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Tang C, Jiang P, Tang J, Liao J, Zeng Q. Diffuse large B-cell lymphoma with contemporary involvement of central and peripheral nervous system: A case report and literature review. Heliyon 2024; 10:e28552. [PMID: 38560176 PMCID: PMC10981111 DOI: 10.1016/j.heliyon.2024.e28552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Simultaneous involvement of the peripheral nervous system (PNS) and central nervous system (CNS) during the same period in diffuse large B-cell lymphoma (DLBCL) is rarely documented. In this particular case, the diagnosis of diffuse large B-cell lymphoma was pathologically confirmed, with invasion into the basal ganglia, diencephalon, and several peripheral nerves. The initial clinical manifestations were dyspnoea and hyperventilation. Case presentation The patient presented to the hospital with fatigue, dyspnoea, and limb pain for over 7 months, accompanied by progressive breathlessness and unconsciousness in the last 6 days. Initial treatment with glucocorticoids for Guillain-Barre syndrome (GBS) proved ineffective in controlling the severe shortness of breath and hyperventilation, necessitating the use of ventilator-assisted ventilation. 18-Fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET/CT) showed that the basal ganglia, brainstem, and multiple peripheral nerves were thickened and metabolically active. There were atypical cells in the cerebrospinal fluid; the pathology indicated invasive B-cell lymphoma, demonstrating a propensity toward diffuse large B-cell lymphoma (DLBCL). After receiving chemotherapy, the patient regained consciousness and was successfully weaned off ventilator assistance but died of severe pneumonia. Discussion The early clinical manifestations of DLBCL lack specificity, and multifocal DLBCL complicates the diagnostic process. When a single primary disease cannot explain multiple symptoms, the possibility of DLBCL should be considered, and nervous system invasion should be considered when nervous system symptoms are present. Once nervous system involvement occurs in DLBCL, whether the central or peripheral nervous system, it indicates a poor prognosis.
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Affiliation(s)
- Chuwen Tang
- Department of Emergency Medicine, Luohu District People's Hospital, Shenzhen, 518001, China
| | - Peng Jiang
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jinhui Tang
- GMU-GIBH Joint School of Life Sciences, Guangzhou Medical University, Guangzhou, 510182, China
| | - Jinli Liao
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qingli Zeng
- Department of Emergency Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
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Wu D, Liu H, Hao L, Han X, Wang S, Xiang Y, Yu S, Wang Y. Primary peripheral nerve lymphoma: a case report and literature review. Neurol Sci 2024; 45:1447-1454. [PMID: 37991640 DOI: 10.1007/s10072-023-07192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/29/2023] [Indexed: 11/23/2023]
Abstract
Neurolymphomatosis (NL) is an uncommon malignant lymphoma characterized by selective infiltration of the central and peripheral nervous system. In this case report, we present a patient diagnosed with diffuse large B-cell lymphoma who initially manifested with peripheral neuropathy, primarily characterized by weakness of the left lower limb. By exploring its clinical manifestations, ancillary tests, and reviewing the relevant literature, we aim to deepen our understanding, diagnosis, and treatment of this disease. A 48-year-old male patient presented to the Department of Neurology, Hematology, and Neurosurgery with complaint of left lower limb weakness that had persisted for over 11 months. Initial laboratory tests and cerebrospinal fluid analysis yielded negative results. Electromyography examination indicated damage to the left lumbar plexus and iliac plexus nerves raising suspicions of nerve root involvement. Enhanced MRI of the lumbosacral plexus nerves revealed thickening and enhanced signals in left nerve roots at T12-L1, L1-2, and L3-4 levels. Additionally, local thickening and enhancement of signals were observed in the left erector spine muscle, psoas major, and iliopsoas muscles compared to the contralateral side. PEC/CT imaging displayed multiple soft tissue density shadows in the left foraminal area at the T12-1 and L1-2 levels. Bone marrow examination excluded hematological disease. Subsequent biopsy of the left foraminal nerve root at T12-L1 and the vertebral muscle at L3 level confirmed a diagnosis of diffuse large B-cell malignant lymphoma, indicating PNSL due to the involvement of multiple nerve roots. Following diagnosis, the patient underwent chemotherapy, resulting in the alleviation of his symptoms. Diagnosing PNSL can be challenging due to the nonspecific clinical manifestations and often inconclusive laboratory test results. Misdiagnosis and delayed diagnosis are common pitfalls. Electromyography may reveal damage to the affected peripheral nerves, while MR imaging might show nerve root thickening, and PET/CT can demonstrate increased lesion uptake. However, the definitive diagnosis relies on a biopsy of the lesion. Treatment for PNSL typically involves chemotherapy.
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Affiliation(s)
- Di Wu
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education & Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, China
| | - Hui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education & Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, China
| | - Lingyu Hao
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education & Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, China
| | - Xu Han
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education & Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, China
| | - Sihan Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education & Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, China
| | - Yijia Xiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
- Tianjin Neurological Institute, Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education & Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, China
| | - Shizhu Yu
- Tianjin Neurological Institute, Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education & Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, China.
| | - Yi Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China.
- Tianjin Neurological Institute, Key Laboratory of Post-Trauma Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education & Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, China.
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3
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Silva MI, Santos P, Viegas D, Miranda M, Montes V, Pita F, Carmona C. Neurolymphomatosis as primary presentation of extra-nodal NK/T-cell lymphoma, nasal type. Neurol Sci 2024:10.1007/s10072-024-07445-4. [PMID: 38472552 DOI: 10.1007/s10072-024-07445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/03/2024] [Indexed: 03/14/2024]
Abstract
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.
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Affiliation(s)
- Maria Inês Silva
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal.
| | - Pedro Santos
- Department of Hematology, Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal
| | - Diana Viegas
- Department of Hematology, Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal
| | - Miguel Miranda
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal
| | - Vera Montes
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal
| | - Fernando Pita
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal
| | - Cátia Carmona
- Department of Neurology, Hospital de Cascais Dr. José de Almeida, Cascais, Portugal
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4
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Leung SL, Daniels SP, Hacquebord JH, Ward N, Adler RS. Pronator syndrome and anterior interosseous nerve palsy due to neurolymphomatosis: a case report. Skeletal Radiol 2024; 53:577-582. [PMID: 37566147 DOI: 10.1007/s00256-023-04410-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/22/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
Pronator syndrome is a median nerve entrapment neuropathy that can be difficult to diagnose due to its variable presentation and objective findings. Neurolymphomatosis is an uncommon disease in which malignant lymphocytes infiltrate central or peripheral nerve endoneurium and is often missed for prolonged periods prior to diagnosis. We present a rare case of pronator syndrome and anterior interosseous nerve palsy due to neurolymphomatosis that was occult on initial MRI in spite of the presence of a median nerve mass discovered intra-operatively during neurolysis. This case demonstrates the value of ultrasound for the examination of peripheral nerve pathology and illustrates its utility as an adjunct to MRI, in part due to the ability to screen a large region.
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Affiliation(s)
- Sophie L Leung
- Department of Radiology, NYU Langone Health, Langone Orthopedic Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA.
| | - Steven P Daniels
- Department of Radiology, NYU Langone Health, Langone Orthopedic Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA
| | - Jacques H Hacquebord
- Division of Hand Surgery, Department of Orthopedic Surgery; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, 530 1st Avenue, Suite 8U, New York, NY, 10016, USA
| | - Nicholas Ward
- Department of Pathology, NYU Langone Health, 240 East 38th Street, 22nd Floor, New York, NY, 10016, USA
| | - Ronald S Adler
- Department of Radiology, NYU Langone Health, Langone Orthopedic Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA
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5
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Soleimani H, Khoroushi F, AtaeiAzimi S, Jafarian A, Salarzaei O, Aminzadeh B. Recurrence of diffuse large B-cell lymphoma in sciatic and tibial nerves: A case report. Radiol Case Rep 2024; 19:535-539. [PMID: 38044904 PMCID: PMC10686859 DOI: 10.1016/j.radcr.2023.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 12/05/2023] Open
Abstract
Infiltration of peripheral or cranial nerves with lymphatic cells is a rare condition that is known as neurolymphomatosis (NL). The involvement could be primary or secondary and mostly occurs in patients with a history of B-cell lymphoma. The most common peripheral nerve involved is the sciatic nerve. Patients may present with painful or painless mononeuropathy or polyneuropathy, and MRI is the perfect modality to evaluate the suspicious clinical findings that may demonstrate enlargement, thickening, and enhancement of the involved nerve or an enhancing mass lesion in the course of the nerve. Biopsy can be safely performed to confirm the diagnosis. Few articles have reported the cases of peripheral nerve involvement by lymphoma as well as MRI features of this diagnosis. In this article, we report a case of NL using MRI, ultrasound, and pathologic features and also present a brief review of relevant literature.
