Primary Malignant Lymphoma in a Spinal Cord Presenting as an Epidural Mass with Myelopathy: A Case Report

Abstract

We report the case of a 47-year-old man who presented with progressive paraparesis and sphincter changes over 2 weeks. Magnetic resonance imaging revealed a spinal epidural mass from T9 to L2. We performed a decompressive laminectomy and mass removal. The histopathology was consistent with a small lymphocytic lymphoma. No metastatic lesion was noted in the chest and abdomen-pelvic computerized tomography (CT) and positron emission tomography computerized tomography (PET-CT) scan. The final diagnosis was primary spinal lymphoma, so we performed chemotherapy combined with radiotherapy. At one year follow-up, he had no neurological deficit and no recurrence on neurologic and radiologic exams. Primary spinal cord lymphomas should be considered in the differential diagnosis of spinal cord tumors. Early surgical management is mandatory to achieve a recovery of neurologic function, especially if the patient has a neurological deficit.

A Rare Case of Malignant Lymphoma Occurred at Spinal Epidural Space: A Case Report

“…However, follicular lymphoma which occurs at extranodal sites as a primary lesion is uncommon 4 5 8) . It is reported to be 0.8-2.8% which forms epidural tumor primarily among malignant lymphomas 6) . Only one patient has been presented with a primary spinal epidural follicular lymphoma 2) .…”

“…Patients with primary epidural non-Hodgkin's lymphoma who presented paraplegia of recent onset and underwent decompressive laminectomy showed significant neurological improvement. Meanwhile, surgery alone is reported not to be effective at patients' median overall survival 6) . The researchers thus suggest that the combination therapy of surgical and non-surgical treatment such as radiotherapy and/or chemotherapy should be done 6) .…”

“…Meanwhile, surgery alone is reported not to be effective at patients' median overall survival 6) . The researchers thus suggest that the combination therapy of surgical and non-surgical treatment such as radiotherapy and/or chemotherapy should be done 6) . Here, we have performed an L5-S2 decompressive laminectomy with subtotal lesion excision with significant neurological improvement.…”

Diffuse Large B-Cell Lymphoma Mimicking Schwannoma of Lumbar Spine

“…Therefore, in a case in which the tumor is readily accessible through a posterior approach, the neurosurgeon should choose laminectomy, with a dural incision and gross total resection as the treatment of choice. Many authors have reported high success rates (85%-97.2%) for gross total resection of spinal intradural extramedullary tumors 3 4 6) . One study reported that 80% of the lesions showed well-demarcated dissection plane and no adhesion to the spinal cord, with gross total resection being easily achieved, which was similar to the reported gross total resection rate of 70%-90% for intramedullary tumors 13) .…”

Primary Malignant Lymphoma Presenting as an Isolated Epidural Mass

“…The term lymphoma is used when the process is confined to a mass lesion with minimal or no evidence of peripheral blood and bone marrow involvement [ 1 , 2 , 3 ]. Isolated primary malignant lymphoma is a rare form of extranodal lymphoma, and severe compression of the spinal cord as the initial manifestation of primary malignant lymphoma of the spine is much rarer, with an incidence of less than 5% [ 4 , 5 , 6 ]. It is known to occur mainly in the thoracic region.…”