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. 2018 Jul;16(1):623-631.
doi: 10.3892/ol.2018.8629. Epub 2018 May 4.

Primary cauda equina lymphoma diagnosed by nerve biopsy: A case report and literature review

Kayo Suzuki  1 , Taketoshi Yasuda  1 , Toshihito Hiraiwa  1 , Masahiko Kanamori  2 , Tomoatsu Kimura  1 , Yoshiharu Kawaguchi  1
Affiliations

Primary cauda equina lymphoma diagnosed by nerve biopsy: A case report and literature review

Kayo Suzuki et al. Oncol Lett. 2018 Jul.

Abstract

Primary cauda equina lymphoma (CEL) is a rare malignant tumor among various neoplasms that affects the cauda equina nerve roots. The present case report described the case of a 65-year-old man who presented with cauda equina syndrome with progressive motor palsy in the legs and gait disturbance over the last 5 months. Magnetic resonance (MR) images showed enlargement of the cauda equina occupying the dural sac from the L1-S1 level with isointensity to the spinal cord signal on both T1- and T2-weighted imaging. Enhancement of the cauda equina was seen on contrast MR images. On F-18 2-fluoro-2-deoxy-glucose positron emission tomography examination, diffuse accumulation of 2-fluoro-2-deoxy-glucose was observed in the cauda equina with a maximum standardized uptake value of 4.9. Based on elevation of soluble interleukin 2 receptor in cerebrospinal fluid and a biopsy of the enlarging cauda equina, a diagnosis of CEL of the diffuse large B-cell type was made. The present case report provided a detailed case discussion and a review of the available literature on this rare entity, focusing on clinical characteristics and imaging of primary CEL.

Keywords: FDG-PET/CT; MR imaging; cauda equina lymphoma; nerve biopsy; sIL-2R.

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Figures

Figure 1.
Figure 1.
Magnetic resonance images of a cauda equina lesion. (A) The cauda equina showed low signal intensity compared to the conus on a T2-weighted image. (B) On a sagittal enhanced T1-weighted image, the cauda equina roots showed diffuse enhancement from the level of the L1 vertebra to S1. (C) At the level of the L4/5 disc, each cauda equina root was obviously enlarged.
Figure 2.
Figure 2.
FDG-PET. At the level from the conus to the cauda equina (arrows), diffuse accumulation of FDG was observed with a maximum SUV of 4.9. FDG-PET, F-18 2-fluoro-2-deoxy-glucose positron emission tomography; SUV, standardized uptake value.
Figure 3.
Figure 3.
Histopathological examination and immunohistochemistry of the cauda equina following a biopsy. (A) Hematoxylin and eosin staining revealed lymphoma cells (*) infiltrated into the nerve (**) (magnification, ×100). (B) Lymphoma cells presented a large nuclei and little cytoplasm with a high magnification view (magnification, ×200). Immunohistochemistry showed that the atypical large lymphoma cells were negative for (C), CD3, (D) CD5, and (E) CD10 (magnification, ×200). (F) The nerve region infiltrated by lymphoma cells in figure A was positive by S-100 staining (magnification, ×100). Immunostaining for (G) CD20, (H) BCL2, and (I) MUM-1 were diffusely strong positive for the atypical large lymphoma cells (magnification, ×200). Immunostaining for (J) BCL6 was weakly positive for the atypical large tumor cells (magnification, ×200). CD, cluster of differentiation; BCL2, B-cell lymphoma 2; MUM-1, multiple myeloma oncogene 1.
Figure 4.
Figure 4.
Gadolinium-enhanced T1-weighted magnetic resonance images at 3 months after the completion of chemotherapy. On an axial image at the level of the L4/5 disc, the cauda equina roots showed disappearance of enhancement.
Figure 5.
Figure 5.
Frequency of involvement of different vertebral levels by cauda equina lymphomas. The levels from L1 to L4 of the spine are frequently involved in lymphoma as seen on MR images.
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