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Affiliation(s)
- Hourieh Soleimani
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzaneh Khoroushi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sajad AtaeiAzimi
- Department of Hematology-Oncology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - AmirHossein Jafarian
- Department of Pathology, Pathology Cancer Molecular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Omid Salarzaei
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Aminzadeh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Rohatgi S, Nirhale S, Rao P, Naphade P, Khan F. Neurolymphomatosis as an Initial Presentation of Non Hodgkins Lymphoma: A Case Report. Neurol India 2023; 71:991-993. [PMID: 37929441 DOI: 10.4103/0028-3886.388126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Neurolymphomatosis (NL) is a rare clinical disease where neoplastic cells invade the cranial nerves, roots, plexus, or other peripheral nerves in patients with hematologic malignancy mainly Non-Hodgkins Lymphoma(NHL). Primary NL occurs as the first manifestation of a hematologic malignancy. We report a 68-year male who presented to us with low backache and burning paraesthesia in the back of both lower limbs followed by a left foot drop. The clinical and electrophysiological examination was suggestive of bilateral lumbosacral radiculopathy involving L2-S1 roots. Plain MRI of the lumbosacral spine was normal. F18FDG PET CT Scan revealed increased uptake in both L5 and left L3 roots. Contrast-enhanced MRI of the lumbosacral spine showed marked fusiform thickening and enhancement of both L5 and left L3 roots CT-guided Biopsy from left L5 root, lymph node, and bone marrow was suggestive of large B cell lymphoma-germinal center cell type. The diagnosis was neurolymphomatosis secondary to NHL.
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Affiliation(s)
- Shalesh Rohatgi
- Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Satish Nirhale
- Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Prajwal Rao
- Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Pravin Naphade
- Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Furqan Khan
- Department of Neurology, Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
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7
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Wada A, Uchida Y, Hokkoku K, Kondo A, Fujii Y, Chiba T, Matsuo T, Tsukamoto H, Hatanaka Y, Kobayashi S, Sonoo M. Utility of nerve ultrasound in the management of primary neurolymphomatosis: Case report and review of the literature. Clin Neurophysiol Pract 2023; 8:92-96. [PMID: 37255717 PMCID: PMC10225816 DOI: 10.1016/j.cnp.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/08/2023] [Accepted: 04/16/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Primary neurolymphomatosis (NL) is a critical differential diagnosis of asymmetric multiple mononeuropathy and radiculoplexopathy. Its diagnosis is often challenging due to the lack of typical clinical signs of systemic lymphoma. We report a case of primary NL where nerve ultrasound (NUS) played an important role in the diagnosis and follow-up of the disease. Case presentation A 52-year-old man developed asymmetric painful multiple mononeuropathy in the right upper limb with cranial nerve involvement. After being referred to our department, the patient underwent NUS, which revealed marked enlargement and increased vascularity in the right upper limb nerves, brachial plexus, and cervical nerve roots. Furthermore, an epineural hypoechoic mass, a characteristic finding of NL, was seen in the right median nerve. These NUS findings prompted us to perform 18F-fluorodeoxyglucose positron emission tomography/computed tomography and a subsequent biopsy on the right axillary lymph node, confirming NL. Notably, the NUS abnormalities dramatically subsided, demonstrating the effectiveness of chemotherapy. Discussion The diagnostic utility of NUS for NL has been documented by many recent reports. Additionally, NUS can work as a quick follow-up tool for NL, as seen in our case.
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Affiliation(s)
- Arena Wada
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Yudai Uchida
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Keiichi Hokkoku
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Amuro Kondo
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Yuki Fujii
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Takashi Chiba
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Takuji Matsuo
- Department of Hematology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | | | - Yuki Hatanaka
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Shunsuke Kobayashi
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
| | - Masahiro Sonoo
- Department of Neurology, Teikyo University School of Medicine, Tokyo 173-8606, Japan
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Miyajima T, Ogasawara R, Tsukamoto S, Ishio T, Yokoyama E, Izumiyama K, Mori A, Saito M, Morioka M, Kondo T. Thiotepa-based high-dose chemotherapy with autologous stem cell transplantation for neurolymphomatosis. Int J Hematol 2023. [PMID: 36689064 DOI: 10.1007/s12185-023-03544-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
Neurolymphomatosis (NL) is a rare clinical entity characterized by lymphomatous infiltration of the peripheral nervous system. According to recent retrospective data, consolidative high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) may be beneficial for NL. However, few reports to date have discussed optimal conditioning regimens. Herein, we report two cases of NL in patients with relapsed intravascular large B-cell lymphoma who received consolidative thiotepa-containing HDC-ASCT. Case 1: A 56-year-old woman who relapsed 2 months after the first complete remission (CR) and underwent ASCT. Case 2: A 65-year-old woman who relapsed 8 months after the first CR and underwent ASCT. Both patients engrafted. Time to neutrophil engraftment was 10 and 12 days after HDC-ASCT, and CR was sustained for 26 and 18 months, respectively, as of the last follow-up. Although there is little evidence supporting the utility of thiotepa-based HDC-ASCT in patients with NL, the results of this case report suggest that further studies are warranted to determine its efficacy in this setting.
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Lopez AR, Sohani AR, O’Shea A, Ng TS. Neurolymphomatosis in Recrudescent Diffuse Large B-cell Lymphoma. Asia Ocean J Nucl Med Biol 2023; 11:89-92. [PMID: 36619186 PMCID: PMC9803627 DOI: 10.22038/aojnmb.2022.66666.1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 01/10/2023]
Abstract
Neurolymphomatosis is an uncommon manifestation of lymphoma, often presenting with painful polyneuropathy or polyradiculopathy and concomitant distal extremity weakness. Differentiation from other etiologies resulting in similar neuropathic symptoms such as compressive or inflammatory pathologies can be difficult and often results in delayed diagnosis. Here we describe a case of neurolymphomatosis affecting a 64-year-old man with a history of diffuse large B-cell lymphoma (DLBCL) in remission presenting with a right-sided foot drop following a gunshot wound. MRI at that time demonstrated thickening and enhancement of the cauda equina nerve roots. Over the course of the subsequent eight months, he developed left lower extremity sensory symptoms, left-sided foot drop and signs of upper motor neuron involvement, including left facial weakness, dysphonia, and dysphagia. 18F-FDG PET/CT revealed intensely avid left lumbosacral nerve roots, bilateral lower extremity and left upper extremity neurovascular bundles. Left sural nerve biopsies showed infiltration of DLBCL and confirmed neurolymphomatosis. We highlight the role of 18F-FDG PET/CT, with histological verification, for the diagnosis of an extended course of neurolymphomatosis occurring in the absence of typical painful neuropathy but with cranial and peripheral neuropathies.
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Affiliation(s)
| | - Aliyah R. Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Aileen O’Shea
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas S.C. Ng
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, MA, USA,Corresponding author: Thomas S.C. Ng. Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, White 4, 55 Fruit St, Boston MA 02114. Tel: (617) 732-5938; Fax: (617) 726 6165;
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Okamura‐Shiki I, Asakura K, Ikeda T. Neurolymphomatosis as a manifestation of relapsed diffuse large B-cell lymphoma. EJHaem 2022; 3:1396-1397. [PMID: 36467846 PMCID: PMC9713069 DOI: 10.1002/jha2.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Ikue Okamura‐Shiki
- Division of Haematology and Stem Cell TransplantationShizuoka Cancer CenterShizuokaJapan
| | - Koiku Asakura
- Division of Diagnostic RadiologyShizuoka Cancer CentreShizuokaJapan
| | - Takashi Ikeda
- Division of Haematology and Stem Cell TransplantationShizuoka Cancer CenterShizuokaJapan
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11
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Arçay A, Bural GG, Şenol U. Neurolymphomatosis with Spinal Nerve Root Involvement Demonstrated on 18F-FDG PET/CT. Mol Imaging Radionucl Ther 2022; 31:242-243. [PMID: 36268937 PMCID: PMC9585998 DOI: 10.4274/mirt.galenos.2021.05902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 56 years old woman with a diagnosis of diffuse large B-cell lymphoma had dyspnea, weakness in the left upper extremity and vocal cord paralysis after chemotherapy. She underwent cervical, thoracal and lumbosacral magnetic resonance imaging (MRI) however findings on MRI could not entirely explain the symptoms of the patient. Therefore, the patient underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography and the scan revealed focal symmetrical 18F-FDG uptake on the cervical, thoracal and lumbal spinal nerve roots. Considering the symptoms of the patient and cerebrospinal fluid cytology findings, hypermetabolic spinal nerve roots were interpreted as lymphoma involvement.
