Gupta Manoj, Pasricha Sunil, Ahmed Rayaz, Choudhury Partha Sarathi
Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
Indian J Nucl Med. 2023 Jan-Mar;38(1):44-49. doi: 10.4103/ijnm.ijnm_165_22. Epub 2023 Feb 24.
Neurolymphomatosis is rarely encountered in high-grade lymphomas. In this case series, we retrospectively analyzed six neurolymphomatosis cases to look for possible risk factors, common and uncommon presentations, and the lessons learned. Neuropathic pain was the most common symptom with mono or polyradiculopathy in this series. However, all lymphomatous infiltrated nerves diagnosed on fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) were not symptomatic. The lumbar, brachial plexus, and trigeminal nerve were the most common sites and were depicted well on FDG PET/CT. Magnetic resonance imaging (MRI) of the brain better delineates cranial nerves and meningeal involvement. Cerebrospinal fluid flow cytometry was normal until meninges were involved. FDG PET/CT incrementally evaluated extra-neural disease sites, thus helping in deciding biopsy sites and further management. We concluded that a whole-body FDG PET/CT including limbs with MRI brain was the appropriate investigation for evaluating suspected neurolymphomatosis in advanced-stage diffuse large B-cell lymphoma.
神经淋巴瘤在高级别淋巴瘤中很少见。在这个病例系列中，我们回顾性分析了6例神经淋巴瘤病例，以寻找可能的危险因素、常见和不常见的表现以及经验教训。在这个系列中，神经性疼痛是最常见的症状，伴有单发性或多发性神经根病。然而，所有在氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（FDG PET/CT）上诊断出的淋巴瘤浸润神经均无症状。腰椎、臂丛神经和三叉神经是最常见的部位，在FDG PET/CT上显示良好。脑部磁共振成像（MRI）能更好地描绘颅神经和脑膜受累情况。在脑膜受累之前，脑脊液流式细胞术结果正常。FDG PET/CT逐步评估神经外疾病部位，从而有助于确定活检部位和进一步的治疗方案。我们得出结论，对于评估晚期弥漫性大B细胞淋巴瘤疑似神经淋巴瘤，包括脑部MRI和肢体的全身FDG PET/CT是合适的检查方法。
