Primary Spinal Epidural Lymphoma As a Cause of Spontaneous Spinal Anterior Syndrome: A Case Report and Literature Review

Abstract

Background Primary spinal epidural lymphoma (PSEL) is one of the rarest categories of tumors. Spinal cord compression is an uncommon primary manifestation and requires to be treated with surgery for the purpose of diagnosis and decompression. Case Presentation A 45-year-old man presented with a new onset thoracic pain and progress to an anterior spinal syndrome with hypoesthesia and loss of thermalgesia. Magnetic resonance image showed a paravertebral mass that produces medullary compression at T3. The patient was taken up to surgery, where the pathology examination showed a diffuse large B-cell lymphoma. Conclusions PSEL is a pathological entity, which must be considered on a middle-aged man who began with radicular compression, and the treatment of choice is decompression and biopsy. The specific management has not been established yet, but the literature suggests chemotherapy and radiotherapy; however, the outcome is unclear.

Keywords: epidural; spinal compression; spinal epidural lymphoma.

Fig. 1

(a) Sagittal thoracic spine T1-weighted image. (b) Sagittal thoracic spine T2-weighted image.(c) Sagittal thoracic spine contrast material-enhanced T1-weighted image. Vertebral body osteophytes at anterior marginal. Vertebral bodies show multiple irregular areas, hypointense on T1 and hypertense on T2, with heterogeneous enhancement in postcontrast sequence mainly in the vertebral body of T3, where we also observe a paravertebral mass hypointense on T1 and T2, with homogeneous enhancement, which produces medullar compression. Schmorl nodes at the T9–T11 level. Protrusion of the disk at T6–T7 level.

Fig. 2

(a) Axial thoracic spine T1-weighted image. (b) Axial thoracic spine T2-weighted image. (c) Axial thoracic spine contrast material-enhanced T1-weighted image. The vertebral body at T3 level, with hypointense areas in T1 and hypertense in T2, with heterogeneous enhancement in postcontrast sequence. Right epidural mass with homogeneous enhancement; it involved the vertebral body and transverse apophysis that condition radicular compression at the right neural foramen and spinal cord compression

Fig. 3

Surgical view. Fibrotic, gray colored, vascularized lesion; approximately 3 × 1.5 × 1 cm in diameter.

Fig. 4

Pathology examination. (a) Histologically between bone trabeculae. (b) Proliferation of atypical lymphoid cells with hyperchromatic nuclei and scant amount of cytoplasm is observed.

Fig. 5

Neoplastic cells were strongly positive for CD20 and BCL-2, focally positive for CD5 and CD10, and negative for CD30; CD3 was positive in small lymphocytes reactive appearance, and the cell proliferation marker Ki67 positivity was found in 20% of neoplastic cells.