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Affiliation(s)
- Ayça Arçay
- Akdeniz University Faculty of Medicine, Department of Nuclear Medicine, Antalya, Turkey
| | - Gonca Gül Bural
- Akdeniz University Faculty of Medicine, Department of Nuclear Medicine, Antalya, Turkey
| | - Utku Şenol
- Akdeniz University Faculty of Medicine, Department of Radiology, Antalya, Turkey
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Doran S, Lambe G, Nasoodi A. Claw sign of brachial plexopathy on 18F-FDG PET/CT in neurolymphomatosis following successful treatment of lymphoma. Eur J Hybrid Imaging 2022; 6:11. [PMID: 35641583 PMCID: PMC9156605 DOI: 10.1186/s41824-022-00132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 11/10/2022] Open
Abstract
Neurolymphomatosis is a rare neurological manifestation associated with non-Hodgkin’s lymphoma. Here we present a case of brachial plexus neurolymphomatosis in a patient with relapsed non-Hodgkin’s lymphoma exquisitely demonstrated on 18F-FDG PET/CT. It highlights the characteristic imaging features and importance of multimodality imaging in diagnosing neurolymphomatosis.
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Affiliation(s)
- Simon Doran
- Radiology Department, St James Hospital, Dublin, Ireland
| | - Gerard Lambe
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Afshin Nasoodi
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland.
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13
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Barahona D, Adlerstein I, Donoso J, Mercado F. Sciatic and median nerve neurolymphomatosis as initial presentation of B-cell lymphoma. Radiologia (Engl Ed) 2022; 64:266-269. [PMID: 35676058 DOI: 10.1016/j.rxeng.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/08/2020] [Indexed: 10/18/2022]
Abstract
Neurolymphomatosis (NL) is the infiltration of cranial nerves or nerves and roots from the peripheral nervous system by lymphoma, usually by B-cell non-Hodgkin's lymphoma. It is uncommon as initial presentation of the disease and can lead to extremely heterogeneous clinical manifestations. We report the case of a 72-year old male who presented with numbness of the right hand, progressive weakness in both lower limbs and weight loss. 18F-FDG PET/CT showed bilateral hypermetabolic adrenal masses, gastric ulcer, small hypermetabolic adenopathies, multiple focal bone marrow uptake and intense uptake in both sciatic nerves and right median nerve. A node and gastric biopsy confirmed diffuse large-B-cell lymphoma, activated B cell type, with posterior resolution of peripheral nerves uptake after beginning chemotherapy.
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Affiliation(s)
- D Barahona
- Departamento de Imagenología, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Vitacura, Santiago, Chile.
| | - I Adlerstein
- Departamento de Imagenología, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Vitacura, Santiago, Chile
| | - J Donoso
- Departamento de Hematología, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Vitacura, Santiago, Chile
| | - F Mercado
- Departamento de Imagenología, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Vitacura, Santiago, Chile
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14
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Abstract
Though metastasis and malignant infiltration of the peripheral nervous system is relatively rare, physicians should have a familiarity with their presentations to allow for prompt diagnosis and initiation of treatment. This article will review the clinical presentations, diagnostic evaluation, and treatment of neoplastic involvement of the cranial nerves, nerve roots, peripheral nerves, and muscle. Due to the proximity of the neural structure traversing the skull base, metastasis to this region results in distinctive syndromes, most often associated with breast, lung, and prostate cancer. Metastatic involvement of the nerve roots is uncommon, apart from leptomeningeal carcinomatosis and bony metastasis with resultant nerve root damage, and is characterized by significant pain, weakness, and numbness of an extremity. Neoplasms may metastasize or infiltrate the brachial and lumbosacral plexuses resulting in progressive and painful sensory and motor deficits. Differentiating neoplastic involvement from radiation-induced injury is of paramount importance as it dictates treatment and prognosis. Neurolymphomatosis, due to malignant lymphocytic infiltration of the cranial nerves, nerve roots, plexuses, and peripheral nerves, deserves special attention given its myriad presentations, often mimicking acquired demyelinating neuropathies.
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15
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Lee YC, Juhng SK, Kang HJ. Neurolymphomatosis of the Ulnar Nerve Presenting as Cubital Tunnel Syndrome: A Case Report. J Hand Surg Asian Pac Vol 2022; 27:394-397. [PMID: 35443886 DOI: 10.1142/s242483552272016x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lymphoma is a malignant tumour of the lymphatic system. Neurolymphomatosis occurs when lymphoma cells invade the peripheral nervous system (PNS). Neurolymphomatosis has been reported involving the sciatic nerve, nerve roots and within the axilla and the upper arm. It can cause nerve dysfunction depending on the involved nerve. Neurolymphomatosis involving the ulnar nerve is rare. We report a patient with neurolymphomatosis of the ulnar nerve around the elbow that presented with features of cubital tunnel syndrome. A high index of suspicion is necessary in patients with cubital tunnel syndrome that present with uncommon symptoms such as sudden onset, rapid progression and/or severe pain. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Yeong Chang Lee
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, South Korea
| | - Seon Kwan Juhng
- Department of radiology, Wonkwang University Hospital, Iksan, South Korea
| | - Hong Je Kang
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, South Korea
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Murakami K, Koh J, Taruya J, Ito H. Neurosarcoidosis Mimicking the Recurrence of Malignant Lymphoma. Case Rep Neurol 2021; 13:605-612. [PMID: 34703450 PMCID: PMC8460933 DOI: 10.1159/000518378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/02/2021] [Indexed: 11/19/2022] Open
Abstract
A 67-year-old woman with a recurrent history of malignant lymphoma (ML) presented with muscle weakness and paresthesia of the fingertips and feet. Due to the elevated level of serum soluble interleukin-2 receptor and increased 18F-fluorodeoxyglucose uptake in a mediastinal lymph node, neurolymphomatosis was initially suspected. Neurological and electrophysiological examinations were consistent with mononeuropathy multiplex. A diagnosis of neurosarcoidosis was made based on the presence of noncaseating epithelioid granulomas in the mediastinal lymph node, along with the presence of the uveitis, cardiac inflammation, and mononeuropathy multiplex. She was treated with glucocorticoids and azathioprine, and her symptoms disappeared. Sarcoidosis following ML is rare, and since biopsy of nervous systems is often improbable, differentiating neurosarcoidosis and neurolymphomatosis can be difficult as their clinical symptoms can be similar. Clinicians should consider systemic pathological investigations based on 18F-fluorodeoxyglucose positron emission tomography examination in addition to comprehensive evaluation to accurately diagnose neurosarcoidosis.
