T-cell neurolymphomatosis involving cauda equina and sciatic nerves

Abstract

A 60-year-old man with T-cell lymphoma post chemotherapy presented with progressive left greater than right lower extremity weakness and allodynia. Fluorodeoxyglucose-PET was consistent with neoplastic infiltration of multiple lumbosacral roots and sciatic nerves (figure). Spinal fluid cytology showed malignant T-cells, supporting the diagnosis of neurolymphomatosis. Resolution of the imaging abnormalities and clinical improvement occurred following high dose intrathecal methotrexate.Neurolymphomatosis is an especially rare complication of T-cell malignancies. 1 If spinal fluid cytology cannot make the diagnosis, as in this case, radiographic directed proximal nerve and root biopsy may be helpful.

Neurolymphomatosis: an International Primary CNS Lymphoma Collaborative Group report

“…The information collected from the literature contains inadequate information on clinical management as some of the case reports addressed only the unusual neuroimaging findings. 8,11,[14][15][16][17][18][19][20][21] In the current series, the majority of patients (70%) were managed by systemic chemotherapy. The most effective regimen is unknown, and the selection is often based on protocols used to treat CNS involvement by malignant lymphoma.…”

Cauda equina syndrome secondary to intravascular lymphoma

“…Alternatively, PET scan may identify subclinical involvement. 8 In our patient, the sural nerve action potential was normal, arguing against its potential value in diagnosis. Elevations of LDH, CSF protein, and the presence of a monoclonal protein may support a diagnosis of IVL.…”

Neurolymphomatosis of the lumbosacral plexus and its branches: case series and literature review

“…In Table 1, we have summarized 23 case reports where isolated lumbosacral plexus NL occurred de novo or as the index manifestation of recurrent lymphoma. As expected, B-cell histopathology was reported in 21 cases (92.3%), and T-cell lymphoma was noted in only 2 cases [19, 28]. The median age at presentation was 62 years, compared to 70 years in a large UK epidemiological survey for diffuse large B-cell lymphoma [32].…”