High-grade B-cell NHL of the brachial plexus followed by infiltration of the spinal cord

Abstract

Sirs: Primary lymphoma of the central nervous system (CNS) account for about 1–3 % of all primary brain tumors. Involvement of the peripheral nervous system by lymphoma is a rarity, typically secondary, either by direct extension of the neoplasm from an adjacent, involved site or in the context of systemic dissemination. Only a few cases have been reported with the tumor confined to the peripheral nervous system [4]. Most of these cases, however, still have shown concomitant central nervous system involvement with either positive cerebrospinal fluid analysis or leptomeningeal involvement, suggesting that peripheral disease results from secondary spread of tumor cells [4]. We report the case of a 48-yearold woman who presented with progressive numbness and weakness of her right arm. A magnetic resonance imaging (MRI) scan showed a contrast enhancing lesion infiltrating the lower part of the brachial plexus and extending to the entry zone of the C8 spinal root (Fig. 1). An open biopsy of the spinal ganglion C8 revealed unspecific lymphocytic infiltration. Cytological examination of CSF was not diagnostic. A following MRI scan showed a regression of the contrast-enhancing lesion of the right brachial plexus, but also an infiltration of the cervical spinal cord. Four months later a further MRI scan revealed a contrast enhancing lesion of the cervical spinal cord at the C6/C7 level. An open biopsy of this lesion revealed a high grade Non Hodgkin’s B-cell lymphoma (Fig. 2). The patient underwent a combination of systemic and intrathecal chemotherapy following the “Bonn Protocoll” consisting of methotrexate, cytarabine, ifosfamide, cyclophosphamide and steroids [3]. After four cycles of chemotherapy complete tumor response was confirmed. One year later, however, she developed paralysis of the oculomotor and trigeminal nerves. MRI scan revealed a contrast enhancing lesion in the cavernous sinus but no residual tumor in the spinal cord or brachial plexus. The patient LETTER TO THE EDITORS