Low-grade B-cell lymphomas in the spinal epidural space: A case series and review of the literature

Lymphoma rarely arises within the central nervous system and occurs most commonly in association with disseminated systemic disease. Primary epidural lymphomas of the spine are infrequently encountered and are usually high-grade, diffuse large B-cell lymphomas. Low-grade lymphomas arising in the spine are rarer than high-grades and are usually marginal zone lymphomas. While treatments for systemic high-grade lymphomas are well defined, treatment of low-grade lymphomas arising within the Dura or within the epidural space are less defined. We present two cases of primary spinal Dural- and epidural-based low-grade lymphomas diagnosed surgically and treated with local adjuvant radiation without chemotherapy. Both patients demonstrated excellent long term symptomatic and systemic disease control. We review the literature on epidural and Dural low-grade lymphomas to guide treatment of these rare lesions.