of the epidural mass demonstrated a classic-type Hodgkin lymphoma. Early pathology-specific treatment allowed to avoid urgent surgery, achieve survival and restore of neurological function. Conclusions Children and adolescents with back pain and neurological abnormalities should be prioritized to avoid diagnostic delay resulting in potential loss of neurological function. SCC requires a prompt radiological assessment and an expert multidisciplinary management.

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Section: Discussionmentioning

confidence: 97%

Spinal cord compression as tumor onset: an unusual case report of Hodgkin lymphoma in a teenager

et al. 2021

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“… 10 Epidural lesions in HL may arise from hematogenous dissemination but are more likely to develop as a result of local invasion from retroperitoneal or thoracic lymph nodes. 10 The thoracic spine appears to be the most commonly implicated site, followed by the lumbar spine. 10 Of note, back pain is not an uncommon complaint in the pediatric population, with a prevalence of ∼10% at age 10y and ∼30% at 13y of age.…”

Section: Discussionmentioning

confidence: 99%

“… 10 The thoracic spine appears to be the most commonly implicated site, followed by the lumbar spine. 10 Of note, back pain is not an uncommon complaint in the pediatric population, with a prevalence of ∼10% at age 10y and ∼30% at 13y of age. 14 That notwithstanding, chronic back pain has a relatively high yield for serious pathology including mechanical, infectious, inflammatory and neoplastic etiologies.…”

Section: Discussionmentioning

confidence: 99%

“… 11 , 12 It is the main presenting feature in only ∼0.2% of cases. 10 Epidural lesions in HL may arise from hematogenous dissemination but are more likely to develop as a result of local invasion from retroperitoneal or thoracic lymph nodes. 10 The thoracic spine appears to be the most commonly implicated site, followed by the lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, extra-nodal HL only very rarely presents with spinal cord compression (SCC), described in only a few rare case reports. [10][11][12] Hence, it may not be in the list of potential differential diagnoses and management of such patients may be suboptimal as a result. Here, we describe the case of a pediatric, adolescent patient presenting with SCC and discuss the challenges for HL diagnosis and initial management.…”

Section: Introductionmentioning

confidence: 99%

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Hodgkin Lymphoma Presenting With Spinal Cord Compression: Challenges for Diagnosis and Initial Management

et al. 2021

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Hodgkin lymphoma (HL) can present with extra-nodal disease, but spinal cord compression is exceptionally rare. We describe a 15-year-old presenting with hip/back pain with normal initial examination. Persistent pain and raised inflammatory markers prompted further investigation with MRI, which revealed an epidural mass causing spinal cord compression. On examination, there was no palpable lymphadenopathy or cauda equina syndrome, but absent lower limb reflexes were noted. Following multidisciplinary discussion, it was determined that cauda equina syndrome was imminent and therefore surgical debulking was undertaken, both to prevent this complication and establish a diagnosis. At surgery, the tumor was highly vascular. Frozen section confirmed lesional material. Following surgery, and given the frozen section findings, a short course of steroids was commenced to reduce any peri-surgical edema. Unfortunately, histopathology was ultimately non-diagnostic, due to failure of immunohistochemistry on technically challenging material. Consequently, ultrasound-guided excision biopsy of a (non-palpable) cervical lymph node was performed five days later; histopathology showed typical effacement of the normal architecture and a conspicuous population of CD15/CD30-positive larger pale cells present, confirming nodular sclerosis classic HL, despite recent steroids. We review the available literature for HL presenting with spinal cord compression and describe the challenges for diagnosis and initial management in such cases.

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Unusual case of spinal cord compression revealed a double primary Hodgkin’s lymphoma of the spinal cord

Filali,

Ansari,

El Haddad

et al. 2024

BMJ Case Rep

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Hodgkin’s lymphoma revealed by a medullary compression with a double primary vertebral localisation is extremely rare. We report the case of a boy in middle childhood who was presented with slow progression of medullary compression syndrome over 9 months, ultimately leading to paraplegia with loss of sphincter tone. The spinal MRI showed two tumour processes at T9 and L1 with epidural extension. An anatomical-pathological examination of the biopsy of the tumour mass, along with immunohistochemical analysis, confirmed the diagnosis of a lymphocyte-rich classic Hodgkin’s lymphoma, stage IV according to the Ann Arbor classification. The therapeutic strategy was based on chemotherapy. This study aims to report a unique clinical presentation of Hodgkin’s lymphoma in a paediatric patient and underscores the diagnostic challenges encountered in such an uncommon scenario.

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Hodgkin Lymphoma revealed by epidural spinal cord compression

Abstract: Though chemotherapy is the gold standard treatment for Hodgkin Lymphoma, surgical spinal decompression may be required in epidural involvement of the disease. Diagnosis may be suspected in the presence of lymphadenopathy and general health decay.

Cited by 7 publications

References 8 publications

Spinal cord compression as tumor onset: an unusual case report of Hodgkin lymphoma in a teenager

Spinal cord compression as tumor onset: an unusual case report of Hodgkin lymphoma in a teenager

Hodgkin Lymphoma Presenting With Spinal Cord Compression: Challenges for Diagnosis and Initial Management

Unusual case of spinal cord compression revealed a double primary Hodgkin’s lymphoma of the spinal cord

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