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Affiliation(s)
- Keishu Murakami
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - Jinsoo Koh
- Department of Neurology, Wakayama Medical University, Wakayama, Japan.,Department of Neurology, Social Insurance Kinan Hospital, Tanabe, Japan
| | - Junko Taruya
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
| | - Hidefumi Ito
- Department of Neurology, Wakayama Medical University, Wakayama, Japan
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17
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Peng L, Yang H, Zhao Y, He J, Stebbing J, Chen B. Neurolymphomatosis of multifocal peripheral nerve involvement: a case report. Ann Palliat Med 2021; 11:2529-2537. [PMID: 34670378 DOI: 10.21037/apm-21-2256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022]
Abstract
The infiltration and invasion of nerve trunks, nerve roots, and cranial nerves by lymphomatous malignant cells is defined as "neurolymphomatosis". It is mainly caused by lymphoma cells directly infiltrating the peripheral nerves, with a low incidence. Neurolymphomatosis is a rare condition of neoplastic endoneurial invasion, which is primary or secondary to non-Hodgkin's lymphoma and leukemia. We describe a case of primary peripheral neurolymphomatosis of multifocal involvement in a 77-year-old male patient. He presented with left lower limb pain and was diagnosed with CD20+ diffuse large B cell lymphoma (DLBCL). Magnetic resonance imaging (MRI), fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) computed tomography (CT), and nerve biopsy contributed to the diagnosis. Genomic profiling, programmed death ligand-1 (PD-L1) expression and tumor mutational burden (TMB) were also assessed. CDKN2A/CDKN2B deletions have been identified. PD-L1 expression assessed by 28-8 antibody was 1% positivity, and TMB of the sample was 11.6 muts/Mb. The patient responded well to rituximab combined with chemotherapy, however, he died after 3 cycles of chemotherapy due to severe lung infection and subsequent complication of respiratory failure. Here we report the clinical, radiological, pathological and molecular findings of the patient affected by multifocal neurolymphomatosis without systemic involvement of other organs.
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Affiliation(s)
- Ling Peng
- Department of Respiratory Disease, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Hanjin Yang
- Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yilei Zhao
- Department of Radiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jingsong He
- Department of Hematology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Justin Stebbing
- Division of Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bin Chen
- Department of Orthopedics, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Ghosh S, Azzi J, Chan AM, Nael K, Renteria AS, Steinberg A, Petersen BE. Primary Extranodal NK/T-Cell Lymphoma Presenting as Neurolymphomatosis Involving Multiple Cranial Nerves: A Case Report. Acta Haematol 2021; 145:97-105. [PMID: 34569490 DOI: 10.1159/000518797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Sharmila Ghosh
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacques Azzi
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy M Chan
- Department of Medical Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anne S Renteria
- Acute Leukemia & Stem Cell Transplant and Cellular Therapy Programs, Lipson Cancer Institute at Rochester Regional Health, Rochester, New York, USA
| | - Amir Steinberg
- Bone Marrow Transplant Program, Westchester Medical Center, Hawthorne, New York, USA
| | - Bruce E Petersen
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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19
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Abstract
We present a case of indolent neurolymphomatosis in a 55-year-old male patient with worsening pain and weakness in his right leg over the past few months. The patient has a past medical history of type II diabetes mellitus, four-year history of worsening left foot drop, left lower limb pain and weakness attributed to diabetic amyotrophy, and back pain. The new right-sided symptoms prompted further imaging which revealed a left sciatic nerve mass which was biopsied. Initial biopsy results were inconclusive. 18F-FDG PET/CT revealed the full extent of this patient's disease and helped plan for a more representative biopsy site, which finally established a diagnosis of diffuse large B-cell lymphoma involving the lumbosacral nerve roots. The patient underwent a course of chemotherapy. 18F-FDG PET/CT was ordered again at the end of treatment showing partial response to therapy. He underwent radiation therapy to the site of residual disease, with complete metabolic response of lesions on follow up PET CT.
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Affiliation(s)
| | | | - Ayah Megahed
- Yale New Haven Health-Bridgeport Hospital, United States of America
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20
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Pacoureau L, Labeyrie C, Catalan P, Echaniz-Laguna A, Henriquez S, Laparra A, Cauquil C, Chrétien P, Hacein-Bey-Abina S, Goujard C, Adam C, Lambotte O, Adams D, Noël N. Neuropathies périphériques associées aux syndromes lymphoprolifératifs : spectre clinique et démarche diagnostique. Rev Med Interne 2021; 42:844-854. [PMID: 34373143 DOI: 10.1016/j.revmed.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 10/20/2022]
Abstract
Lymphoproliferative syndromes (multiple myeloma, Waldenström's disease, chronic lymphocytic leukemia, lymphomas) may be associated with peripheral neuropathies. The mechanism can be dysimmune, associated or not with monoclonal gammopathies; paraneoplastic; infiltrative; or more commonly, iatrogenic or due to vitamin deficiency. The diagnosis can be complex, especially when the neuropathy is the presenting manifestation, requiring a close cooperation between internists and neurologists. The positive diagnosis of the neuropathy is based on a systematic electro-clinical investigation, which specifies the topography and the mechanism of the nerve damage, sometimes reinforced by imaging examinations, in particular, nerve and/or plexus MRI. The imputability of the neuropathy to a lymphoproliferative syndrome is based on a set of arguments including the clinical context (B signs, tumour syndrome), first-line laboratory tests (hemogram, protein electrophoresis, viral serologies, complement), auto-antibodies discussed according to the neuropathy (anti-MAG, anti-gangliosides) and sometimes more invasive examinations (bone marrow or neuro-muscular biopsies).
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Affiliation(s)
- L Pacoureau
- Service de médecine interne et immunologie clinique, Assistance publique-Hôpitaux Paris Saclay, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France
| | - C Labeyrie
- Service de neurologie, Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Sud, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France; Centre de référence neuropathies amyloïdes familiales et autres neuropathies rares (NNERF), Groupe hospitalier universitaire Paris Sud, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France
| | - P Catalan
- Service de médecine interne et immunologie clinique, Assistance publique-Hôpitaux Paris Saclay, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Saclay, Faculté de médecine, Le Kremlin Bicêtre, France
| | - A Echaniz-Laguna
- Université Paris Saclay, Faculté de médecine, Le Kremlin Bicêtre, France; Service de neurologie, Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Sud, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France; Centre de référence neuropathies amyloïdes familiales et autres neuropathies rares (NNERF), Groupe hospitalier universitaire Paris Sud, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France
| | - S Henriquez
- Service de médecine interne et immunologie clinique, Assistance publique-Hôpitaux Paris Saclay, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Saclay, Faculté de médecine, Le Kremlin Bicêtre, France
| | - A Laparra
- Service de médecine interne et immunologie clinique, Assistance publique-Hôpitaux Paris Saclay, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Saclay, Faculté de médecine, Le Kremlin Bicêtre, France
| | - C Cauquil
- Service de neurologie, Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Sud, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France; Centre de référence neuropathies amyloïdes familiales et autres neuropathies rares (NNERF), Groupe hospitalier universitaire Paris Sud, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France
| | - P Chrétien
- INSERM, UTCBS, Unité des technologies chimiques et biologiques pour la Santé, Université de Paris, CNRS, 75006 Paris, France; Service d'immunologie biologique, Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Sud, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France
| | - S Hacein-Bey-Abina
- INSERM, UTCBS, Unité des technologies chimiques et biologiques pour la Santé, Université de Paris, CNRS, 75006 Paris, France; Service d'immunologie biologique, Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Sud, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France
| | - C Goujard
- Service de médecine interne et immunologie clinique, Assistance publique-Hôpitaux Paris Saclay, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Saclay, Faculté de médecine, Le Kremlin Bicêtre, France
| | - C Adam
- Service d'anatomie pathologique et neuropathologie, Assistance publique-Hôpitaux de Paris, Groupe Hospitalier Universitaire Paris Sud, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France
| | - O Lambotte
- Service de médecine interne et immunologie clinique, Assistance publique-Hôpitaux Paris Saclay, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Saclay, Faculté de médecine, Le Kremlin Bicêtre, France; Inserm UMR 1184, Immunologie des maladies virales et auto-immunes (IMVA), Université Paris Saclay, 94275 Le Kremlin-Bicêtre cedex, France; CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Université Paris Saclay, 94275 Le Kremlin-Bicêtre cedex, France
| | - D Adams
- Université Paris Saclay, Faculté de médecine, Le Kremlin Bicêtre, France; Service de neurologie, Assistance publique-Hôpitaux de Paris, Groupe hospitalier universitaire Paris Sud, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France; Centre de référence neuropathies amyloïdes familiales et autres neuropathies rares (NNERF), Groupe hospitalier universitaire Paris Sud, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France
| | - N Noël
- Service de médecine interne et immunologie clinique, Assistance publique-Hôpitaux Paris Saclay, Hôpital Bicêtre, 94275 Le Kremlin-Bicêtre cedex, France; Université Paris Saclay, Faculté de médecine, Le Kremlin Bicêtre, France; Inserm UMR 1184, Immunologie des maladies virales et auto-immunes (IMVA), Université Paris Saclay, 94275 Le Kremlin-Bicêtre cedex, France; CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Université Paris Saclay, 94275 Le Kremlin-Bicêtre cedex, France.
