Primary sciatic nerve lymphoma: a case report and review of the literature

Abstract

A patient with primary B cell non-Hodgkin's lymphoma of the sciatic nerve is described. He presented with neuropathic symptoms in the left leg, initially diagnosed as tarsal tunnel syndrome. Magnetic resonance imaging (MRI) identified the abnormality in the sciatic nerve. A fascicular biopsy of the sciatic nerve showed a diffuse large B cell non-Hodgkin's lymphoma. The patient was treated with chemotherapy and rituximab (anti-CD20 monoclonal antibody). Four months later he was in remission, and remains so 48 months from presentation. Primary lymphoma of single peripheral nerves may be a unique subtype of extranodal lymphoma, which usually follows an aggressive course and has a variable response to current therapeutic strategies. MRI is useful, alongside electrophysiological studies, in patients with atypical peripheral nerve symptoms.

Intraoperative high-resolution ultrasound and contrast-enhanced ultrasound of peripheral nerve tumors and tumorlike lesions

“…Similar to a description by Descamps et al, 8 MRI of this patient revealed a contrast-enhancing edematous lesion of the sciatic nerve that resembled a perineurioma or amyloidoma. Intraoperative findings and iHRU revealed a unique pathology, well distinguishable from that of all other tumor entities.…”

“…Other extremely rare nerve tumors or tumorlike lesions, such as perineurioma, amyloidoma, lymphoma, 4,7,8,18 and multifocal acquired demyelinating sensory and motor neuropathy (MADSAM), are even harder to distinguish preoperatively.…”

Medial Elbow Mass in an 18-year-old Woman

“…Lymphoma can present as a mononeuropathy [7,8] with no other apparent disease [20]. On MRI the nerve often appears mildly enlarged with an irregular to nodular appearance, mild to moderate hyperintensity on T2-weighted sequences, and mild enhancement of the entire nerve [20].…”

“…On MRI the nerve often appears mildly enlarged with an irregular to nodular appearance, mild to moderate hyperintensity on T2-weighted sequences, and mild enhancement of the entire nerve [20]. The diagnosis was excluded when hematoxylin and eosin-stained biopsy sections did not show the large, pleomorphic, and mitotically active lymphoid cells seen with lymphoma [7,8].…”

MRI and pet-CT in the diagnosis and follow-up of a lymphoma case with multifocal peripheral nerve involvement

“…Our case was an NK/T-cell subtype of lymphoma. The response of these lymphomas to treatment is variable (10). Various treatment approaches have been applied, including chemotherapy, radiotherapy, and surgery, alone and in various combinations (11).…”