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|Year : 2018 | Volume
| Issue : 2 | Page : 580-581
Lumbosacral nerve root lesion with malignant lymphoma
Haruo Nishijima1, Tomoaki Akagi2, Tatsuya Ueno1, Tomoya Kon1, Rie Haga1, Yukihisa Funamizu1, Akira Arai1, Chieko Suzuki1, Jin-ichi Nunomura1, Masayuki Baba1, Masahiko Tomiyama1
1 Department of Neurology, Aomori Prefectural Central Hospital, Aomori City, Aomori, Japan
2 Department of Hematology, Aomori Prefectural Central Hospital, Aomori City, Aomori, Japan
|Date of Web Publication||15-Mar-2018|
Dr. Haruo Nishijima
Department of Neurology, Aomori Prefectural Central Hospital, 2-1-1 Higashi-tsukurimichi, Aomori City, Aomori 030-8553
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nishijima H, Akagi T, Ueno T, Kon T, Haga R, Funamizu Y, Arai A, Suzuki C, Nunomura Ji, Baba M, Tomiyama M. Lumbosacral nerve root lesion with malignant lymphoma. Neurol India 2018;66:580-1
|How to cite this URL:|
Nishijima H, Akagi T, Ueno T, Kon T, Haga R, Funamizu Y, Arai A, Suzuki C, Nunomura Ji, Baba M, Tomiyama M. Lumbosacral nerve root lesion with malignant lymphoma. Neurol India [serial online] 2018 [cited 2020 Jun 1];66:580-1. Available from: http://www.neurologyindia.com/text.asp?2018/66/2/580/227301
A 66-year old man presented with a one-year history of progressive pain and weakness in his left leg. Neurological examination showed severe paresis, muscle atrophy, areflexia of the left leg, and dysesthesia and hypoesthesia in L5, S1, S2 dermatome, all of which suggested a lumbosacral polyradiculopathy. Routine hematological examinations were within normal limits. Cerebrospinal fluid examination showed an elevated protein level (83 mg/dl) with slight pleocytosis (13 cells/mm 3). Cytological analysis of the cerebrospinal fluid showed no malignancy. Needle electromyography showed diffuse signs of denervation of the nerves related to L5 and S1 nerve roots. Enhanced computed tomography presented an intrapelvic tumor-like lesion [Figure 1]a and [Figure 1]b. The lesion seemed to protrude to the pelvis through the anterior sacral foramina. Lumbosacral magnetic resonance imaging (MRI) revealed a left-side dominant swelling in L5, S1, and S2 nerve roots [Figure 1]c. Sagittal [Figure 1]d and coronal [Figure 1]e T1-weighted MRI image showed a distinct gadolinium-enhancement of the left lumbosacral nerve roots. Initial whole-body examination revealed no other lesions. He received intravenous immunoglobulin and steroid therapy after a tentative diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy had been made. Leg pain was temporarily relieved, although leg weakness and muscle atrophy never recovered. Soluble interleukin-2 receptor was elevated to 2070 U/ml. Finally, a repeated cytological examination of the cerebrospinal fluid and random skin biopsy revealed large atypical cells positive for CD 20 and he was diagnosed as having a diffuse large B-cell lymphoma. Malignant lymphoma is a common disease and an occasional cranial nerve infiltration has been described. However, infiltration of the peripheral nervous system by the lymphoma cells, termed as “neurolymphomatosis,” is a rare presentation of the disease.,,,
|Figure 1: (a and b) Intrapelvic tumor-like lesion seen on computed tomographic images. (c) Swelling in the lumbosacral nerve roots in nerve root imaging by diffusion-weighted magnetic resonance imaging. (d) Gadolinium-enhancement of the left nerve roots on sagittal T1-weighted imaging. (e) Gadolinium-enhancement of the left S2 nerve root on coronal T1-weighted imaging|
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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
We have no financial support or relationships that may pose conflict of interest.
Conflicts of interest
There are no conflicts of interest.
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