Spinal Lymphoma Research Articles

Primary vertebral and spinal epidural non-Hodgkin's lymphoma with spinal cord compression.

We examined eight patients with primary spinal epidural non-Hodgkin's lymphoma presenting with spinal cord compression and proven histologically after laminectomy (7 cases) or biopsy (1 case) by MRI. The most common findings were an isointense or low signal relative to the spinal cord on T1-weighted images (T1WI) and high signal on T2-weighted images (T2WI). Spinal cord compression, vertebral bone marrow and paravertebral extension were assessed. Contrast enhancement was intense in seven of the eight cases and homogeneous in all of them. T2WI (performed in 2 cases) may be useful to distinguish metastatic carcinomas and sarcomas. T1WI demonstrated the full extent of the epidural lesion, which was well-delineated in all cases. When the paravertebral extension is not well-defined, a study with contrast medium should be performed.

Spinal malignant lymphoma appearing after radiation and chemotherapy of a pineal region tumor

The occurrence of malignant lymphoma in the pineal region is very rare. We experienced a case of pineal region tumor that was treated by radiation and chemotherapy. After 1 year, the tumor metastasized to the cauda equina and was operated on. The diagnosis was malignant lymphoma. Although the incidence of intracranial malignant lymphoma is known to be on the increase recently, malignant lymphoma should be considered in the differential diagnosis of pineal region tumors.

MR IMAGING AND CT OF CENTRAL NERVOUS SYSTEM TUBERCULOSIS IN THE PATIENT WITH AIDS

CNS TB represents a disease that complicates AIDS with an increasing incidence in endemic areas as well as in developed countries in those patients who have some risk factors such as intravenous drug abuse. Although TB infection of the CNS in AIDS patients may follow a rapidly progressive course, the imaging findings otherwise are similar to those of the nonimmunosuppressed population. Meningeal enhancement, hydrocephalus, parenchymal granulomata, and infarcts are seen frequently and are often observed in combination with one another. Nevertheless, the differential diagnosis in AIDS patients must include other opportunistic infections and primary or metastatic lymphoma of the CNS. Spinal TB usually is seen in the form of epidural abscess secondary to tuberculous spondylitis, although it may be seen in isolation of spinal column involvement. The differential diagnosis includes spinal lymphoma or pyogenic abscess formation. Radiculomyelitis or isolated spinal cord tuberculomata are much less frequently observed and can be suspected on imaging only if there is concomitant evidence of the classic findings of intracranial TB.

Mr Imaging of Spinal Lymphoma

Fourteen patients with spinal lymphoma examined by MR imaging were reviewed. Thirteen of them also had extraspinal lymphoma. Vertebral involvement was found in 12 patients, epidural in 10, and paraspinal in 8 patients. On the basis of MR imaging at 0.3 T, spinal lymphoma may be divided into three types of growth pattern according to the main location: paraspinal, vertebral, and epidural. Most frequently, all three locations were found simultaneously on MR (7/14). In one patient the location was vertebral with epidural extension, in one paraspinal with vertebral extension, in 3 it was entirely vertebral, and in 2 entirely epidural. Multiple plane T1-weighted imaging gave complete information about the extent of spinal lymphoma. The signal intensity was lower than or equal to muscle and lower than bone marrow in paraspinal and vertebral lesions on T1-weighted images and high on T2-weighted images. Epidural lesions showed a hypo- or isointense signal relative to the cord on T1-weighted images except in one case and a hyperintense signal on T2-weighted images. Compression of the cord and cauda equina due to bulging of diseased vertebral bodies and epidural lesions was well demonstrated. MR imaging was also found useful in the follow-up of treatment.

MR Imaging of Spinal Lymphoma

MR Imaging of Spinal Lymphoma

Primary spinal epidural non-Hodgkin's lymphoma: report of eight patients and review of the literature.

