Brain Tumor Res Treat.  2023 Jan;11(1):66-72. 10.14791/btrt.2022.0038.

A Rare Occurrence of Primarily Extranodal Spinal Epidural Lymphoma With Spinal Cord Compression and Invasion to the Thoracic Cavity

• Seok MC
• Madadi AK
• Mosleh MM
• Chang SH
• Sohn MJ

• KMID: 2539331
• DOI: http://doi.org/10.14791/btrt.2022.0038

Abstract

A 41-year-old man suffered from progressive radiculomyelopathy caused by spinal epidural mass primarily encasing the spinal cord at the cervicothoracic vertebrae that extended into the thoracic cavity through the neural foramen. An urgent decompressive laminectomy and epidural tumor resection were performed to prevent neurological deterioration and effective spinal cord decompression. The histopathologic diagnosis was diffuse large B-cell lymphoma. As first-line treatment for stage II extranodal lymphoma, he received 6 cycles of R-CHOP (rituximab/cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisone) chemotherapy. Consequently, follow-up positron-emission tomography CT and MR images demonstrated a complete metabolic response (Deauville score 1). This rare occurrence of primarily extranodal spinal epidural lymphoma with limited disease will be presented in a literature review.

Keyword

Lymphoma; Non-Hodgkin; Diffuse large cell lymphoma; Spinal cord compression; Epidural neoplasms

Figure

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  Fig. 1 Preoperative MRI findings. A-C: The fat suppression with gadolinium (Gd) enhancement showed that consecutive epidural mass extended into both intervertebral foramina from C3 to T7 vertebrae lesions (white arrows) on sagittal and coronal sections. D and E: The spinal cord was encased by diffuse homogenously enhancing mass lesions (white arrows) on axial T1-weighted imaging with Gd enhancement at T1 and T4 vertebra.

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  Fig. 2 PET CT scan on staging workup. A and B: PET-CT indicates that extranodal spinal epidural lymphoma extended into the unilateral mediastinal cavity through the left pleura spread (sagittal and coronal image, white arrows). C and D: The multiple lymph node invasion in the left supraclavicular (C, white arrows) and mediastinal lymph nodes along with ribs suggests metastasis (D, white arrows). PET, positron-emission tomography.

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  Fig. 3 Intraoperative photos of initial and surgical resection and histologic features. A and B: Upon exposing the spinal cord, avascular amorphous encasing mass was continuously compressed the spinal cord. C: Following adequate surgical decompression, the spinal cord was satisfactorily expanded from tumor decompression. D: On histologic findings, H&E staining (×200) demonstrates atypical round-shaped large cells in scanty cytoplasm with basophilic or vesicular nuclei that are compatible with diffuse large B-cell lymphoma.

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  Fig. 4 Immunohistochemistry findings and chemoport insertion. A and B: Immunohistochemistry findings reveal a high Ki-67 proliferative index of 40% (A) and a strong positive CD20 as a B-cell marker (B). C: Chemoport was inserted into the right subclavian vein for R-CHOP (rituximab/cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisone) chemotherapy.

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  Fig. 5 Radiographic imaging follow-up after 6 cycles of R-CHOP chemotherapy. A and B: Follow-up MR image of fat suppression Gd enhancement demonstrates complete radiographic and metabolic response (Deauville score 1) at 6 months. C and D: PET scan images also define initial extranodal spinal epidural lymphoma with left supraclavicular and mediastinal lymph node invasion that has completely disappeared. R-CHOP, rituximab/cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisone; Gd, gadolinium; PET, positron-emission tomography.

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