Spinal Lymphoma Research Articles

Clinical reasoning in feline spinal disease: which combination of clinical information is useful?

The aim of this study was to evaluate if a combination of discrete clinical characteristics can be used to identify the most likely differential diagnoses in cats with spinal disease. Two hundred and twenty-one cats referred for further evaluation of spinal disease were included and categorised as follows: non-lymphoid neoplasia (n = 44); intervertebral disc disease (n = 42); fracture/luxation (n = 34); ischaemic myelopathy (n = 22); feline infectious peritonitis virus myelitis (n = 18); lymphoma (n = 16); thoracic vertebral canal stenosis (n = 11); acute non-compressive nucleus pulposus extrusion (n = 11); traumatic spinal cord contusion (n = 8); spinal arachnoid diverticula (n = 7); lumbosacral stenosis (n = 5); and spinal empyema (n = 3). Information retrieved from the medical records included signalment, clinical history and clinical presentation. Univariate analyses of variables (clinical history, breed, age, sex, general physical examination findings, onset, progression, spinal hyperaesthesia, asymmetry, ambulatory status and neuroanatomical location) were performed, and variables were retained in a multivariate logistic regression model if P <0.05. Multivariate logistic regression revealed that intervertebral disc disease most often occurred in middle-aged, purebred cats with a normal general physical examination and an acute onset of painful and progressive clinical signs. Ischaemic myelopathy occurred most often in older cats with a stable or improving, non-painful, lateralising, C6-T2 myelopathy. Spinal fracture/luxation occurred most often in younger cats and resulted most often in a peracute onset, painful, non-ambulatory neurological status. Concurrent systemic abnormalities or abnormal findings detected on general physical examination were significantly associated with feline infectious peritonitis virus myelitis, spinal lymphoma or spinal empyema. This study suggests that using easily identifiable characteristics from the history and clinical examination can assist in obtaining a preliminary differential diagnosis when evaluating cats with spinal disease. This information could aid veterinary practitioners in clinical decision-making.

Prognostic Factors Associated With Bone Lymphoma Primarily Presenting in the Spine.

Retrospective analysis. To determine the prognostic indicators in patients with bone lymphoma of the spine. To date, prognosis for patients with spinal bone lymphoma is based on results from small series. Large population-based observational studies are lacking. The Surveillance, Epidemiology, and End Results Registry was used to identify all patients with bone lymphoma of the spine from 1995 through 2014. Overall survival (OS) and disease-specific survival (DSS) estimates were obtained using the Kaplan-Meier method and compared across groups using log-rank test. Association of survival with variables was assessed using Cox proportional-hazards regression analysis. Nomograms were established and validated by R software. A total of 1338 patients were identified with bone lymphoma of the spine. The trend of incidence was relative steady from 1995 to 2014. The mean and median age of diagnosis was 62.9 and 66.0 years, respectively. Men constituted a slightly greater proportion (55.5%) of the cohort. The most common subtype of lymphoma was diffuse large B-cell lymphoma (59.8%). The 5- and 10-year OS rates for those patients were 60.6% and 44.7%, respectively. Multivariate analysis revealed that age, sex, marital status, and race were sociodemographic predictors of OS and DSS. Extracompartmental invasion of tumor and stage IV of lymphoma were significantly correlated with poor OS and DSS. Patients without surgery or radiotherapy was linked to a poor OS. Both OS and DSS of patients with spinal bone lymphoma improved in 2005 to 2014 when compared to 1995 to 2004. In addition, pretreatment nomograms to predict 5- and 10-year survival were established. The findings of this study provide population-based estimates of the prognosis for patients with spinal bone lymphoma. Both sociodemographic and clinical factors may have an impact on the outcomes. 4.

Primary intraspinal non-Hodgkin’s lymphoma: Case report and review of literature

We present the unique case of an 67-year-old female patient with primary intraspinal B-cell non-Hodgkin’s lymphoma without cerebral manifestation mimicking myelitis in clinical presentation and neuroradiological diagnostic. It illustrates the broad spectrum of differential diagnoses for paraplegia and the importance of rapid interdisciplinary diagnostic work-up since the neurologic status after treatment mainly depends on the delay of treatment. Review of existing literature suggests combined radio- and chemotherapy as well as high-dose intravenous methotrexate or rituximab. The rising incidence of spinal lymphomas especially in patients with acquired immunodeficiency underlines the importance of fast diagnosis and initiation of treatment of this rare entity.