Eight patients treated for histologically confirmed primary spinal epidural non-Hodgkin's lymphoma diagnosed between January 1979 and August 1989 (6.6% of all cases of intraspinal lymphoma) were studied. There were six men and two women. The median age was 70 years (range, 43-80 yr). Patients sought treatment for a prodrome of back pain (median duration, 3 mo) followed by an acute neurological deterioration (median duration, 6 d). The most common findings were a discrete sensory level in 5 patients, hyperreflexia in 5 patients, and paraparesis or paraplegia in 5 patients. Radiographically, there was an absence of bony destruction by these tumors. All patients underwent a decompressive laminectomy, subtotal tumor resection, and spinal irradiation (median dose, 3800 cGy). Two patients had low-grade lymphomas (one B cell and one T cell), and 6 patients had intermediate-grade lesions (six B cell). Two patients with B-cell lymphomas (one low-grade and one intermediate-grade) developed metastatic disease 15 and 17 months after the initial diagnosis; no evidence of lymphoma developed in the other 6 patients. The median survival was 22 months (range, 2-71 mo). Lymphoma was the cause of death in only 1 of the 4 patients who died, and the 4 younger patients are alive and well. Primary spinal epidural non-Hodgkin's lymphoma should be a diagnostic consideration in the older patient who seeks treatment for spinal cord compression manifested by a prodrome of back pain, followed by a rapid neurological deterioration, normal plain spine radiographs, and neuroimaging consistent with an extradural compressive lesion. Surgery for this diagnosis followed by spinal irradiation should result in significant neurological improvement.

Spinal lymphoma in cats: 21 cases (1976-1989)

Summary Medical records of 21 cats with spinal lymphoma were reviewed. All cats were evaluated for neurologic deficits, although 85% of cats necropsied had multicentric disease. Eighty-one percent of cats had hind limb paresis. Results of FeLV tests were positive in 84.2% (16/19) of the cats, and 68.7% (11/16) of the cats had leukemic bone marrow. Spinal lymphoma was confirmed by necropsy in 13 cats, by examination of a biopsy specimen in 1 cat, and by examination of cells aspirated from an epidural lesion in 2 cats. In the remaining 5 cats, a presumptive diagnosis was made on the basis of neurologic examination findings, positive FeLV test results, and leukemic bone marrow. Nine cats were treated with chemotherapy alone. The complete remission rate was 50% in 6 cats given cyclophosphamide, vincristine, and prednisone. The median duration of complete remission was 14 weeks. Complete remissions were not observed in 3 cats given only corticosteroids. A single cat treated by laminectomy and postoperative chemotherapy had a prolonged remission (62 weeks). At necropsy, lymphoma of the cns was limited to the vertebral canal in 10 of 13 cats; 2 cats had malignant tissue in the brain and vertebral canal, and in the remaining cat, the tumor extended into the brachial plexus. Most tumors extended over multiple vertebral bodies, and 4 cats had more than 1 level of spinal cord involvement. The lymphoma was high-grade lymphoblastic or immunoblastic type in all cats.

MR Imaging of Spinal Lymphoma

MR Imaging of Spinal Lymphoma

Primary Intramedullary Spinal Cord Lymphoma: Report of a Case

A case of primary intramedullary spinal cord malignant lymphoma is described. The patient was a 24-year-old female with a preceding history of a lupus-erythematosus-like disorder. The presenting symptom of the spinal cord tumor was spastic paresis of the lower extremities. Radiological examinations including magnetic resonance imaging (MRI) of the spinal cord revealed an intramedullary tumor from levels C2 to T6. A decompressive laminectomy was performed with the pathological diagnosis of poorly differentiated lymphocytic lymphoma with T-cell surface marker. Postoperative cerebrospinal radiation up to 40.5 Gy was performed. The patient is alive without disease 18 months after completion of the therapy. MRI proved to be a very useful method for evaluation of the response to therapy and for follow-up. Primary involvement of the spinal cord with non-Hodgkin's lymphoma is unusual and this is the ninth case of primary intramedullary spinal cord lymphoma reported.

Primary malignant lymphoma of the central nervous system

The occurrence of primary malignant lymphomas of the central nervous system in a population of approximately 1 million people has been analyzed retrospectively. Over a 12-year period, about 1000 tumors of the central nervous system were registered. Among these, 22 were primary malignant lymphomas; incidence, 1.83 per million per year. Thirteen of these tumors were of high-grade malignancy and nine were of low-grade malignancy (Kiel classification of non-Hodgkin lymphomas). The majority of the tumors were B-cell lymphomas, and there were no Hodgkin lymphomas. Neither spinal nor meningeal lymphomas occurred. Nine patients were treated only surgically, whereas 11 received postoperative irradiation or chemotherapy, or both. Of the latter patients, six are alive and well at the time of writing. The importance of making a correct diagnosis preoperatively is stressed, inasmuch as radical operation is unfavorable for these patients. A better prognosis is obtained with combinations of irradiation and chemotherapy.

