Case report: magnetic resonance imaging of primary lymphoma of the cauda equina

Primary cauda equina lymphoma confirmed by autopsy: A case report

Compared with those involving the central nervous system, lymphomas involving the peripheral nervous system, namely neurolymphomatosis, are extremely rare. Neurolymphomatosis is classified as primary or secondary; the former is much rarer than the latter. Herein, we present an autopsied case of primary cauda equina lymphoma (PCEL), a type of primary neurolymphomatosis, with a literature review of autopsied cases of PCEL as well as primary neurolymphomatosis other than PCEL (non-PCEL primary neurolymphomatosis). A 70-year-old woman presented with difficulty walking, followed by paraplegia and then bladder and bowel disturbance. On magnetic resonance imaging, the cauda equina was diffusely enlarged and enhanced with gadolinium. The brainstem and cerebellum were also enhanced with gadolinium along their surface. The differential diagnosis of the patient included meningeal tumors (other than lymphomas), lymphomas, or sarcoidosis. The biopsy of the cauda equina was planned for a definite diagnosis, but because the patient deteriorated so rapidly, it was not performed. Eventually, she was affected by cranial nerve palsies. With the definite diagnosis being undetermined, the patient died approximately 1.5 years after the onset of disesase. At autopsy, the cauda equina was replaced by a bulky mass composed of atypical B-lymphoid cells, consistent with diffuse large B-cell lymphoma (DLBCL). The spinal cord was heavily infiltrated, as were the spinal/cranial nerves and subarachnoid space. There was metastasis in the left adrenal. The patient was finally diagnosed postmortem as PCEL with a DLBCL phenotype. To date, there have been a limited number of autopsied cases of PCEL and non-PCEL primary neurolymphomatosis (nine cases in all, including ours). The diagnosis is, without exception, B-cell lymphoma including DLBCL, and the histology features central nervous system parenchymal infiltration, nerve root involvement, and subarachnoid dissemination (lymphomatous meningitis). Metastases are not uncommon. All clinicians and pathologists should be aware of lymphomas primarily involving the peripheral nervous system.

Primary Cauda Equina Lymphoma Treated with CNS-Centric Approach: A Case Report and Literature Review

Primary cauda equina lymphoma is an extremely rare entity previously documented in only 24 reported cases. Primary cauda equina lymphoma represents a subtype of neurolymphomatosis, which occurs when lymphoma cells with neurotropism infiltrate and destroy peripheral nerves, spinal nerve roots, nerve plexuses and cranial nerves. The cauda equina is an anatomic structure located in the lower part of the spinal canal consisting of multiple lumbar and sacral nerve roots. Herein, we report a unique case of primary cauda equina diffuse large B-cell lymphoma presenting as a tumor mass in the lower spinal canal, which was treated with a CNS-centric treatment approach followed by autologous hematopoietic stem cell transplantation.

MR Imaging Characteristics of Primary T-Cell Lymphoma of the Cauda Equina: A Case Report and Literature Review

Primary central nervous system lymphoma is a rare form of extranodal non-Hodgkin lymphoma, and primary T-cell lymphoma of the cauda equina is extremely rare. We describe a case involving a 56-year-old female who presented with low back pain and radiating leg pain for 4 months. MRI of the lumbar spine revealed an elongated, multinodular intradural lesion of approximately 10 cm from the L4 body to the S2 body level with iso-signal intensity on T1-weighted imaging, heterogeneous iso- and high-signal intensity on T2-weighted imaging, and a heterogeneous intense enhancement on gadolinium contrast-enhanced T1-weighted imaging. A peripheral T-cell lymphoma of the cauda equina was diagnosed on the basis of immunohistochemical and T-cell receptor gamma gene rearrangement analysis after intradural biopsy of the mass.

Primary Cauda Equina T-Cell Lymphoblastic Lymphoma

BACKGROUND

T-cell lymphoblastic lymphoma (T-LBL) is a rare and aggressive form of non-Hodgkin lymphoma. This report describes, to our knowledge, the first adult case of a primary cauda equina T-LBL. Treatment consists of multiagent chemotherapy, and surgical removal of T-LBL does not improve outcome. We discuss the workup of patients with an intradural spinal mass, together with a review of the literature on primary spinal lymphoma of the cauda equina.