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Hamaguchi M, Kokubun N, Matsuda H, Onuma H, Aoki R, Takahashi W, Mitani K, Suzuki K. A case report of secondary neurolymphomatosis showing selective nerve infiltration and massive lumbar plexus enlargement. BMC Neurol 2021; 21:296. [PMID: 34311723 PMCID: PMC8314556 DOI: 10.1186/s12883-021-02330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 07/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Neurolymphomatosis (NL) is a rare manifestation of malignant lymphoma that shows selective infiltration to the peripheral nervous system primarily or secondarily. We report a patient with secondary NL caused by germinal center B-cell (GCB)-type diffuse large B-cell lymphoma (DLBCL) who showed selective infiltration of the lumbar plexus to the spinal cord and massive nerve enlargement resulting in severe pain. Case presentation A 72-year-old female exhibited asymmetric motor and sensory impairments and pain in the lower limbs that progressed for five months. Magnetic resonance imaging (MRI) showed an enlarged lumbar plexus, which continued to the cauda equina via the L3 and L4 spinal nerves. Her symptoms gradually worsened. Ten months after the onset of symptoms, the enlarged cauda equina filled the spinal canal space, and the spinal cord was swollen. A cauda equina biopsy was performed, and she was diagnosed with GCB-type DLBCL with CD10 positivity. The primary tumor was found in a mammary cyst. The autopsy study did not show apparent infiltration, except in the nervous system. Conclusions Although there are many neurologic phenotypes of malignant lymphoma, the association between the cytological characteristics of lymphoma and the neurological phenotypes is still unclear. Several reports of CD10-positive secondary NL are available, whereas peripheral or central nervous tissue origin lymphoma cases are mostly negative for CD10. CD10 staining may be useful for distinguishing primary NL from secondary NL. NL often has a strong organotropism for peripheral nervous tissue, which makes early diagnosis challenging. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02330-5.
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Affiliation(s)
- Mai Hamaguchi
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan.
| | - Norito Kokubun
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Hadzki Matsuda
- Department of Neurosurgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Hiroki Onuma
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Reika Aoki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Wataru Takahashi
- Department of Hematology and Oncology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Kinuko Mitani
- Department of Hematology and Oncology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
| | - Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, 321-0293, Japan
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Fritzhand SJ, Esmaeli B, Sun J, Debnam JM. Primary disease sites and patterns of spread in cases of neurolymphomatosis in the orbit associated with lymphoma. Cancer Imaging 2021; 21:39. [PMID: 34039437 PMCID: PMC8157741 DOI: 10.1186/s40644-021-00409-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurolymphomatosis involving the cranial nerves (CNs) is rare. We sought a better understanding of the primary disease sites and patterns of spread in neurolymphomatosis of the orbit and retro-orbital cranial nerves. METHODS Patients with lymphoma and MRI evidence of neurolymphomatosis of CN II, III, IV, V1, or V2 were retrospectively reviewed. Demographics and primary disease site and sites of neurolymphomatosis on MRI were recorded. Wilcoxon rank sum test was used to compare number of sites of neurolymphomatosis with lymphoma type and survival. RESULTS The study included 18 patients. The most frequent types of lymphoma were diffuse large B-cell (DLBCL) (n = 9) and marginal zone (n = 3). In 9 patients, lymphoma presented as a mass (n = 7) or infiltrative disease (n = 2) directly involving the orbit; in 6, a maxillofacial mass spread directly to CNs; and in 3, lymphoma at remote sites spread to orbital CNs. Overall, 81 sites of neurolymphomatosis were noted. The most common sites were the maxillary nerve (V2) including at the infraorbital fissure or foramen rotundum (17 patients; 19 nerves), pterygopalatine fossa (16 patients; 19 nerves), and cavernous sinus (9 patients; 12 nerves). Number of sites of neurolymphomatosis was significantly lower for DLBCL than for other lymphoma types (p = 0.007). Number of sites of neurolymphomatosis did not affect survival (p = 0.26). The mean interval between the pathologic diagnosis and MRI documentation of the full extent of neurolymphomatosis was 39 days after pathologic diagnosis. CONCLUSIONS Based on our study results, neurolymphomatosis in the orbit appears to be frequently associated with an orbital and/or maxillofacial mass and commonly involves CN V2, the pterygopalatine fossa, and the cavernous sinus. DLBCL may be associated with fewer sites of neurolymphomatosis than other lymphomas. In patients with lymphoma, a systematic search for neurolymphomatosis is imperative for early detection.
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Affiliation(s)
- Seth J Fritzhand
- School of Nursing and Health Studies, Georgetown University, Washington, DC, USA
| | - Bita Esmaeli
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Matthew Debnam
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Blvd., Unit 1482, Houston, TX, 77030, USA.
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23
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Kim KT, Kim SI, Do YR, Jung HR, Cho JH. Sciatic nerve neurolymphomatosis as the initial presentation of primary diffuse large B-cell lymphoma: a rare cause of leg weakness. Yeungnam Univ J Med 2021; 38:258-263. [PMID: 34162045 PMCID: PMC8225502 DOI: 10.12701/yujm.2021.00983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Abstract
Neurolymphomatosis (NL) is defined as the involvement of the peripheral nervous system in lymphocytic invasion. It is a very rare form of lymphoma that may occur as an initial presentation or recurrence. It affects various peripheral nervous structures and can therefore mimic disc-related nerve root pathology or compressive mononeuropathy. NL often occurs in malignant B-cell non-Hodgkin lymphomas. Notwithstanding its aggressiveness or intractability, NL should be discriminated from other neurologic complications of lymphoma. Herein, we present a case of primary NL as the initial presentation of diffuse large B-cell lymphoma (DLBCL) of the sciatic nerve. The patient presented with weakness and pain in his left leg but had no obvious lesion explaining the neurologic deficit on initial lumbosacral and knee magnetic resonance imaging (MRI). NL of the left sciatic nerve at the greater sciatic foramen was diagnosed based on subsequent hip MRI, electrodiagnostic test, positron emission tomography/computed tomography, and nerve biopsy findings. Leg weakness slightly improved after chemotherapy and radiotherapy. We report a case wherein NL, a rare cause of leg weakness, manifested as the initial presentation of primary DLBCL involving the sciatic nerve at the greater sciatic foramen.
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Affiliation(s)
- Kyoung Tae Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Il Kim
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Young Rok Do
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Hye Ra Jung
- Department of Pathology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Jang Hyuk Cho
- Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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Alazawi S, Elomri H, Taha R, Bakr M, Abdelhamid MT, Szabados L, Yassin M, Sabah HE, Aboudi K, Ellahie A, Fadul A, Gameil A, Al Battah A, Fernyhough LJ. Neurolymphomatosis of the median nerve, optic nerve, L4 spinal nerve root and cauda equina in patients with B-cell malignancies: a case series. J Med Case Rep 2021; 15:133. [PMID: 33766128 PMCID: PMC7995761 DOI: 10.1186/s13256-021-02714-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 02/02/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Neurolymphomatosis is rare. Neoplastic lymphocytes are seen to invade nerves (cranial or peripheral), nerve roots or other related structures in patients with hematological malignancy. It is a separate entity from central nervous system lymphoma. Neurolymphomatosis has most commonly been described in association with B-cell non-Hodgkin lymphoma. Neurolymphomatosis in the context of Burkitt lymphoma and the post-renal transplant setting has not been described before. CASE REPORTS We report for the first time in the Arabian Gulf countries and nearby Arab states four cases of neurolymphomatosis (one Asian, and the other 3 are from Arabic nationals) occurring between 2012 and 2017 involving the median nerve, optic nerve, nerve root and cauda equina in patients with Burkitt lymphoma, Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia and diffuse large B-cell lymphoma. CONCLUSIONS Neurolymphomatosis is rare and can be difficult to diagnose by biopsy but reliably confirmed by a combined imaging approach. Prior treatment with high-dose dexamethasone might suppress 18F-fluorodeoxyglucose (FDG) activity and decrease the sensitivity of positron emission tomography/computed tomography (PET/CT). The prognosis is generally poor but using high-dose methotrexate as well as high-dose chemotherapy and autologous stem cell transplantation may be an effective way to treat neurolymphomatosis.
