Solitary intradural extramedullary recurrence of testicular diffuse large B-cell lymphoma mimicking a schwannoma: illustrative case.

Background: The purpose of this case report is to highlight the presentation, radiographic challenges, and clinical decision-making prior to operative intervention in an 84-year-old man with a delayed recurrence of diffuse large B-cell lymphoma (DLBCL) in a rare location of the intradural extramedullary space of the cervical spine.

Observations: The authors report the case of a cervical intradural extramedullary neoplasm in an 84-year-old male who presented with ataxic gait and right-sided weakness. The patient has a history of testicular DLBCL. Initial MRI revealed a mass at C6-7 mimicking the appearance of either a schwannoma or a meningioma. He underwent resective surgery of the neoplasm, which proved to be a recurrence of DLBCL by histopathology and immunohistochemistry.

Lessons: Diagnosing rare malignancies like lymphoma in the spine requires considering the patient's history, as imaging alone might not allow distinguishing between different tumor types. For patients with a history of lymphoma, malignant recurrence in the spine should be considered in the differential diagnosis of solitary spinal masses, even when imaging suggests more common lesions. https://thejns.org/doi/10.3171/CASE24830.