Spinal Cord Injury Caused by Epidural B-Cell Lymphoma: Report of Two Cases

Abstract

Background/Objective: Spinal cord injury (SCI) caused by cancer is increasing in incidence as the mean age of our patient population increases. Understanding the prognosis and functional outcome requires knowledge of diseases of the spinal column. This paper presents the unusual presentation of epidural B-cell lymphoma.Methods: Case reports.Results: Two patients presented with an unusual cause of SCI, namely B-cell lymphoma. Both patients presented with sensory deficits greater than motor deficits and gait disorder. Both achieved functional independence at the community ambulation level and tumor remission with chemotherapy and radiation therapy.Conclusions: B-cell epidural tumors are an uncommon cause of SCI. Functional outcome can be quite good, as can tumor outcome. Residual sensory deficits greater than motor deficits are not uncommon. INTRODUCTIONWith safety initiatives to prevent catastrophic neurologic injuries and with our aging society, the absolute and relative incidence of nontraumatic spinal cord injury (SCI) is on the rise. In the older population, unique causes of SCI directly related to age are seen, such as cervical stenosis from degenerative and rheumatologic causes, ischemia caused by abdominal aortic aneurysms, and cancer. Tumor-related SCI represents 25% of nontraumatic SCIs and 8% of all SCI cases (1). In all cancer cases, understanding the tumor type for correct identification allows for treatment planning and prognosis setting. This is critical in understanding the role of rehabilitation and setting reasonable functional goals for the individual patient. Neurologic status, overall health, extent of disease (spinal and extraspinal), and primary pathology influence proper treatment selection (2). A 1-year survival after rehabilitation for patients with metastatic spine

Primary dural lymphoma: A novel concept of heterogeneous disease

“…Our literature review investigated ‘dural’, ‘epidural’ and ‘meningeal’ lymphomas, and identified many PDL cases, including 166 well‐documented cases . Particularly, PDLs diagnosed prior to the Revised European American Lymphoma (REAL) classification (1994), and where more recent reclassification was not possible, were not included.…”

“…Most cases of dural lymphoma consist of secondary dural involvement in the context of systemic or other organs' primary lymphomas, and well‐documented cases of primary dural lymphoma (PDL) are less common. Primary dural lymphomas are distinct from primary lymphomas of the central nervous system (CNS) that encompasses brain, spinal cord and subarachnoid space .…”

Primary Spinal Epidural Lymphoma: Case Report

“…Ekstranodal lenfomanın epidural mesafeyi etkilemesi son derece nadir görülen bir olaydır, SENHL tüm lenfomaların yaklaşık % 4'ünü oluşturur. 6 NHL vakalarında spinal kanal yerleşimi %0,1-6,5 oranında görülür. En sık epidural alanda yerleşim gösterir.…”

“…SENHL'ların sonradan epidural boşluğa yayılan paraspinal lenf nodlarından, vertebral göv-deden veya hastalığın hematojen yayılımı ile buradaki lenfoid dokuyu infiltre etmesi sonucu kaynaklandığı düşünülmektedir. 6 Son dönemdeki immunohistokimyasal ve elektron mikroskop ça-lışmaları SENHL'ların tümünün çoğunlukla B lenfositlerden kaynaklandığını göstermiştir. Diğer tipler daha nadirdir.…”

“…Araştırmalar epidural NHL'nin prognozunun diğer epidural kitlelerden daha iyi olduğunu gös-termektedir. 6 Sonuç olarakNHL'nin epidural yerleşimi son derece nadirdir. Spinal kord veya kauda equina basısına neden olabilir.…”