Lee Gin Hoong, Hsueh Hsueh-Wen, Wang Kuo-Chuan, Yu Shan-Chi, Huang Hsin-Yi, Chao Chi-Chao, Hsieh Sung-Tsang
Department of Neurology.
Department of Surgery.
Neurologist. 2023 Jul 1;28(4):247-249. doi: 10.1097/NRL.0000000000000471.
Isolated primary neurolymphomatosis is a rare manifestation of lymphoma, which is challenging to diagnose as there is only involvement of the nervous system, and nerve biopsy is not frequently pursued due to the high risk of irreversible complications.
We present a case of isolated primary neurolymphomatosis of diffuse large B-cell lymphoma restricted to only the right brachial plexus and right axillary nerve. The clinical course has been indolent for several years. The initial examination, including MRI and the cerebrospinal fluid study, did not yield any evidence of malignancy. Eventually, due to the patient's symptom progression and the follow-up imaging findings, we conducted a partial nerve biopsy of the brachial plexus to confirm the malignancy. His neurological symptoms did not further deteriorate post-biopsy.
Isolated primary neurolymphomatosis with an indolent course is rare and challenging to diagnose. Serial MRI and fluorodeoxyglucose-positron emission tomography reveal clues for tumor involvement. Partial nerve biopsy or targeted fascicular nerve biopsy could be an alternative for achieving a pathologic diagnosis.
孤立性原发性神经淋巴瘤是淋巴瘤的一种罕见表现形式，由于仅累及神经系统，诊断具有挑战性，并且由于存在不可逆并发症的高风险，神经活检并不常用。
我们报告一例局限于右臂丛神经和右腋神经的弥漫性大B细胞淋巴瘤孤立性原发性神经淋巴瘤病例。临床病程已持续数年。包括MRI和脑脊液检查在内的初始检查未发现任何恶性肿瘤证据。最终，由于患者症状进展以及后续影像学检查结果，我们对臂丛神经进行了部分神经活检以确诊恶性肿瘤。活检后他的神经症状未进一步恶化。
病程缓慢的孤立性原发性神经淋巴瘤罕见且诊断具有挑战性。系列MRI和氟脱氧葡萄糖正电子发射断层扫描可揭示肿瘤累及的线索。部分神经活检或靶向束状神经活检可能是实现病理诊断的一种替代方法。