"Primary" spinal epidural lymphomas. A clinico-pathological study.

The surgical records at the National Institute of Mental Health and Neurosciences, Bangalore, revealed 75 cases of spinal epidural malignant tumours operated on in a period of 8 years (1972-1980). Of these, 21 cases (30.4%) were labelled as "primary" spinal lymphomas, with no evidence of any systemic lymphomatous deposit anywhere in the body at the time of surgery. An analysis of their clinical behaviour, treatment, histological classification, and prognosis showed that a (majority of the patients had lower limb weakness and localized pain at the site of lesion as the presenting clinical symptom, b) laminectomy with decompression of the tumour followed by radiotherapy was the treatment of choice, c) histologically mixed histiocytic lymphocytic variety of lymphoma was commonest, and d) six survivors had a histiocytic lymphocytic lymphoma, suggesting a better prognosis associated with this type.

Epidural spinal lymphoma in an infant. Case report.

✓ A malignant lymphoma involving the spinal epidural space is reported in a 1½-year-old-boy. This is probably the youngest patient reported with a spinal epidural lymphoma.

Radiation Therapy for Lymphoma of the Spinal Canal

There is a paucity of reports concerning lymphomatous involvement of the spinal canal. Review of the literature leaves one confused as to the incidence of primary central nervous system involvement by lymphoma, its best management, and the results to be expected from it. In an attempt to clarify these points, we have reviewed the experience of the Division of Radiotherapy of the Columbia-Presbyterian Medical Center and New York Neurological Institute with 53 histologically proved cases of spinal canal lymphoma. This discussion is limited to involvement of the spinal canal; intracranial and peripheral nerve involvement is excluded. By the term lymphoma, we include Hodgkin's disease, lymphosarcoma, and reticulumcell sarcoma, but exclude leukemia and myeloma. Fifty-eight patients with lymphoma of the spinal canal were registered between January 1935 and December 1964. The hospital charts were not available for review in 5 cases, leaving 53 for analysis. Histologic proof of epidural disease was obtained in 48. In 5 the histologic diagnosis was made from biopsy of another site. In addition, the clinical course, roentgenographic and laboratory data, and treatment response were consistent with spinal canal lymphoma. The sex ratio was 34 males to 19 females, and the age at presentation ranged from nine to seventy-one years, the mean age being forty-three and a half years (Fig. 1). Local or radiating pain was experienced by all patients and was the most frequent initial symptom. Other initial symptoms were : paraparesis (6 cases) , bowel disturbance (1 case), nonspecific respiratory symptoms (6 cases), and pruritus (1 case). Forty-seven patients had a sensory deficit on admission; 42 had motor weakness or paralysis. Sphincteric disturbance was present in 26. The duration of symptoms prior to hospitalization averaged six weeks, with 7 patients noting symptoms for less than two weeks and 5 for more than one year. In contrast with other series, spinal canal involvement was the first manifestation of lymphoma in 45 patients (7). No histological type demonstrated a predilection for a particular area of the spinal canal (Fig. 2). Roentgenographic studies showed adjacent bony involvement in 29 patients. A paravertebral soft-tissue mass was noted radiographically or at the time of surgery in 30 cases. In 32 patients myelography was performed; in all the findings were abnormal and showed an extradural mass constricting the intradural space. Laboratory studies proved of little diagnostic aid except that the cerebrospinal fluid protein value was elevated in all 47 patients in whom the test was performed. The mode of treatment, clinical response, and survival in 51 cases are shown in Figure 3. Thirty-nine patients (77 per cent) benefited from therapy. Although the therapeutic result was generally inversely proportional to delay between onset of symptoms and institution of treatment, several patients made an excellent recovery despite sphincteric disturbance for periods of several days.