Daher Ahmad, Kamiya-Matsuoka Carlos, Woodman Karin
Department of Neuro-Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX.
J Clin Neuromuscul Dis. 2018 Mar;19(3):124-130. doi: 10.1097/CND.0000000000000183.
Peripheral nervous system damage from hematologic malignancies is related to neoplastic cells infiltration of peripheral nerves or to monoclonal antibody production cross-reacting with peripheral nerves' antigens. Neurolymphomatosis (NL), a rare manifestation of hematologic malignancies, occurs when malignant cells invade the peripheral nerves leading to various manifestations. Here, we report a case of NL with 2 hematologic malignancies in a 79-year-old woman presenting with lower extremity pain/weakness. Investigation revealed anemia, IgM kappa monoclonal gammopathy, and elevated anti-MAG titer. Electrodiagnostic studies were consistent with mononeuropathy multiplex while imaging suggested malignancy in her ovaries and right S1 nerve root. Bone marrow and ovarian biopsies revealed chronic myelomonocytic leukemia, Waldenstrom macroglobulinemia, and diffuse large B-cell lymphoma. She received standard chemotherapy resulting in radiographic resolution of disease and symptomatic relief. NL can precede the diagnosis of hematologic malignancy but its symptoms are not easily identifiable, whereas management depends on the treatment of the underlying tumor.
血液系统恶性肿瘤所致的周围神经系统损害与肿瘤细胞浸润周围神经或与周围神经抗原发生交叉反应的单克隆抗体产生有关。神经淋巴瘤（NL）是血液系统恶性肿瘤的一种罕见表现，当恶性细胞侵犯周围神经导致各种表现时就会发生。在此，我们报告一例79岁女性患有2种血液系统恶性肿瘤并伴有下肢疼痛/无力的神经淋巴瘤病例。检查发现贫血、IgM κ单克隆丙种球蛋白病以及抗MAG滴度升高。电诊断研究结果符合多灶性单神经病，而影像学检查提示其卵巢和右侧S1神经根存在恶性病变。骨髓和卵巢活检显示为慢性粒单核细胞白血病、华氏巨球蛋白血症和弥漫性大B细胞淋巴瘤。她接受了标准化疗，疾病在影像学上得到缓解且症状减轻。神经淋巴瘤可先于血液系统恶性肿瘤的诊断出现，但其症状不易识别，而治疗则取决于对潜在肿瘤的治疗。
