Isolated Neurolymphomatosis of the Cauda Equina and Filum Terminale

Abstract

Case report. We report the case of a previously healthy 16-year-old boy who presented with back pain and decreased mobility. Magnetic resonance imaging (MRI) revealed an extensive intradural lesion in the region of the thoracolumbar junction. Neurolymphomatosis is a rare but well-described entity in which malignant lymphocytes, more commonly of B-cell lineage, infiltrate the peripheral nervous system. Isolated involvement of spinal nerve roots and subsequent clinical presentation directly due to this is unusual, and there have been few such published cases. Retrospective case study with follow-up examination at 6-months and 1-year. The patient was transferred directly to the operating theater from MRI for urgent decompressive laminectomy. Diagnosis of neurolymphomatosis of the cauda equina and filum terminale by diffuse large B-cell lymphoma was confirmed by histopathology. The patient received adjuvant chemotherapy and radiotherapy. At 6- and 12-month follow-up, the patient's back pain had resolved and lower limb function was improving slowly. MRI revealed no evidence of residual or recurrent disease. This case highlights the importance of prompt diagnosis through high-resolution imaging, as well as the role of emergent neural decompression once a diagnosis of spinal cord compression has been established (regardless of the ultimate cause). It exposes some of the diagnostic pitfalls associated with the imaging of unusual spinal lesions, and it underlines the importance of obtaining an urgent and accurate tissue diagnosis to allow for the instigation of appropriate medical therapy.