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Affiliation(s)
- S Alazawi
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.
- Weill Cornell Medicine, Doha, Qatar.
| | - H Elomri
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - R Taha
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - M Bakr
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - M T Abdelhamid
- Department of Radiology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
- Medicine, Mansoura University, Mansoura, Egypt
| | - L Szabados
- Department of Radiology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - M Yassin
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - H El Sabah
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - K Aboudi
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - A Ellahie
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - A Fadul
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - A Gameil
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
| | - A Al Battah
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - L J Fernyhough
- Department of Hematology/Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
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Abstract
Background To report our experience with a group of patients referred for refractory CIDP who fulfilled “definite” electrodiagnostic EFNS criteria for CIDP but were found to have an alternate diagnosis. Methods Patients who were seen between 2017 and 2019 for refractory CIDP that fulfilled “definite” electrodiagnostic ENFS criteria for CIDP, but had an alternate diagnosis, were included. Patients who correctly had CIDP, anti MAG neuropathy, or MMN with conduction block, were excluded from the study. Demographics, clinical and electrophysiological characteristics, pertinent workup, final alternate diagnoses, and outcomes were collected. Results Seven patients were included: POEMS (n = 5), CANOMAD (n = 1), and neurolymphomatosis (n = 1). Most patients reported neuropathic pain and leg swelling (n = 6) or significant weight loss (n = 4). All patients had a monoclonal protein, and most patients who were tested had an elevated VEGF and CSF cyto-albuminologic dissociation. Electrophysiology showed pronounced intermediate more than distal demyelination, and axonal loss in the lower extremities. Response to steroids or IVIG varied, but some patients did respond to these treatments, especially early in the disease. Conclusion Pain, systemic symptoms, suggestive electrophysiological findings, and/or a serum monoclonal protein should raise suspicion for CIDP mimics. Initial response to steroids or IVIG, over reliance on CSF, and electrophysiology findings can all be misleading.
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Affiliation(s)
- Orly Moshe-Lilie
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Erik Ensrud
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Thomas Ragole
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Chahin Nizar
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Diana Dimitrova
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Chafic Karam
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St., 3 West Gates, Philadelphia, PA, 19104, USA.
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Barahona D, Adlerstein I, Donoso J, Mercado F. Sciatic and median nerve neurolymphomatosis as initial presentation of B-cell Lymphoma. Radiologia (Engl Ed) 2020; 64:S0033-8338(20)30171-5. [PMID: 33358595 DOI: 10.1016/j.rx.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/08/2020] [Indexed: 11/26/2022]
Abstract
Neurolymphomatosis (NL) is the infiltration of cranial nerves or nerves and roots from the peripheral nervous system by lymphoma, usually by B-cell non-Hodgkin's lymphoma. It is uncommon as initial presentation of the disease and can lead to extremely heterogeneous clinical manifestations. We report the case of a 72-year old male who presented with numbness of the right hand, progressive weakness in both lower limbs and weight loss. 18F-FDG PET/CT showed bilateral hypermetabolic adrenal masses, gastric ulcer, small hypermetabolic adenopathies, multiple focal bone marrow uptake and intense uptake in both sciatic nerves and right median nerve. A node and gastric biopsy confirmed diffuse large-B-cell lymphoma, activated B cell type, with posterior resolution of peripheral nerves uptake after beginning chemotherapy.
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Affiliation(s)
- D Barahona
- Departamento de Imagenología, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Vitacura, Santiago, Chile.
| | - I Adlerstein
- Departamento de Imagenología, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Vitacura, Santiago, Chile
| | - J Donoso
- Departamento de Hematología, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Vitacura, Santiago, Chile
| | - F Mercado
- Departamento de Imagenología, Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Vitacura, Santiago, Chile
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Jeong J, Kim SW, Sung DH. Neurolymphomatosis: a single-center experience of neuromuscular manifestations, treatments, and outcomes. J Neurol 2020; 268:851-859. [PMID: 33098033 DOI: 10.1007/s00415-020-10202-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Neurolymphomatosis (NL) is a disease characterized by the infiltration of malignant lymphocytes into the peripheral nervous system. We report clinical features, radiographic findings, modes of treatment, and outcomes of patients with NL. METHODS We retrospectively investigated patients with NL. We extracted data, including clinical features, magnetic resolution imaging (MRI), 18F-fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans, cerebrospinal fluid cytology findings, the results of electrodiagnostic studies, as well as patient treatments and outcomes. RESULTS Ten NL patients were identified. All patients reported pain/paresthesia and weakness in the affected area. The MRI scans were abnormal in eight out of nine patients with an enhancement of the spinal nerve root, plexus, peripheral nerve trunk, and cranial nerve. The FDG PET/CT scans were positive in all patients. Radiculopathy or radiculoplexopathy was the most common electrodiagnostic finding. Neurological improvement was observed in only three patients. The condition of the nine patients who underwent multimodality treatments for cancer eventually deteriorated and the patients died. CONCLUSIONS NL should be considered in the differential diagnosis of any type of neuropathy in patients with lymphoma. Because it could be confused with other neuropathies in lymphoma and various musculoskeletal diseases, a high index of suspicion and familiarity with clinical manifestation of NL are key. FDG PET/CT was the most sensitive diagnostic imaging modality to detect relevant neural invasion. The root within the spinal neural foramen was the most frequently affected neural structure. Early diagnosis of this rare neurologic manifestation of lymphoma may improve treatment outcomes.
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Affiliation(s)
- Jisun Jeong
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Sun Woong Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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Sheng S, Sharma R, Samant R, Yuan J, Nalleballe K, Kapoor N. Isolated primary neurolymphomatosis with cranial multineuritis: a case presentation. Neurol Sci 2020; 42:1223-1226. [PMID: 33040194 DOI: 10.1007/s10072-020-04806-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Isolated primary neurolymphomatosis (NL) of cranial multineuritis is a very rare condition that refers to the lymphomatous invasion of cranial nerves only. There are sparse cases of isolated cranial nerves NL reported worldwide. CASE PRESENTATION We present magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) findings of a 63-year-old female patient suffering from isolated neurolymphomatosis of cranial multineuritis with a wide constellation of syndromes including binocular diplopia, left facial paralysis and pain, syncope episodes, and progressive dysphagia. A contrasted MRI brain showed multiple cranial nerves enhancement. Extensive workup for infectious, autoimmune, neoplastic, paraneoplastic, or inflammatory etiologies had been unrevealing except CSF cytology revealed large atypical monotypic B cells that were suspicious for non-Hodgkin lymphoma on the third large volume tap. The decision of biopsy was deferred after the risks and benefits discussion. Following the four cycles of empiric methotrexate-based induction chemotherapy, the patient's symptoms resolved, and a complete radiographic response was achieved without whole-brain radiation or autologous hematopoietic cell transplantation. In the latest follow-up, she is independent with her daily activities and remains in clinical and radiographic remission more than 3 years since initial chemotherapy. CONCLUSION Isolated NL of cranial nerves can present diagnostic and management pitfalls for the neurologist, neurosurgeons, and oncologists. Since current diagnostic modalities have modest sensitivity and a pathological diagnosis is often difficult, empiric treatment once other possibilities are ruled out can carry a good prognosis.