Lymphome primitif de la queue de cheval : à propos d’un cas et revue de la littérature

Primary spinal lymphoma of the cauda equine is a very rare lesion that usually occurs in the brain tissue. The disease is classified as primary if there was no evidence of systemic lymphoma by screening at the time of diagnosis. we report a case of a 75-year- old previously healthy man presented with leg weakness and urinary incontinence since 3 months. Neurological examination revealed a cauda equina syndrome. Spinal magnetic resonance imaging (MRI) revealed after intravenous contrast injection a homogenous enhancement (multiple lesions) in dura matter and in the filum terminalis. Brain, cervical and thoracic MRI did not reveal any mass. A biopsy of the lumbar dura was performed after a lumbar laminectomy and revealed a malignant lymphoma. Primary spinal lymphoma of the cauda equina is a rare lesion with no specific laboratory or radiologic findings: only the anatomopathologic exam confirmed the diagnosis. Prognosis is poor despite aggressive treatment with radiotherapy, chimiotherapy or combination of them.

Primary lumbar spinal epidural b-lymphoblastic lymphoma: A case report

Background: Primary spinal epidural non- Hodgkin’s lymphoma (PSENHL) is an uncommon disease. Most PSENHL are diffuse large B-cell lymphomas, and thoracic spine is the most common site of involvement. Primary spinal epidural B-Lymphoblastic Lymphoma (LBL) is particularly rare. So far only one case at thoracic segment was reported. Case presentation: A 16-year-old female presented with a history of pain in her lower back and lower extremities for 7 d, pain aggravated and weakness for 4 d, urinary incontinence for 2 d. Magnetic Resonance Imaging (MRI) scan revealed an extradural mass lesion at L3 to L5 level, which was at first suggestive of a neurogenic tumor. L4-L5 laminectomy was performed and tumor was totally resected. Histopathological examination after surgery revealed B-lymphoblastic lymphoma (LBL)/-Acute Lymphoblastic Leukemia (ALL). Postoperative blood counts, bone marrow biopsy and aspiration were negative. The final diagnosis of primary spinal epidural B-LBL was made. Patient was treated with vincristine, daunorubicin, cyclophosphamide, L-asparaginase and prednisone after surgery. After 2 months of follow up, all the symptoms were relieved. Conclusion: Primary spinal epidural non-Hodgkin’s lymphoma should be considered in the differential diagnosis of the patients who present with spinal cord or cauda equina compression. This is the first primary spinal epidural B-LBL at lumbar reported as we known.

Clinicopathologic characteristics and prognostic factors for primary spinal epidural lymphoma: report on 36 Chinese patients and review of the literature

BackgroundDue to the uncommon nature of primary spinal epidural lymphomas (PSELs), there has been little research looking at prognostic indicators for the tumor. To our knowledge, this is the largest study to evaluate possible clinical and pathologic prognostic factors in PSEL patients.MethodsWe retrospectively reviewed 130 cases of PSEL, including 36 Chinese patients and 94 published case reports from 1985 to 2015. Patient treatment regimens included surgery (S; n = 119), surgery followed by chemotherapy (S + CT; n = 25), surgery followed by radiotherapy (S + RT; n = 26), and surgery followed by chemotherapy and radiotherapy (S + CT + RT; n = 50).ResultsReview of the most recent case follow-up data (time varied) found 51 patients (47%) alive and tumor-free, 10 patients (9%) alive with tumor present, and 47 patients (44%) deceased. The 3-year overall survival (OS) and disease-free survival (DFS) rates were 81.1% and 46.3%, respectively. Favorable prognostic factors found by univariate analysis were female sex, B-cell lymphoma diagnosis, cervical spine location, and combined modality treatment. Furthermore, multivariate analysis revealed that thoracic spine location (HR = 4.629, 95% CI = [1.911, 31.667], P = 0.042 for OS) and the lack of combined modality treatment (HR = 12.697, 95% CI = [2.664, 48.612], P < 0.0001 for DFS) were associated with poor survival in PSEL patients.ConclusionsPSEL demonstrates specific clinical features and is associated with a relatively good prognosis. Thoracic spine location is a significant poor prognostic factor, and combined modality treatment is associated with improved disease-free survival, but not overall survival.