CASE DESCRIPTION

A 54-year-old woman with Crohn's disease, for which she was taking immunosuppressive medication, presented with progressive back pain radiating to both legs and deteriorating neurologic deficits caused by an intradural, contrast-enhancing lesion in the L1-5 region. During acute surgery, the tumor was partially resected. Immunohistochemical phenotyping revealed a T-LBL. No other lymphoma localizations were found after subsequent staging. Despite extensive treatment, the patient died of disseminated disease throughout the central nervous system, 6 weeks after the diagnosis.

CONCLUSIONS

Pain and progressive neurologic complaints can be symptoms of a (malignant) intradural spinal tumor. Intradural lymphoma must be considered as a differential diagnosis by clinicians because it can mimic neoplasms that often require urgent surgery. The histopathologic diagnosis should preferably be obtained by way of cerebrospinal fluid analysis or tumor biopsy because tumor resection has no beneficial effect on the oncologic outcome.

Primary cauda equina lymphoma diagnosed by nerve biopsy: A case report and literature review

Primary cauda equina lymphoma (CEL) is a rare malignant tumor among various neoplasms that affects the cauda equina nerve roots. The present case report described the case of a 65-year-old man who presented with cauda equina syndrome with progressive motor palsy in the legs and gait disturbance over the last 5 months. Magnetic resonance (MR) images showed enlargement of the cauda equina occupying the dural sac from the L1-S1 level with isointensity to the spinal cord signal on both T1- and T2-weighted imaging. Enhancement of the cauda equina was seen on contrast MR images. On F-18 2-fluoro-2-deoxy-glucose positron emission tomography examination, diffuse accumulation of 2-fluoro-2-deoxy-glucose was observed in the cauda equina with a maximum standardized uptake value of 4.9. Based on elevation of soluble interleukin 2 receptor in cerebrospinal fluid and a biopsy of the enlarging cauda equina, a diagnosis of CEL of the diffuse large B-cell type was made. The present case report provided a detailed case discussion and a review of the available literature on this rare entity, focusing on clinical characteristics and imaging of primary CEL.

Cauda equina syndrome secondary to neurolymphomatosis: Case report and literature review

Neurolymphomatosis is a rare disorder characterised by infiltration of neoplastic lymphocytes into the peripheral nervous system. A wide variety of symptoms can manifest depending on its nature and location, making its diagnosis a real challenge. Treatment is based on methotrexate, although various chemotherapy regimens are currently available for patients with systemic disease. We present the case of a male patient with neurolymphomatosis of the cauda equina, together with a review of all cases published to date.

Cauda equina lymphoma--a rare presentation of primary central nervous system lymphoma: case report and literature review

The spinal cord is an extremely rare site for primary central nervous system (CNS) lymphoma (< 1%). Very few cases of primary cauda equina (including conus) lymphoma were previously reported. We report such a case, and with literature review, discuss their clinical features, operative and histopathological findings. Although rare, with an increasing incidence of CNS lymphoma, they should be considered in the differential diagnosis of intradural lesions. Furthermore, with intraoperative smear to establish diagnosis, extensive surgery can be avoided. The controversial role of glucocorticoids in the management of these patients is also discussed.

Primary B-cell lymphoma of the cauda equina, successfully treated with high-dose methotrexate plus high-dose cytarabine: a case report with MRI findings

Primary malignant lymphoma of the cauda equina is an extremely rare disease. Previously, there have been only 12 reported cases of malignant lymphoma of the cauda equina, and most cases relapsed early in the clinical course. So, the optimal treatment strategy for this condition has not been established yet and the prognosis is thought to be poor. We experienced a case of B-cell malignant lymphoma of the cauda equina, with rapid progression of the muscle weakness of the bilateral lower extremities, successfully treated with high-dose methotrexate plus high-dose cytarabine (Ara-C) chemotherapy, followed by radiotherapy and in complete remission without any recurrence signs, 1.5 years after the initial diagnosis. Intrathecal chemotherapy with MTX, Ara-C, and predonisolone was simultaneously performed. We should carefully continue to monitor the clinical course of our case, with the examinations of magnetic resonance imaging and cerebrospinal fluid in order not to overlook any subtle neurological changes or other clinical symptoms.

Non-Hodgkin's lymphoma involving the cauda equina and ocular cranial nerves: case reports and literature review

Although rare, direct infiltration of the cauda equina by non-Hodgkin's lymphoma (NHL) must be considered as a potential cause of subacute onset paraplegia. We present two cases of lymphomatous involvement of the cauda equina presenting with subacute paraplegia, each associated with a palsy of an oculomotor nerve. We highlight the need to use gadolinium-enhanced magnetic resonance imaging (MRI) when investigating potential cauda equina lesions, since it is crucial in detecting and outlining the extent of disease. Differential diagnoses and treatment options for NHL involving the cauda equina are also discussed.

