Çeçen Dilber Ayçiçek, Tatarlı Necati, Turan Süslü Hikmet, Özdoğan Selçuk, Barışık Nagehan Özdemir
Department of Neurosurgery, Dr. Lütfi Kırdar Kartal Education and Research Hospital, 34852 Istanbul, Turkey.
Department of Pathology, Dr. Lütfi Kırdar Kartal Education and Research Hospital, 34852 Istanbul, Turkey.
Case Rep Surg. 2015;2015:639253. doi: 10.1155/2015/639253. Epub 2015 Jun 23.
Background. Primary spinal dural lymphomas (PSDL) are tumors with characteristic histopathology of a lymphoma, which are completely in the spinal epidural space without any other systemic involvement. Extranodal primary lymphoma involving nervous system prefers thalamus/basal ganglia, periventricular region, cerebellum, eyes, meninges/dura, and cranial nerves or spinal cord. Rare spinal localization with acute spinal cord compression is worth attention. Case Presentation. A 48-year-old male presented with a several-month-long history of upper back pain. Lately, he had numbness and weakness at both lower extremities and was unable to walk for one week. A spinal MRI showed a thoracic lesion with cord compression at T2-T4 levels. The patient underwent surgical decompression, with his final histopathology showing diffuse large B-cell lymphoma. Systemic work-up was negative for nodal disease. Following surgery, he received radiotherapy combined with chemotherapy. He experienced a good outcome after four years. Conclusion. The upper thoracic cord is a rare location for primary spinal lesions/metastases, both of which prefer the lower thoracic and upper lumbar regions. In cases of progressive paraparesis, there should be immediate surgical intervention in the case of denovo disease, followed by combined radiotherapy and chemotherapy procedures.
背景。原发性脊髓硬脊膜淋巴瘤(PSDL)是具有淋巴瘤特征性组织病理学表现的肿瘤,完全位于脊髓硬膜外间隙,无任何其他全身受累情况。累及神经系统的结外原发性淋巴瘤好发于丘脑/基底神经节、脑室周围区域、小脑、眼睛、脑膜/硬脑膜以及脑神经或脊髓。罕见的伴有急性脊髓压迫的脊柱定位值得关注。病例报告。一名48岁男性,有长达数月的上背部疼痛病史。最近,他双下肢出现麻木和无力,且无法行走一周。脊髓MRI显示T2 - T4水平有一个胸椎病变伴脊髓受压。患者接受了手术减压,最终组织病理学显示为弥漫性大B细胞淋巴瘤。全身检查未发现淋巴结疾病。手术后,他接受了放疗联合化疗。四年后他取得了良好的预后。结论。上胸段脊髓是原发性脊柱病变/转移瘤的罕见部位,这两者更倾向于下胸段和上腰段。对于进行性截瘫病例,如果是新发疾病,应立即进行手术干预,随后进行放疗和化疗联合治疗。