Spinal epidural lipomatosis in children with hematologic malignancies

Abstract

Summary Background Abnormal fat deposition in the epidural space or spinal epidural lipomatosis (SEL) due to corticosteroid treatment or obesity may cause obstruction to cerebrospinal fluid flow. Little is known about SEL in patients with hematologic malignancies who require frequent lumbar punctures and corticosteroid treatment that places them at risk. Patients and methods Records and radiologic images of patients with SEL and leukemia or non Hodgkin lymphoma (NHL) treated at a single institution from 1999–2009 were reviewed. Risk factors were compared with 405 control patients with leukemia. Results Fourteen patients with leukemia or NHL were diagnosed with SEL. The majority of patients underwent diagnostic imaging after unsuccessful lumbar punctures within one month of their primary diagnosis. Prior to SEL diagnosis, all patients received systemic and/or intrathecal corticosteroids. SEL diagnosis led to modification of intrathecal administration in 8 patients, including Ommaya reservoir placement in 4 patients. All patients completed protocol-specified chemotherapy without neurologic symptoms or surgical intervention. Risk factors for developing SEL include older age and high body mass index. Conclusions Investigation for SEL in leukemia or lymphoma patients with difficult lumbar punctures is warranted. Placement of an Ommaya reservoir may facilitate safe CNS-directed therapy in severely affected patients.

An unusual case of spinal cord compression from concomitant spinal epidural lipomatosis and Hodgkin's lymphoma

“…Our patient had not previously taken corticosteroid medications, as a diagnosis of lymphoma had not been made prior to surgery. SEL has been described in patients with non-Hodgkin's lymphoma [ 4 , 5 ] and other haematological malignancies [ 4 , 6 – 9 ] who had been taking exogenous corticosteroids, patients on long-term steroid treatment, as well as carcinoid-induced SEL caused by ACTH secreting tumours with Cushing's syndrome [ 2 ]. To our knowledge, this is the second case reported of SEL in a patient with Hodgkin's lymphoma; with one previous case in a patient with only inguinal lymph node involvement [ 7 ].…”