A fatal back pain: report of two cases of diffuse large B cell/Burkitt-like nervous system lymphoma

Lumbosacral epidural lymphoma: A case report and comprehensive review of literature

Key Clinical Message

Epidural lymphoma of the lumbosacral region is a rare condition that manifests with back pain and nonspecific neurological symptoms. Our case which was diagnosed with diffuse large B-cell lymphoma, highlights the importance of recognizing early lymphoma symptoms to enable timely treatment and improved outcomes.

Abstract

Lymphoma rarely presents in the lumbosacral epidural space. Initial presentations of lymphoma are of paramount importance in the timely diagnosis and management of the disease. We report a 42-year-old woman presented with 4 years of low back pain and progressive right lower extremity paresthesia. Lumbar MRI revealed an epidural soft tissue lesion compressing nerves at L4 to the coccyx. Laminectomy and tumor resection were performed. Pathologic findings confirmed diffuse large B-cell lymphoma. We systematically reviewed the literature on lymphomas with lumbar epidural space involvement reported since 1990. Twenty-four cases from 19 reports were identified. The mean age of lumbar epidural lymphoma cases was 39.5 ± 17.8 years, and 72% were male. The most common subtype was diffuse large B-cell lymphoma, and common presentations included back pain, lower extremity neurological deficits, and bowel/bladder dysfunction. Overall, lymphomas presenting in the spine can pose diagnostic challenges owing to nonspecific initial symptoms. Our case highlights the importance of recognizing early lymphoma symptoms to enable timely treatment and improved outcomes.