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Affiliation(s)
- Sen Sheng
- Department of Neurology, The University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 500, Little Rock, AR, 72205, USA.
| | - Rohan Sharma
- Department of Neurology, The University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 500, Little Rock, AR, 72205, USA
| | - Rohan Samant
- Department of Radiology, The University of Arkansas for Medical Sciences, Little Rock, USA
| | - Junliang Yuan
- Department of Neurology, Peking University Sixth Hospital, National Clinical Research Center for Mental Disorders, Beijing, China
| | - Krishna Nalleballe
- Department of Neurology, The University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 500, Little Rock, AR, 72205, USA
| | - Nidhi Kapoor
- Department of Neurology, The University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 500, Little Rock, AR, 72205, USA
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Makranz C, Arkadir D, Nachmias B, Gatt ME, Eliahou R, Atlan K, Mordechai A, Goldshmit N, Lossos A. Neurological misdiagnoses of lymphoma. Neurol Sci 2020; 42:1933-1940. [PMID: 32974798 DOI: 10.1007/s10072-020-04724-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lymphoma of the nervous system is rare and usually involves the brain, spinal cord, or peripheral nerves. Hence, it has varied clinical presentations, and correct diagnosis is often challenging. Incorrect diagnosis delays the appropriate treatment and affects prognosis. We report 5 patients with delayed diagnosis of lymphoma involving the central and/or peripheral nervous system, initially evaluated for other neurological diagnoses. We also discuss the challenge of diagnosis and appropriate testing. METHODS Retrospective review of 2011-2019 records of patients with confirmed nervous system lymphoma diagnosed in a tertiary care medical center. RESULTS We present 5 adult patients initially evaluated for inflammatory myelopathy, inflammatory lumbosacral plexopathy, atypical parkinsonism, and demyelinating disease of the CNS. Final diagnosis of the nervous system lymphoma was delayed by 4 to 18 months and was based on tissue biopsy in 4, and on CSF and bone marrow examination in 1 patient. CONCLUSIONS Lymphoma may imitate various central and peripheral nervous system disorders. We suggest several red flags that indicate the need to consider lymphoma, including subacute but progressive symptomatic evolution, painful neurological deficit, unclear clinical diagnosis, and transient steroid responsiveness. Correct diagnosis often requires a combination of diagnostic tests, while pathology testing is crucial for early diagnosis and is strongly recommended in the appropriate clinical setting.
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Affiliation(s)
- Chen Makranz
- Departments of Oncology and Neurology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - David Arkadir
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Boaz Nachmias
- Department of Hematology, Sharett Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Moshe E Gatt
- Department of Hematology, Sharett Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ruth Eliahou
- Departments of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Karine Atlan
- Departments of Pathology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Anat Mordechai
- Departments of Oncology and Neurology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Netta Goldshmit
- Department of Hematology, Sharett Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alexander Lossos
- Departments of Oncology and Neurology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Nepal P, Batchala PP, Rehm PK, Fadul CE. Diffuse large B-cell lymphoma relapse presenting as extensive neurolymphomatosis. Neuroradiol J 2020; 33:230-235. [PMID: 32401669 DOI: 10.1177/1971400920924799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 56-year-old woman with a history of diffuse large B-cell non-Hodgkin lymphoma (DLBCL-NHL) in remission for two years presented with weight loss and multifocal sensory/motor symptoms. Magnetic resonance imaging (MRI) of the neuraxis and whole-body FDG PET/CT led to a diagnosis of secondary neurolymphomatosis (NL). MRI demonstrated extensive thickening and enhancement of multiple cranial nerves and peripheral nerve plexuses with corresponding elevated metabolism on FDG PET/CT. Treatment with chemotherapy resulted in complete response on FDG PET/CT and subsequently she underwent autologous stem cell transplantation. NL is a rare manifestation of lymphoma affecting the peripheral nervous system. Nonspecific neuropathic symptoms make clinical diagnosis difficult. Though nerve biopsy is considered the gold standard, MRI and FDG PET/CT are accepted alternatives for making the diagnosis. We review imaging findings in NL, describe the differential diagnosis, and discuss the limitations of the imaging modalities.
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Affiliation(s)
- Pankaj Nepal
- Department of Radiology and Medical Imaging, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Patrice K Rehm
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Camilo E Fadul
- Division of Neuro-oncology, Department of Neurology, University of Virginia Health System, Charlottesville, VA, USA
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Murthy NK, Sharma M, Spinner RJ. Primary peripheral nerve tumors associated with nerve-territory herpes zoster. Acta Neurochir (Wien) 2020; 162:1147-51. [PMID: 32193725 DOI: 10.1007/s00701-020-04292-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
Herpes viruses have been described as markers of occult cancer and have also been implicated in oncogenesis. This group of viruses includes varicella-zoster virus (VZV) which is well-known for its ability to evade the immune response by lying dormant in the dorsal root ganglion of peripheral nerves. Although it is common knowledge that VZV reactivation causes herpes zoster (shingles), there have been no reports in literature of herpes zoster manifesting in the dermatomal territory of peripheral nerves involved by either benign or malignant tumors. We report two cases of patients with peripheral nerve tumors who presented with herpes zoster in the dermatomal distribution of the involved nerves. One patient had primary neurolymphomatosis, whereas the other had a sacral schwannoma. We believe these are the first cases to be reported that demonstrate herpes zoster at clinical presentation in patients with peripheral nerve tumors. This suggests that VZV may have the potential to cause peripheral nerve tumors via a complex interplay of viral oncogenes and alterations in host immunological responses.
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Bourque PR, Sampaio ML, Warman-Chardon J, Samaan S, Torres C. Neurolymphomatosis of the lumbosacral plexus and its branches: case series and literature review. BMC Cancer 2019; 19:1149. [PMID: 31775683 PMCID: PMC6882218 DOI: 10.1186/s12885-019-6365-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022] Open
Abstract
Background Neurolymphomatosis (NL) is a direct process of invasion of peripheral nerves by lymphoma. It occurs in roughly 5% of patients with lymphoma and represents a particularly difficult diagnostic dilemma when it is the presenting focal manifestation of occult lymphoma. Case presentation We present 3 examples of invasion of the lumbosacral plexus and its branches. These cases demonstrate a protean clinical picture with regards to the time relationship to the clinical course of lymphoma and the neuroanatomical extent of lumbosacral plexus invasion. We demonstrate the complementary role of different imaging modalities. A review of the literature summarizes 23 reports where lumbosacral plexus invasion was the index manifestation, at the time of first diagnosis or recurrence of lymphoma. This series confirms the strong preponderance of B-cell type (92%). There is a marked predilection for involvement of the sciatic nerve (74%), either focally or in a longitudinally extensive fashion, from the ischium to the popliteal fossa. There can also be restricted and discrete involvement of tibial and fibular branches. In recent years, ultrasound and CT have been given a more limited role, as screening tools or as a guide for biopsy. MRI neurography and PET-CT have become leading diagnostic modalities for diagnosis, staging and assessment of treatment response. Conclusion The diagnosis of NL may be challenging, and it was once only reached at autopsy. Improved diagnostic imaging of focal or even asymptomatic disease offers new hope for earlier diagnosis and successful targeted therapy.
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Affiliation(s)
- Pierre R Bourque
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marcos Loreto Sampaio
- The Ottawa Hospital Research Institute, Ottawa, Canada. .,Department of Radiology, University of Ottawa, Ottawa, Canada.
| | - Jodi Warman-Chardon
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sam Samaan
- Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Carlos Torres
- The Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Radiology, University of Ottawa, Ottawa, Canada
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Narita K, Kobayashi H, Kitadate A, Abe Y, Miura D, Takeuchi M, Matsue K. Neurolymphomatosis of the sciatic and tibial nerves as an initial presentation of lung diffuse large B cell lymphoma detected by positron emission tomography/computed tomography. Int J Hematol 2019; 110:385-386. [PMID: 31309418 DOI: 10.1007/s12185-019-02705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Kentaro Narita
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan.
| | - Hiroki Kobayashi
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Akihiro Kitadate
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Yoshiaki Abe
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Daisuke Miura
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
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DeVries AH, Howe BM, Spinner RJ, Broski SM. B-cell peripheral neurolymphomatosis: MRI and (18)F-FDG PET/CT imaging characteristics. Skeletal Radiol 2019; 48:1043-50. [PMID: 30666391 DOI: 10.1007/s00256-019-3145-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/27/2018] [Accepted: 01/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the MRI and 18F-FDG PET/CT imaging characteristics of peripheral neurolymphomatosis. MATERIALS AND METHODS All institutional cases of neurolymphomatosis with an MRI or 18F-FDG PET/CT from 2000 to 2017 were retrospectively reviewed. Included cases were biopsy-proven neurolymphomatosis or lymphoma patients with clinical and imaging evidence of neurolymphomatosis that resolved after chemotherapy. Multiple imaging parameters and clinical characteristics were recorded. RESULTS There were 27 cases of B-cell neurolymphomatosis in 25 patients (18 M, 7 F; mean age 64.6 ± 10.0 years). Of the total cases, 85% (23/27) were biopsy-proven. Most were diagnosed after disease progression or recurrence (20/27, 74%), and presented with isolated nerve involvement (18/27, 67%). Bone marrow biopsy (17/19, 89%) and CSF cytology (16/23, 70%) were usually negative. On 18F-FDG PET/CT, neurolymphomatosis presented as a linear or fusiform (23/26, 88%), FDG-avid (average SUVmax: 7.1 ± 4.5, range, 1.5-17.0) mass, and on MRI as a T2-weighted hyperintense (21/22, 95%), enhancing (21/22, 95%), linear or fusiform mass (19/22, 86%), with associated muscle denervation (14/22, 64%). FDG avidity was significantly higher in patients with muscular denervation on MRI (mean SUVmax 8.2 ± 4.6 vs. 4.3 ± 2.3, p = 0.04). CONCLUSIONS B-cell neurolymphomatosis most commonly manifests as T2-weighted hyperintense, enhancing linear or fusiform neural enlargement associated with muscular denervation on MRI, with intense FDG activity on PET/CT. It is most often an isolated site of disease, presenting after progression or recurrence. A familiarity with the imaging appearance of neurolymphomatosis can help refine the differential diagnosis, direct biopsy, and aid in accurate diagnosis.
