Durán C, Infante J R, Serrano J, Rayo J I, García L, Domínguez M L, Sánchez R
Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, España.
Rev Esp Med Nucl. 2009 Nov-Dec;28(6):295-8. doi: 10.1016/j.remn.2009.07.002. Epub 2009 Oct 28.
Neurolymphomatosis is a rare neurological manifestation of non-Hodgkin's lymphoma (NHL) and it may be its first and sole manifestation. Diagnosis is often difficult and nerve biopsy is generally required. However, this it is not always possible to perform or is not conclusive. We present the case of a 66-year-old woman diagnosed with giant B-cell NHL. After 6 cycles of chemotherapy, imaging and molecular biology techniques showed complete remission. At four months after treatment, the patient complained of low back pain of radicular distribution. CT and MRI imaging showed signs of lymphoproliferative activity of L5 and also lesions to thoracic nerve roots. A PET-CT was requested in order to complete the diagnosis and plan the treatment. Imaging confirmed the presence of tumor recurrence with neurolymphomatosis and also indicated lesions on the chest and abdominal level. Thus, it was decided to start a new line of chemotherapy, without performing the histological study through biopsy. This case illustrates the important role played by PET-CT imaging in neurolymphomatosis diagnosis. This technique can help the patient avoid more aggressive procedures, such as a biopsy, and can also be useful in the follow-up and assessment of the treatment response to NHL-diagnosed patients.
神经淋巴瘤病是非霍奇金淋巴瘤（NHL）一种罕见的神经系统表现，且可能是其首发及唯一表现。诊断往往困难，通常需要进行神经活检。然而，活检并非总能实施，或者结果并不具有决定性。我们报告一例66岁女性患者，诊断为弥漫大B细胞NHL。经过6个周期化疗后，影像学和分子生物学技术显示完全缓解。治疗4个月后，患者主诉有放射状分布的下背部疼痛。CT和MRI成像显示L5有淋巴增殖活动迹象，同时胸神经根有病变。为完善诊断并制定治疗方案，进行了PET-CT检查。影像学检查证实存在肿瘤复发伴神经淋巴瘤病，且显示胸部和腹部有病变。因此，决定开始新的化疗方案，未通过活检进行组织学研究。该病例说明了PET-CT成像在神经淋巴瘤病诊断中所起的重要作用。这项技术有助于患者避免进行如活检等更具侵袭性的检查，也可用于对NHL确诊患者治疗反应的随访和评估。