Primary Spinal Epidural B-Lymphoblastic Lymphoma

Extranodal lymphomas constitute 20% to 30% of all non-Hodgkin's lymphomas. The common sites involved are skin, stomach, brain, and small intestine. Epidural localization is a rare site for lymphomas, accounting for 10% of spinal epidural tumors. Lymphomas occurring primarily in the epidural space without other previously detected lymphomatous foci (i.e., primary spinal epidural lymphomas) represent an even rarer entity. We report a case of primary spinal epidural B-lymphoblastic lymphoma. The patient presented with paraparesis, and a spinal epidural lesion was diagnosed. Considering the rapidity of symptom onset, the possibility of epidural abscess was considered, and he underwent partial laminectomy with decompression of the lesion. Histopathology and immunohistochemistry were diagnostic of B-lymphoblastic lymphoma. The present case is the first report in the literature of B-lymphoblastic lymphoma presenting as a spinal epidural lesion.

Primary spinal intradural extramedullary lymphoma: A novel management strategy

Primary spinal intradural extramedullary lymphoma remains a very rare entity in spinal oncology. In this case report, we present the first treatment of a PSIEL diagnosed by cytopathologic analysis alone followed by urgent radio- and chemotherapy in the literature. At 18-month follow-up, our patient was ambulatory with near total imaging resolution of the lesion. In conclusion, surgical excision or biopsy may not be necessary when suspicion for PSIEL exists, and may delay prompt medical and radiation treatment due to necessity for wound healing. Further research into the management of extramedullary lymphoma treatment strategies is warranted.

Correction chirurgicale de la cyphose post-vertébroplastie par ostéotomie trans-pédiculaire. À propos de trois observations

We report a case of three patients treated with pedicle subtraction osteotomy for post-vertebroplasty kyphosis. These patients were initially treated with a vertebroplasty for vertebral fracture (two cases) and spinal lymphoma (1 case). All of these patients worsened progressively on a clinical and radiographic level with progression of the spinal deformity in the form of kyphosis. The surgery consisted of transpedicular osteotomy instrumented at the level of the vertebra cemented with maximum removal of intra-corporeal cement. One of the three patients required a supplementary anterior approach to achieve good quality bone fusion. In all three cases the post-vertebroplasty kyphosis was able to be reduced by at least 50 % emphasizing the feasibility and relevance of the pedicle subtraction osteotomy in a context of cemented vertebra.

MRI feature of the primary spinal lymphoma

MRI feature of the primary spinal lymphoma

MAGNETIC RESONANCE IMAGING FINDINGS IN THE SPINE OF SIX DOGS DIAGNOSED WITH LYMPHOMA.

Lymphoma is one of the most common neoplasms in the dog. Despite its prevalence and the increasing use of advanced diagnostic imaging in veterinary patients only few reports of magnetic resonance imaging (MRI) findings in spinal lymphoma have been published to date. The purpose of this retrospective case series study was to describe the MRI findings in dogs with confirmed lymphoma affecting the spine and/or paraspinal soft tissues. Medical records were searched for patients that had MRI of the spine and a diagnosis of lymphoma during the period of 2005-2015. Data recorded from retrieved MRI studies were presence of focal or multifocal disease, structures involved, and signal characteristics on T2-W, short tau inversion recovery (STIR), and T1-W sequences prior to and following intravenous contrast medium administration. Six dogs met the inclusion criteria. Common findings included multifocal disease (4/6), vertebral involvement (5/6), spinal cord compression (4/6), and involvement of more than one spinal compartment (medullary cavity, vertebral canal, paraspinal soft tissues) (6/6). Vertebral changes were confined to the medullary cavity without evidence of cortical osteolysis. There was questionable involvement of the spinal cord in one case. All spinal and paraspinal lesions identified were T2-W isointense to hyperintense, STIR hyperintense, T1-W hypointense to isointense, and showed variable moderate to strong contrast enhancement. Additional lesions identified were enlarged intraabdominal lymph nodes, hepatomegaly, splenomegaly, and a splenic nodule. The STIR and T1-W postcontrast sequences were subjectively the most useful in identification of the spinal and paraspinal lesions.

