Spinal Meningeal Mass Lesion: A Rare Presentation of Primary Dural Follicular Lymphoma.

IF 1.1 4区 医学 Q4 CLINICAL NEUROLOGY
Jessica D White, Michelle J Clarke, Jonas Paludo, Andrew L Feldman, Ugur T Sener
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Abstract

Introduction: The differential diagnosis of a spinal intradural extramedullary mass lesion is broad and includes meningioma, schwannoma, neurofibroma, leptomeningeal metastasis, and myxopapillary ependymoma. Though rare, lymphoma should be included in the differential diagnosis of a dural mass lesion.

Case report: A 38-year-old man presented with back pain that progressed over 1 month with associated focal tenderness over his mid to lower thoracic spine. He developed intermittent numbness of the bilateral lower extremities, nuchal rigidity, difficulty sleeping, and night sweats. A magnetic resonance imaging of the thoracic spine demonstrated a dorsal intradural extramedullary enhancing lesion from T7 to T10 extending outside the spinal canal. Dural thickening across the entire circumference of the spinal cord was noted. Computed tomography (CT)-guided biopsy of the thoracic lesion was performed, and pathology was consistent with follicular lymphoma. Fluorodeoxyglucose positron emission tomography:CT demonstrated no systemic disease. Bone marrow biopsy was negative for malignancy. Symptoms resolved with dexamethasone therapy. He was treated with bendamustine and rituximab with follow-up positron emission tomography:CT 2 months later demonstrating a complete response.

Conclusions: Lymphoma can rarely present as an isolated dural lesion and should be considered in the differential diagnosis of intradural extramedullary spinal mass lesions. Prompt diagnosis and initiation of treatment can lead to complete response and resolution of symptoms.

脊椎脑膜肿块病变:罕见的原发性硬脑膜滤泡淋巴瘤。
简介:脊髓硬膜外髓外肿块的鉴别诊断范围很广,包括脑膜瘤、神经鞘瘤、神经纤维瘤、软脑膜转移瘤和黏液乳头状室管膜瘤。淋巴瘤虽然罕见,但应纳入硬膜包块病变的鉴别诊断。病例报告:一名38岁的男性出现背痛,持续时间超过1个月,中下胸椎伴有局灶性压痛。他出现了间歇性的双侧下肢麻木、颈部僵硬、睡眠困难和盗汗。胸椎的磁共振成像显示,从T7到T10,脊髓外脊神经脊膜内增强病变延伸到椎管外。观察到整个脊髓周围的硬脑膜增厚。计算机断层扫描(CT)引导下对胸部病变进行活检,病理学与滤泡性淋巴瘤一致。氟脱氧葡萄糖正电子发射断层扫描:CT显示无系统性疾病。骨髓活检对恶性肿瘤呈阴性。地塞米松治疗后症状缓解。他接受了bendamustine和利妥昔单抗的治疗,并在2个月后进行了正电子发射断层扫描:CT显示完全缓解。结论:淋巴瘤很少表现为孤立的硬膜外病变,应考虑在脊髓硬膜外肿块病变的鉴别诊断中。及时诊断和开始治疗可以导致症状的完全缓解和解决。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Neurologist
Neurologist 医学-临床神经学
CiteScore
1.90
自引率
0.00%
发文量
151
审稿时长
2 months
期刊介绍: The Neurologist publishes articles on topics of current interest to physicians treating patients with neurological diseases. The core of the journal is review articles focusing on clinically relevant issues. The journal also publishes case reports or case series which review the literature and put observations in perspective, as well as letters to the editor. Special features include the popular "10 Most Commonly Asked Questions" and the "Patient and Family Fact Sheet," a handy tear-out page that can be copied to hand out to patients and their caregivers.
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