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LETTERS TO EDITOR
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 258-260

Primary lymphoma of the radial nerve presenting as nerve sheath tumor


1 Department of Neurosurgery, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India
2 Department of Pathology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India

Date of Web Publication11-Jan-2018

Correspondence Address:
Dr. Vengalathur G Ramesh
Department of Neurosurgery, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu,
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.222865

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How to cite this article:
Jayendrapalan J, Ramesh VG, Karthikeyan KV, Devi S. Primary lymphoma of the radial nerve presenting as nerve sheath tumor. Neurol India 2018;66:258-60

How to cite this URL:
Jayendrapalan J, Ramesh VG, Karthikeyan KV, Devi S. Primary lymphoma of the radial nerve presenting as nerve sheath tumor. Neurol India [serial online] 2018 [cited 2019 Jun 18];66:258-60. Available from: http://www.neurologyindia.com/text.asp?2018/66/1/258/222865




Sir,

Extranodal lymphomas are uncommon. Primary extranodal lymphomas are found mainly in the central nervous system, gastrointestinal tract, and skin. Lymphomas arising from the peripheral nerves are exceedingly rare. Sciatic nerve has been the most common nerve involved in the reports so far. Primary lymphoma arising from the radial nerve is rare.

A 65-year old woman presented with a swelling in the left arm with localized pain radiating up to the palm since the last 2 months. Local examination showed a nontender mass on the medial aspect of the lower half of the left arm; the mass was firm in consistency and located in the intermuscular plane. There was no Tinel's sign. There were no signs of distal neurological involvement. There was no evidence of lymphadenopathy or hepatosplenomegaly. Magnetic resonance imaging (MRI) of the left arm showed a T1 isointense, T2 hyperintense mass with intense homogeneous contrast enhancement within the lesion [Figure 1]. Hematological investigations and sonography of the abdomen were normal. The tumor was exposed by a longitudinal incision over the arm overlying the swelling. The tumor was found deeper to the muscle plane and was attached to the radial nerve in the radial groove. The cut section revealed a gray-white, fleshy tumor measuring 8 cm × 5 cm in size with a firm consistency. The tumor could be easily separated from the nerve and excised completely as is the experience with a typical nerve sheath tumor [Figure 2]. Histopathology showed discrete tumor cells arranged in a diffuse pattern with moderate pleomorphism admixed with small lymphocytes. The tumor cells showed moderate amount of clear cytoplasm with marked sclerosis and hyalinization. Immunohistochemically, the tumor cells were positive for leukocyte common antigen (LCA) and cluster of differentiation (CD) 20, and negative for CD3, pancytokeratin, and S100 [Figure 3], [Figure 4], [Figure 5]. These features were suggestive of a diffuse large B-cell lymphoma. The patient is undergoing chemotherapy and is being followed up.
Figure 1: T1 contrast MRI image showing evidence of tumor in the middle and lower 3rd of the right arm with an intense homogeneous contrast enhancement

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Figure 2: The cut section of the tumor revealed a gray white, fleshy tumor measuring 8 cm × 5 cm in size with a firm consistency

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Figure 3: Microphotograph showing discrete tumor cells in a diffuse pattern with clear cytoplasm, irregular nuclear contour and hyalinisation (hematoxylin and eosin ×40)

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Figure 4: Immunohistochemistry for leukocyte common antigen (LCA) showing diffuse membranous positivity in tumor cells

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Figure 5: Immunohistochemistry for CD20 showing diffuse membranous positivity

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The most common tumors of peripheral nerves are schwannomas and neurofibromas. Primary lymphomas of peripheral nerves are very rare. Only 14 cases of peripheral lymphoma of the peripheral nerve have been reported so far [Table 1].
Table 1: Patients of peripheral nerve lymphoma reported so far