Primary NK/T-cell lymphoma of the cauda equina: a case report and literature review

STUDY DESIGN

A case report with a review of the literature.

OBJECTIVE

To describe an unusual case of primary lymphoma of the cauda equina and provide a review of the literature of this condition.

SUMMARY OF BACKGROUND DATA

Primary lymphoma of the cauda equina is extremely rare, and has been reported in 8 cases previously. This report is the first to describe a case of primary nasal type NK/T-cell lymphoma of the cauda equina.

METHODS

We report the case of a 67-year-old man presenting the symptoms of cauda equina syndrome caused by primary lymphoma of the cauda equina.

RESULTS

After laminectomy and removal of the tumor, the patient recovered from the symptoms of cauda equina syndrome except for bladder and bowel dysfunction. Further investigations including immunohistochemical stains made a diagnosis of primary nasal type NK/T-cell lymphoma of the cauda equina, and the patient received radiotherapy to the lumbosacral area. Brain metastasis was detected 8 months after surgery, and the patient died 14 months after his initial clinical presentation despite additional treatments including whole-brain radiotherapy and oral chemotherapy.

CONCLUSION

Although primary lymphoma of the cauda equina is extremely rare, the prognosis of this condition is thought to be poor. Early definitive diagnosis with examination of the cerebrospinal fluid followed by combined treatment with radiotherapy and high-dose methotrexate should be considered.

Malignant lymphoma originating in the cauda equina mimicking the inflammatory polyradiculoneuropathy

A 67-year-old woman was diagnosed with inflammatory polyradiculoneuropathy. The intravenously administered immunoglobulin (IVIG) treatment that she received several times over a 3-year period relieved her clinical symptoms of muscle weakness and sensory disturbances, but these symptoms had worsened thereafter despite further IVIG treatment. MRI detected a solid tumor involving the cauda equina and pathological examinations confirmed this to be malignant lymphoma. The clinical and radiological findings for the malignant lymphoma of the cauda equina in this patient were quite similar to those for the inflammatory polyradiculoneuropathy.

Disseminated enteropathy-type T-cell lymphoma: cauda equina syndrome complicating coeliac disease

A patient with coeliac disease developed a progressive cauda equina syndrome in the 2 months prior to his death, for which no cause could be identified. At post-mortem examination this proved to be due to disseminated enteropathy-type T-cell lymphoma. Although rare, disseminated enteropathy-type T-cell lymphoma should enter the differential diagnosis in any patient with coeliac disease developing new neurological signs.

Palliation and survival in metastatic tumors compressing the cauda equina: a 19-year radiotherapeutic experience

PURPOSE; Radiotherapy (RT) offers a means of promoting an acceptable quality of life in people with incurable cancer. We reviewed our radiotherapeutic experience of metastatic tumors compressing the cauda equina (MTCCE) because large case series and achieved palliation in these patients are infrequently documented in the literature.

METHODS

Seventy-six individuals undergoing RT for MTCCE were identified from a 19-year period (1981-1999). Treatment responses and survival were assessed.

RESULTS

Pain relief was complete in 94%, partial in 3%, and not achieved in 3% of the 32 evaluated patients. Complete resolution of impaired sensation in the lower limbs occurred in three cases, and of anal or bladder sphincter dysfunction in three persons also. Among the 28 evaluable individuals with lower extremity motion impairment, 11 (39%) were nonambulatory and 17 (61%) were ambulatory following treatment. The overall median survival was 3 months; the survival rate at 1 year was 18% and at 3 years 8%.

CONCLUSION

Although long-term survival is not to be expected, the usefulness of RT for palliation of MTCCE may be trusted.

Cauda equina compression by malignant lymphoma: long-term survival following multimodality therapy

Malignant lymphoma compression of the cauda equina is rare. In the literature only a few cases have been described with occasional long term survivors. We report another case of non-Hodgkin's lymphoma presenting with cauda equina compression. Significant palliation and long-term survival were achieved after therapy by decompressive, cytoreductive surgery; local irradiation; and chemotherapy.

Lymphoma at uncommon sites

Lymphoma can often present in unusual situations. This article provides a comprehensive review of the literature in which both non-Hodgkin's lymphoma and Hodgkin's disease are discussed.