Ann Clin Neurophysiol.  2020 Apr;22(1):37-40. 10.14253/acn.2020.22.1.37.

Neurolymphomatosis in patients withmantle cell lymphoma diagnosed byFDG PET-CT

• Kim S
• An H
• Choi YS
• Park KH
• Sohn EH

• KMID: 2500303
• DOI: http://doi.org/10.14253/acn.2020.22.1.37

Abstract

Neurolymphomatosis (NL) is characterized by the infiltration of malignant lymphoma cells into peripheral nerves, nerve roots, plexuses, or cranial nerves. This is a very rare complication of mantle-cell lymphoma. Diagnosing NL is made difficult by cerebrospinal fluid cytology and bone-marrow biopsy results often being negative. NL can appear as the only sign of recurrence in a patient with a previous diagnosis of lymphoma. Here we present two cases of NL in patients with mantle-cell lymphoma diagnosed by positron emission tomography with deoxy-fluoro-D-glucose integrated with computed tomography.

Keyword

FDG PET-CT; Lymphoma; Neurolymphomatosis

Figure

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  Fig. 1. Brain magnetic resonance imaging (MRI) (A-D), spine MRI (E-G), and positron emission tomography with deoxy-fluoro-D-glucose integrated with computed tomography (FDG PET-CT) for diagnosing mantle-cell lymphoma (H) and neurolymphomatosis (I). There were no abnormal signal intensities in diffusion weighted image (A) and T2-weighted (B) images. Diffuse thickening and bilateral enhancement (arrowheads) of the trigeminal nerve were observed in T1-weighted gadolinium-enhanced images (C, D). Diffuse leptomeningeal enhancement (arrowheads) was observed on a T1-weighted gadolinium-enhanced image (F) compared to a nonenhanced T1-weighted image (E). Multiple spinal nerve enhancements (arrows) were observed in a T1-weighted gadolinium-enhanced image (G). Multiple regions exhibiting FDG uptake were observed in the lymph nodes and bone marrow in initial FDG PET-CT (H). Complete remission of the previous lesion with new linear area (blue arrow) of high uptake in the lower spinal cord and cauda equine were observed in subsequent FDG PET-CT (I).

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  Fig. 2. Spine magnetic resonance imaging (A-E) and positron emission tomography with deoxy-fluoro-D-glucose integrated with computed tomography for diagnosing mantle-cell lymphoma (F) and neurolymphomatosis (G). Enlargement of the spinal nerves was observed in T2-weighted (A) and T1-weighted (B) image. Diffuse leptomeningeal enhancement (arrowheads) was observed in T1-weighted gadolinium-enhanced images (C, E). Multiple spinal nerve roots were enhanced (arrows) after gadolinium injection (E) compared to a T2-weighted axial image (D). Multiple lymph nodes showed hypermetabolism in initial FDG PET-CT (F). Thoracolumbar spinal cord hypermetabolism (blue arrow) with improvement of the previous lesion was evident in subsequent FDG PET-CT (G).

Reference

1. Davidson T, Kedmi M, Avigdor A, Komisar O, Chikman B, Lidar M, et al. FDG PET-CT evaluation in neurolymphomatosis: imaging characteristics and clinical outcomes. Leuk Lymphoma. 2018; 59:348–356.

2. Pham M, Awad M. Lymphoma relapse presenting as neurolymphomatosis. Asian J Neurosurg. 2016; 11:73.

3. DeVries AH, Howe BM, Spinner RJ, Broski SM. B-cell peripheral neurolymphomatosis: MRI and (18)F-FDG PET/CT imaging characteristics. Skeletal Radiol. 2019; 48:1043–1050.

4. Vargas TC, Thomas RL, Erickson JC. Leptomeningeal enhancement in a patient with progressive cranial neuropathies and lumbosacral radiculopathies. JAMA Neurol. 2016; 73:345–346.

5. Lin M, Kilanowska J, Taper J, Chu J. Neurolymphomatosis–diagnosis and assessment of treatment response by FDG PET-CT. Hematol Oncol. 2008; 26:43–45.

6. Ferrer A, Bosch F, Villamor N, Rozman M, Graus F, Gutiérrez G, et al. Central nervous system involvement in mantle cell lymphoma. Ann Oncol. 2008; 19:135–141.

7. Faivre G, Lagarde J, Choquet S, Maillart E, Lubetzki C. CNS involvement at diagnosis in mantle cell lymphoma with atypical MRI features. J Neurol. 2014; 261:1018–1020.

8. Baehring JM, Damek D, Martin EC, Betensky RA, Hochberg FH. Neurolymphomatosis. Neuro Oncol. 2003; 5:104–115.

9. Gan HK, Azad A, Cher L, Mitchell PL. Neurolymphomatosis: diagnosis, management, and outcomes in patients treated with rituximab. Neuro Oncol. 2010; 12:212–215.

10. Grisariu S, Avni B, Batchelor TT, van den Bent MJ, Bokstein F, Schiff D, et al. Neurolymphomatosis: an International Primary CNS Lymphoma Collaborative Group report. Blood. 2010; 115:5005–5011.