Spondylodiscite granulomateuse: surtout la tuberculose mais ne pas omettre le lymphome

Les douleurs lombaires relèvent d'étiologies multiples dont le diagnostic peut être source de grandes difficultés. Le lymphome rachidien primitif est rare et son diagnostic nécessite une biopsie souvent scanoguidée. Un homme de 30 ans, était hospitalisé pour lombalgies inflammatoires évoluant dans un contexte d'altération de l'état général avec à l'examen des douleurs à la palpation des apophyses épineux L2L3, sans syndrome tumoral périphérique. Le bilan biologique montrait un syndrome inflammatoire. Le bilan morphologique était en faveur d'une spondylodiscite. La première biopsie montrait une ostéite granulomateuse. L'aggravation clinique et radiologique sous anti bacillaire a mené à reconsidérer le diagnostic et la deuxième biopsie confirme le diagnostic du lymphome. Le diagnostic de tuberculose osseuse en particulier vertébrale nécessite une confirmation bactériologique et ou histologique pour ne pas méconnaître un lymphome osseux primitif.

Primary Vertebral Lymphoma: Two Cases and Literature Review

Introduction Spinal non-Hodgkin lymphomas (NHL) seldom affect spinal cord as first presentation, as there are mostly extradural initially. Usually presented in dorsal region, they are mostly high degree, aggressive, type B on diagnosis. We report two cases with spinal cord compression as first clinical manifestation. Patients and Methods The case reports of two cases of primary vertebral lymphoma from our service were presented. Results A 65 year-old-man had months-long back pain with sudden sphincter-sparing paraparesis; magnetic resonance imaging (MRI) showed prevertebral mass in T3 with vertebral body fracture and medullary compression. HIV testing was positive. Urgent decompressive surgery with tumor resection and stabilization yielded good recovery of motor function. A 69-year-old woman had 3 months of exercise-induced back pain and 10 days of paraplegia before coming to our service. MRI showed epidural invasion with medullary compression. Laminectomy and tumor resection were performed but without neurologic recovery. Burkitt lymphoma was diagnosed in both the cases. Conclusion We report two cases of aggressive NHL presenting as acute spinal cord compression requiring urgent surgical intervention. One of them on a background of undiagnosed HIV infection.

A Rare Case of Malignant Lymphoma Occurred at Spinal Epidural Space: A Case Report.

The sacral spinal epidural space is an uncommon site for primary malignant lymphomas, presenting with symptoms associated with cauda equina compression. Especially, lumbo-sacral epidural lymphoma has been reported to be very rare. We present a rare case of 29-year-old male with sacral spinal epidural malignant lymphoma. The patient complained of tingling sensation in his buttocks that was radiating to his calf. The neurological examination was normal. Magnetic resonance imaging (MRI) with contrast showed a well-defined extradural mass lesion at the mid L5 to mid S2 level. The lesion was iso- to hypointense on T1 and T2 weighted images and showed homogenous enhancement and a focal enhancement in the L5 vertebral body on post-contrast images. The patient underwent a L5-S2 laminectomy and subtotal excision of the lesion. Intra-operatively, the lesion was extradural and not densely adherent to the dura; the lesion was friable, not firm, fleshy, brownish and hypervascular. The histologic diagnosis was grade 2 non-Hodgkin's follicular lymphoma. Even though the primary spinal epidural non-Hodgkin's lymphoma is a very rare disease, clinicians should take it into consideration in the differential diagnosis of patients with spinal epidural tumor.

Primary Dural Spinal Lymphoma Presentation of a Rare Spinal Tumor Case.

