Age / Sex : 29 / M

What is your impression?

Chief complaint :

Headache, diplopia

Discussion

Answer:  

Spinal dural lymphoma (Diffuse large B cell type)

Findings:

On axial and sagittal CT scans, soft tissue density mass like lesion was seen in left posterior portion of central canal at C2-3 level. There was no internal calcification in the mass like lesion.

On axial and sagittal T2WI, mass like dural thickening causing spinal cord compression was seen. This lesion show iso- or slightly high SI on T1WI and homogeneous enhancement on contrast enhanced image. On DWI, the lesion show diffusion restriction.

On brain MRI, diffuse pachymeningeal thickening and enhancement was seen.

Differential Diagnosis:

Meningioma

Hypertrophic pachymeningitis related to infection

IgG4-related hypertrophic pachymeningitis

Discussion:

• rare disease


• Most of them are subtype of secondary CNS lymphoma, primary spinal dural lymphoma is very rare


• Can be single or multiple and closely mimics meningiomas


• Can cause spinal cord compression need decompression


• Show hypercellularity with slightly increase T1 signal and homogeneous enhancement like lymphoma occurs at other site

References:

1. Primary Dural Spinal Lymphoma Presentation of a Rare Spinal Tumor Case – Case Rep Surg. 2015;639253


2. Spinal Leptomeningeal Lymphoma Presenting as Pseudotumor Syndrome - : J Neuro-Ophthalmol 2013; 33: 13-16