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The sciatic nerve is the most commonly involved nerve. Only two cases of lymphoma arising from the radial nerve have been reported so far, one of which had associated lymph node involvement and hence cannot be considered as a primary lymphoma [1], and the other was a primary lymphoma of the radial nerve.[2] The association of autoimmune disorders have been found in the reports of Misdraji et al.,[1] and Descamps et al.[3] Most of the extranodal lymphomas are thought to arise from the lymphoid tissue in the extranodal sites, as in the stomach, thyroid gland, lung, and salivary gland in response to some antigenic stimuli (“mucosa-associated lymphoid tissue”).[1] However, extranodal lymphomas are also found to arise from organs without “mucosa-associated lymphoid tissue”[1] such as the central nervous system, bone, gonads, kidney, soft tissue, and peripheral nerves.[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12] The majority of reported cases of peripheral nerve lymphomas, including the present case, have been diffuse large B-cell lymphomas. Only two reported cases have been T-cell tumors. The optimal adjuvant treatment has not been established so far. Majority of the reported cases underwent chemotherapy. A few authors administered prophylactic radiotherapy to the central nervous system because of the presumed association of central nervous system lymphoma. Our patient is only the second reported case of primary lymphoma arising from the radial nerve.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Misdraji J, Ino Y, Louis DN, Rosenberg AE, Chiocca EA, Harris NL. Primary lymphoma of peripheral nerve: Report of four cases. Am J Surg Pathol 2000;24:1257-65.  Back to cited text no. 1
    
2.
Gonzalvo A, McKenzie C, Harris M, Biggs M. Primary non-Hodgkin's lymphoma of the radial nerve: Case Report. Neurosurgery 2010;67:E872-3.  Back to cited text no. 2
    
3.
Descamps MJ, Barrett L, Groves M, Yung L, Birch R, Lunn MP,et al. Primary sciatic nerve lymphoma: A case report and review of the literature. J Neurol Neurosurg Psychiatry 2006;77:1087-9.  Back to cited text no. 3
    
4.
Purohit DP, Dick DJ, Perry RH, Lyons PR, Schofield IS, Foster JB. Solitary extranodal lymphoma of sciatic nerve. J Neurol Sci 1986;74:23-34.  Back to cited text no. 4
    
5.
Pillay PK, Hardy RW Jr, Wilbourn AJ, Tubbs RR, Lederman RJ. Solitary primary lymphoma of the sciatic nerve: Case report. Neurosurgery 1988;23:370-1.  Back to cited text no. 5
    
6.
Eusebi V, Bondi A, Cancellieri A, Canedi L, Frizzera G. Primary malignant lymphoma of sciatic nerve: Report of a case. Am J Surg Pathol 1990;14:881-5.  Back to cited text no. 6
    
7.
Teissier J. Primary malignant lymphoma localized in the trunk of the ulnar nerve at the elbow. A case report. Ann Chir Main Memb Super 1992;11:170-2.  Back to cited text no. 7
    
8.
Kanamori M, Matsui H, Yudoh K. Solitary T-cell lymphoma of the sciatic nerve: Case report. Neurosurgery 1995;36:1203-5.  Back to cited text no. 8
    
9.
Roncaroli F, Poppi M, Riccioni L, Frank F. Primary non-Hodgkin's lymphoma of the sciatic nerve followed by localization in the central nervous system: Case report and review of the literature. Neurosurgery 1997;40:618-21.  Back to cited text no. 9
    
10.
Kim J, Kim YS, Lee EJ, Kang CS, Shim SI. Primary CD56-positive NK/T-cell lymphoma of median nerve: A case report. J Korean Med Sci 1998;13:331-3.  Back to cited text no. 10
    
11.
Rota S, Zincone A, Piatti M,et al. Solitary sciatic nerve lymphoma. J Peripher Nerv Syst 2006;11:204.  Back to cited text no. 11
    
12.
Kaku MV, Savardekar AR, Muthane Y, Arivazhagan A, Rao MB. Primary central nervous system dural-based anaplastic large cell lymphoma: Diagnostic considerations, prognostic factors, and treatment modalities. Neurol India 2017;65:402-5.  Back to cited text no. 12
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