Background. Primary spinal dural lymphomas (PSDL) are tumors with characteristic histopathology of a lymphoma, which are completely in the spinal epidural space without any other systemic involvement. Extranodal primary lymphoma involving nervous system prefers thalamus/basal ganglia, periventricular region, cerebellum, eyes, meninges/dura, and cranial nerves or spinal cord. Rare spinal localization with acute spinal cord compression is worth attention. Case Presentation. A 48-year-old male presented with a several-month-long history of upper back pain. Lately, he had numbness and weakness at both lower extremities and was unable to walk for one week. A spinal MRI showed a thoracic lesion with cord compression at T2–T4 levels. The patient underwent surgical decompression, with his final histopathology showing diffuse large B-cell lymphoma. Systemic work-up was negative for nodal disease. Following surgery, he received radiotherapy combined with chemotherapy. He experienced a good outcome after four years. Conclusion. The upper thoracic cord is a rare location for primary spinal lesions/metastases, both of which prefer the lower thoracic and upper lumbar regions. In cases of progressive paraparesis, there should be immediate surgical intervention in the case of denovo disease, followed by combined radiotherapy and chemotherapy procedures.

Spinal Burkitt's Lymphoma Mimicking Dumbbell Shape Neurogenic Tumor: A Case Report and Review of the Literature.

Non-Hodgkin's lymphoma (NHL), a disease which may involve the spine, is frequently associated with advanced disease. Radiculopathy caused by spinal root compression as the initial presentation in patients with NHL is very rare and thought to occur in less than 5% of cases. A 69-year-old woman complained of a history of low back pain with right sciatica for 1 month prior to admission. Computed tomography and magnetic resonance imaging of the lumbar spine showed a dumbbell-shape epidural mass lesion extending from L2 to L3, which was suggestive of a neurogenic tumor. After paraspinal approach and L2 lower half partial hemilaminectomy, total excision of the tumor was achieved, followed by rapid improvement of back pain and radiating pain. The lesion was confirmed to be Burkitt's lymphoma by histopathological examination. We then checked whole-body PET-CT, which showed multifocal malignant lesions in the intestine, liver, bone and left supraclavicular lymph node. Although a rare situation, Burkitt's lymphoma should be considered in the differential diagnosis for patients presenting with back and lumbar radicular pain without a prior history of malignancy. Burkitt's lymphoma could be the cause of dumbbell-shape spinal tumor.

Five year review of the pattern and outcome of managment of spinal diseases seen at St. Mary's Hospital Lacor in Uganda

Background: Spinal cord injury or lesion is a devastating event with social, psychological and physical ramifications that has dehumanizing experiences. The aim of this study was to describe the biographic, etiological factors and outcome of patients with spinal lesions cared for at St Mary’s hospital Lacor within a 5yrs period. Methods: Through a 5yrs review of data of paralyzed patients admitted and treated at St Mary’s hospital Lacor from Jan 2009 to Dec 2013, the following secondary data was extracted and analyzed using SPSS version 15: Age, sex, duration of hospitalization, type of paralysis, cause of the spinal lesion, vertebral lesion, outcome and recovery of neurological function. Results: Approximately 241 met the criteria analysis, the mean age for spinal lesion was 31 years, average duration of hospitalization was 61 days and the Male gender predominated (64.3%) compared to the females (35.7%), P-value 0.000. Paraplegia was the commonest form of neurological deficit (79.67%) followed by tetraplegia (13%), P-value 0.000. TB spine is the leading cause of spinal lesion (19%) followed by road traffic accidents (17%) and lymphoma (15.8%). In 16.6% of the patients, the etiology of the spinal cord lesion was not known. Spinal lymphoma lesion was common in pediatric age group compared to TB spine and traumatic spinal lesion (p-value 0.000). Out of the 241 cases studied, 73 (30.3%) recovered their limb function completely and were reintegrated into the community. However 39 (16.2%) died from the lesions and/or the associated complications. Conclusions and Recommendation: Spinal lesions are commonest in young male populations with a mean age of 31 years. TB Spine, RTA and falls represent the commonest etiological factors in youth and adults while lymphomas lead in children. Approximately 30% of spinal lesion recovered and 16% died. The health facilities should consider setting up spinal care units. This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.

Incidence of childhood cancer in Kingston and St Andrew, Jamaica, 1983-2002.

