Primary Spinal Epidural Non-Hodgkin Lymphoma Demonstrated by FDG PET/CT

Abstract

We report the F-18 fluorodeoxyglucose positron emission tomography/computed tomography appearance of a biopsy-proven primary epidural non-Hodgkin lymphoma involving the lower cervical and upper thoracic spine with a small hypermetabolic right middle lobe nodule in a 33-year-old man. The HIV-positive patient presented with mid- to low back pain for several days, which progressed to lower extremity weakness and urinary retention. Primary spinal epidural non-Hodgkin lymphoma is a rare form of malignancy, constituting approximately 0.1% to 3.3% of all lymphomas. In our case, the primary tumor appears as an intensely hypermetabolic soft-tissue mass involving the posterior epidural space from C6 through T9 levels.

Primary bone non-hodgkin lymphoma of the cervical spine. case report and review.

“…The last MRI, performed 36 months after surgery, did not show local recurrence ( Figure 1H,I). PBL is slightly more frequent in male, with a median age at diagnosis ranging from mid-40s to mid-60s with an incidence peak at 50 years, although the age range is wide (1,9,12,14,25). There has been an increase in the incidence of this disease, due to the increasing number of immunosuppressed patients and the ageing of the population (5).…”

“…When the spine bones are involved back pain is the most common symptom. Neurological findings may include decreased sensory levels, hyperreflexia, paraparesis or paraplegia and bowel or bladder dysfunction (2,9,23). Spinal cord compression has been reported to appear as the first manifestation, but usually back pain tends to precede the onset of myelopathy by a variable period of time (1,18,20).…”

“…Other findings such as cortical disruption, pathological fractures or soft tissue masses, can also be present but are difficult to detect with this technique (7,9,12,14,16,23,25). Differential diagnosis should be made at this point with metastatic disease of the affected bone (5,11).…”

“…Short TI Inversion Recovery (STIR) can also detect the abnormality in the bone marrow. MRI is also particularly useful in evaluating the soft tissue extension and for the assessment of spine involvement (9,10,12,14,18,19,25).…”

Complete recovery from paraplegia following total spondylectomy for a primary diffuse B-cell lymphoma of the lumbar spine

“…[7] Positron emission tomography can be of important adjunct in detecting multiple or silent lesions, with the tumor appearing as areas of intense hypermetabolic activity. [8] In the present case, plain radiograph and emergency MRI were of little help for diagnostic orientation as tumor features were unspecific. Our attitude was consequently more hampered by the emergency than by the tumor nature or radiological features.…”