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Table of Contents    
NEUROIMAGES
Year : 2018  |  Volume : 66  |  Issue : 2  |  Page : 580-581

Lumbosacral nerve root lesion with malignant lymphoma


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 Publication15-Mar-2018

Correspondence Address:
Dr. Haruo Nishijima
Department of Neurology, Aomori Prefectural Central Hospital, 2-1-1 Higashi-tsukurimichi, Aomori City, Aomori 030-8553
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.227301

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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 2019 Oct 15];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.[1] However, infiltration of the peripheral nervous system by the lymphoma cells, termed as “neurolymphomatosis,” is a rare presentation of the disease.[2],[3],[4],[5]
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.



 
  References Top

1.
Seilanian-Toosi F, Shams M, Akhavan R, Abbasi B. Multiple cranial nerve enhancement as a rare presentation of secondary brain lymphoma. Neurol India 2018;66:270-2.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Baehring JM, Damek D, Martin EC, Betensky RA, Hochberg EH. Neurolymphomatosis. Neuro-Oncol. 2003;5:104-115.  Back to cited text no. 2
    
3.
Brandstadter R, Brody J, Morgello S, Motiwala R, Shin S, Lublin F, Zhou L. Primary neurolymphomatosis presenting with polyradiculoneuropathy affecting one lower limb. J Clin Neuromuscul Dis. 2015;17:6-12.  Back to cited text no. 3
    
4.
Broen M, Draak T, Riedl RG, Weber WE. Diffuse large B-cell lymphoma of the cauda equine. BMJ Case Rep 2014;2014. bcr2014205950.  Back to cited text no. 4
    
5.
Tsai MC, Non-Hodgkin's B-cell lymphoma of a lumbar nerve root: A rare cause of lumbar radiculopathy. J Clin Neurosci 2013;20:1029-31.  Back to cited text no. 5
    


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