There have been several modifications to the classification of childhood cancers since the first report (1968-1981) specific to the Jamaican paediatric population was published in 1988. This paper reports on paediatric cancer incidence in Kingston and St Andrew, Jamaica, for the 20-year period 1983-2002 based on these modifications. All cases of cancer diagnosed in children (0-14 years), between 1983 and 2002 were extracted from the Jamaica Cancer Registry archives and classified using the International Classification of Childhood Cancer, third edition. Incidence figures were calculated as per the International Agency for Research on Cancer (IARC) reporting format for childhood cancer. There were 272 cases (133 males, 139 females) of childhood cancer identified in the 20-year period. The overall age standardized rate (ASR) was 69.4 per million; that for males was 67.8 per million, and for females, 70.9 per million. The three most common malignancies overall were leukaemia (21.3%), lymphoma (15.8%) and brain and spinal neoplasms (14.0%). In males, the highest ASRs were seen for leukaemia (14.8 per million), lymphoma (12.7 per million), and brain and spinal neoplasms (8.2 per million), and in females, leukaemia (14.4 per million), nephroblastoma (11.3 per million), and brain and spinal neoplasms (10.6 per million). The rankings of the most common childhood malignancies in Jamaica (leukaemia, brain and spinal neoplasms and lymphomas) have shown few changes since the last review. However, there are differences in frequency and gender distribution of nephroblastoma and brain and spinal neoplasms.

Surgical tactics and treatment results at spinal lymphomas

Цель исследования — изучение особенностей лимфом, поражающих спинной мозг и его оболочки, выработка рациональной тактики их лечения. Материалы и методы. Обследованы 9 больных, у которых диагностирована спинальная лимфома. Все больные оперированы, диагноз верифицирован по данным гистологических исследований. Дооперационная диагностика основана на данных клинического и неврологического обследования, рентгенографии, магниторезонансной томографии (МРТ). У 5 больных проведена электронейромиография, у 3 — сцинтиграфия костной ткани. Результаты. Выделены две основные локализации лимфом: I — интрамедуллярное поражение, II — локальное поражение твердой оболочки спинного мозга (ТОСМ) с распространением эпидурально, субдурально или эпи-субдурально. В 3 наблюдениях отмечено интрамедуллярное поражение, в 6 — поражение ТОСМ. Выводы. Выделяют опухоли, первично поражающие спинной мозг, и опухоли, поражающие ТОСМ. Опухоли, поражающие спинной мозг, неходжкинские лимфомы, как правило, первичные. Опухоли, поражающие ТОСМ, лимфомы Ходжкина, как правило, вторичные, после длительного консервативного лечения. Гистологический диагноз лимфомы должен быть подтвержден результатами иммуногистохимических исследований. Тактика лечения спинальных лимфом с неврологическими проявлениями должна быть направлена на удаление очага, декомпрессию спинного мозга с последующим облучением, химиотерапией и, при необходимости, проведением кортикостероидной терапии.

Primary Spinal Marginal Zone Lymphoma Relapse at a Different Spinal Level after Remission of the Primary Lesion

Study Design Case report. Objective Most spinal lymphomas occur in the context of systematic lymphomas. Marginal zone lymphoma (MZL) is a type of B-cell lymphoma originating from the marginal zone of B-cell follicles. Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of extranodal MZL and rarely occurs in the central nervous system. To date, there has been only one case report of primary spinal MALT lymphoma and there are no case reports of relapsed MALT lymphoma at a different location of the spine. Results A 58-year-old man complained of gait disturbance and urinary dysfunction. Magnetic resonance images showed an abnormal lesion in the epidural space at T11–L1 compressing the conus medullaris. The patient underwent laminectomy and partial resection of the tumor. Histopathologic and immunohistochemical findings were consistent with MALT lymphoma. Following postoperative radiotherapy, the epidural mass disappeared completely. Three years later, epidural MALT lymphoma at a different location in the thoracic spine (T8–T10) occurred and caused myelopathy again. Histologic diagnosis of the relapsed tumor was the same as had been seen 3 years previously. Conclusions This is the first case report of relapsed spinal MALT lymphoma at a different location of the thoracic spine. Though the prognosis of MALT lymphoma is fairly good, careful follow-up is needed to screen any relapse or transformation to a high-grade lymphoma.