Weekly Case

Title : Case 691

Age / Sex : 59 / F


Chief complaint : paraplegia, sensory change at bilateral lower extremities


                 complete remission status of diffuse large B cell lymphoma


What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 
추혜정, Hye Jung Choo, 인제대학교부산백병원 (Inje University Busan Paik Hospital)


 


Diagnosis:

neurolymphomatosis



Discussion


Findings: MR images show marked thickening and enhancement at the lumbosacral nerve roots.  PETs show FDG uptakes at the multiple nerves ( lumbosacral nerve roots, cervical nerve roots, both mandibular nerve, both vagus nerve, both brachial plexus, median nerve of right arm) and multiple lymph nodes (in neck, mediastinum)


 Differential Diagnosis: inflammatory peripheral neuropathy, paraneoplastic syndrome of peripheral nerves, chemotherapy-induced peripheral neuropathy


 Discussion:


Neurolymphomatosis



  • Clinical entity characterized by the infiltration of peripheral nerves, nerve roots, plexuses, or cranial nerves by malignant lymphocytes

  • Incidence

    • 10% of primary lymphomas of the nervous system (0.2% of all NHLs)

    • 5%- 29% of NHLs metastasize to the nervous system, and an estimated 10% of these involve the peripheral nerves



  • Symptoms

    • Progressive sensorimotor peripheral neuropathy

    • Plexopathy, or cranial neuropathy



  • MR findings

    • Enlargement or enhancement of nerves or nerve roots beyond the root sleeve.



  • PET-CT

    • Hypermetabolism at the correspondings areas



  • Treatment: similar to that of primary CNS lymphoma


 


 References:



  1. The Diagnostic Dilemma of Neurolymphomatosis. J Clin Neurol. 2016 Jul; 12(3): 274–281.

  2. Neurolymphomatosis on F-18 FDG PET/CT and MRI Findings: A Case Report. Nucl Med Mol Imaging. 2011 Mar; 45(1): 76–78.


 



Correct Answer
Total applicants 27 Correct answers 19
Name Institution
윤유성 순천향대 부천병원, 전문의
여현정 전문의
강지희 전문의
이규정 국군대전병원, 전문의
조영민 전문의
김동언 서울아산병원, 전문의
변성환 전문의
이진영 전문의
이민욱 충남대학교병원, 전문의
이혜란 전문의
문경일 전남대학교병원, 전공의
이승보 서울아산병원, 전문의
권기언 서울아산병원, 전문의
김성진 365병원, 전문의
윤선근 전공의
김형민 연세의대 강남세브란스병원, 전문의
노근탁 전문의
임윤진 단국대학교병원, 전공의
심상우 서울아산병원, 전문의
Semi-Correct Answer
Total applicants 27 Semi-Correct answers 3
최형인 군의관, 전문의
서현주 전문의
백승진 분당차병원, 전공의


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