Recurrence of nasal type NK/T cell lymphoma presenting as neurolymphomatosis on 18F-FDG PET/CT: A case report and literature review

Neurolymphomatosis as primary presentation of extra-nodal NK/T-cell lymphoma, nasal type

Neurolymphomatosis (NL) describes an infiltration of cranial and peripheral nerves by lymphoma cells, most frequently in non-Hodgkin B-cell lymphoma. This clinical entity is rare and poses a challenging diagnosis. We describe a case of a 64-year-old female patient with NL associated with extra-nodal NK/T-cell lymphoma (ENKTL), nasal type, presenting as a painful progressive mononeuropathy multiplex with an oral cavity lesion. ENKTL is usually associated with Epstein-Barr virus (EBV) infection and rarely affects the central and peripheral nervous system. Lumbar puncture, magnetic resonance imaging (MRI), nerve biopsy, and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) help to establish the diagnosis. Thereby, NL should be considered in the differential diagnosis of painful progressive multiple neuropathies, even in patients without previous history of cancer.

Extranodal Natural Killer/T-cell Lymphoma With an Unusual Presentation: A Case Report and Literature Review

The Epstein-Barr virus is closely linked to a lymphoproliferative disease known as natural killer/T-cell lymphoma (NKTL). Early identification of NKTL might be challenging because it can resemble other nasopharyngeal pathologies. Contrary to the presented case, T-cell lymphoma often develops in the nasal canal and spreads to the oral cavity. Here, we present the case of a 45-year-old man with an unusual presentation of NKTL presenting initially as acute follicular tonsillitis.

Lumbosacral Plexus Neurolymphomatosis: A Typical 18FDG PET/CT Pattern to Recognize

ABSTRACT

A 79-year-old man anteriorly treated for primary central nervous system diffuse large B-cell lymphoma with MRI complete response after immunochemotherapy was referred 1 year later for 18FDG PET/CT because of right persistent lombosciatic radicular pain for 6 months with negative medullary and spine MRI and negative cerebrospinal fluid cytology. Linearly intense uptake was observed in several roots of lumbosacral plexus, highly suggestive of peripheral neurolymphomatosis relapse. No specific treatment was engaged because of rapid decrease of performance status leading to death.

Primary Extranodal NK/T-Cell Lymphoma Presenting as Neurolymphomatosis Involving Multiple Cranial Nerves: A Case Report

Neurolymphomatosis (NL) is a rare condition caused by the lymphomatous or leukemic infiltration of nerves and manifests as neuropathy. Most often, NL is associated with B-lineage non-Hodgkin lymphoma (NHL) and only infrequently occurs in conjunction with T- or NK-lineage NHL. Extranodal NK/T-cell lymphoma (ENKTL)-associated NL is exceedingly unusual, with only 9 cases described in the English language literature, in addition to our case. Diagnosis of NL is challenging, as the entity can mimic neuropathies of more common etiologies, and an adequate biopsy may be difficult to obtain. Timely diagnosis demands a high index of suspicion, especially for patients without a history of hematologic malignancy. We expand upon a unique case of NL exclusively involving cranial nerves and cauda equina nerve roots, as the initial manifestation of ENKTL, and contextualize our findings within the framework of previously reported NK/T-lineage NL cases.