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)

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.