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Chague P, Phan CM, Lapusan S, Zhang-Yin J, Cottereau AS. 18F-FDG PET/CT imaging findings of extensive neurolymphomatosis as a relapse of diffuse large B cell lymphoma. Diagn Interv Imaging 2019; 100:527-8. [PMID: 30853415 DOI: 10.1016/j.diii.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/24/2022]
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Abstract
We report a case of a primary malignant lymphoma of the trigeminal nerve that was associated with facial pain. A 65-year-old man was examined at another hospital for unilateral facial pain. Carbamazepine was prescribed, but his symptoms did not improve. Magnetic resonance imaging (MRI) revealed swelling of the trigeminal nerve and a mass lesion in Meckel's cave. The patient was referred to our hospital at this point. Gadolinium-enhanced MRI and F18-Fluorodeoxyglucose-position emission tomography suggested a likely malignant tumour and a biopsy was performed. Histopathological examination showed diffuse a large B cell lymphoma. The patient was treated with high-dose methotrexate (HD-MTX) and radiotherapy. Despite responding well to initial treatment, the patient relapsed, with lymphoma observed throughout the body. He died of pneumonia 18 months after the initial diagnosis. Facial pain is a symptom that is commonly managed in general practice. If symptoms do not improve, repeated imaging studies, including contrast MRI, is warranted. This is the first reported case of primary neurolymphomatosis (NL) of the trigeminal nerve associated with facial pain alone. Furthermore, HD-MTX and radiotherapy may be considered for the management of primary NL of a cranial nerve.
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Affiliation(s)
- Hirotaka Sato
- Department of Neurosurgery, Asahikawa Medical University, Hokkaido, Japan
| | - Satoru Hiroshima
- Department of Neurosurgery, Asahikawa Medical University, Hokkaido, Japan
| | - Ryogo Anei
- Department of Neurosurgery, Asahikawa Medical University, Hokkaido, Japan
| | - Kyousuke Kamada
- Department of Neurosurgery, Asahikawa Medical University, Hokkaido, Japan
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Uematsu N, Sumi M, Kaiume H, Takeda W, Kirihara T, Ueki T, Hiroshima Y, Ueno M, Ichikawa N, Watanabe M, Kobayashi H. [ Neurolymphomatosis due to enteropathy-associated T-cell lymphoma clinically diagnosed by FDG-PET/CT and subsequently confirmed by autopsy]. Rinsho Ketsueki 2019; 59:69-74. [PMID: 29415941 DOI: 10.11406/rinketsu.59.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 59-year-old man who complained of abdominal pain was referred to our hospital. Computed tomography (CT) revealed mesenteric lymph node swelling and intestinal perforation. Histopathological study of the resected ileum and lymph node demonstrated diffuse proliferation of medium-sized atypical lymphocytes. Immunohistochemistry results were positive for cluster of differentiation (CD) 3, CD8, and CD56 cells, negative for CD5 and CD4 cells, and negative for Epstein-Barr virus-encoded RNA-fluorescent in situ hybridization (EBER-FISH). It also revealed the expression of γδ T-cell receptors. On the basis of these findings, enteropathy-associated T-cell lymphoma (EATL) was diagnosed. Although the patient received two courses of cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (CHOP) and dexamethasone, etoposide, ifosfamide, and carboplatin (DeVIC) therapy, facial nerve and lower limb paralysis manifested. Magnetic resonance imaging (MRI) and lumbar puncture revealed central nervous system invasion of the EATL. Despite intrathecal chemotherapy and high-dose cytarabine therapy, the patient's neurological symptoms deteriorated. Fluorodeoxyglucose positron emission tomography (FDG-PET) /CT scan showed the accumulation of FDG along both median and sciatic nerves, and he was diagnosed with neurolymphomatosis (NL). He died on day 120 after admission. Autopsy specimens exhibited infiltration of lymphoma cells in the median and sciatic nerves. Although only one case of suspected NL in a patient with type 2 EATL has been previously reported, we clinically diagnosed NL using FDG-PET/CT and confirmed the diagnosis by autopsy. This case is valuable in terms of the pathological diagnosis of NL.
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Affiliation(s)
| | | | | | | | | | | | | | - Mayumi Ueno
- Department of Oncology, Nagano Red Cross Hospital
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Kobayashi H, Abe Y, Miura D, Narita K, Kitadate A, Takeuchi M, Matsue K. Limited efficacy of high-dose methotrexate in patients with neurolymphomatosis. Int J Hematol 2019; 109:286-291. [PMID: 30604318 DOI: 10.1007/s12185-018-02586-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 11/29/2022]
Abstract
Neurolymphomatosis (NL) is a rare manifestation of non-Hodgkin lymphoma, in which malignant cells infiltrate the peripheral nerves. Most patients are treated with high-dose methotrexate (HD-MTX)-based systemic chemotherapy regimens similar to patients with central nervous system lymphoma. However, because NL is rare, the efficacy of HD-MTX is largely unknown. We reviewed medical records of patients diagnosed with NL over the past 10 years and identified 18 patients. The underlying hematological malignancy was diffuse large B-cell lymphoma (DLBCL) in 10 patients (55.6%), intravascular large B-cell lymphoma in six (33.3%), and other types in two patients. Ten patients were treated with HD-MTX-based systemic chemotherapy; the response rates with and without HD-MTX-based chemotherapy were 100% (n = 10) and 85.7% (n = 6), respectively (P = 0.41). The median progression-free and overall survival rates of patients with versus without HD-MTX treatment were 6.4 vs. 8.5 months (P = 0.97) and 13.5 vs. 8.5 months (P = 0.63), respectively. Despite the initial favorable responses, rapid disease recurrence was observed in most patients administered HD-MTX-based chemotherapy. Our observations suggest that HD-MTX-based chemotherapy may have insufficient efficacy against NL, and that other therapeutic approaches are required to improve the outcomes of patients with this rare disease.
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Affiliation(s)
- Hiroki Kobayashi
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan.
| | - Yoshiaki Abe
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Daisuke Miura
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Kentaro Narita
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Akihiro Kitadate
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
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Liu KC, Hennessey MA, McCall CM, Proia AD. Ocular involvement in neurolymphomatosis. Am J Ophthalmol Case Rep 2018; 10:148-151. [PMID: 29780925 PMCID: PMC5956672 DOI: 10.1016/j.ajoc.2018.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/31/2018] [Accepted: 02/26/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose To describe the ophthalmic symptoms and histopathological findings in a case of primary neurolymphomatosis (NL). Observations A man in his 60s with a prior diagnosis of chronic inflammatory demyelinating polyneuropathy developed facial numbness, diplopia, drooling, and difficulty swallowing. Over a 3-month period, he developed total ptosis and ophthalmoplegia of the right eye with a dilated, non-reactive pupil considered secondary to cranial nerve III and VI palsies. His left pupil subsequently became non-reactive to light and accommodation, and extraocular motility of the left eye was partially limited in all directions of gaze without ptosis. Autopsy findings included primary NL, diffuse large B-cell lymphoma of activated B-cell subtype, involving right and left cranial nerves V, VI, IX, and X; spinal nerve roots; both femoral nerves; and extrascleral, intrascleral, and intraocular short and long posterior ciliary nerves with extension into the adjacent choroid of both eyes. No evidence of lymphoma was identified elsewhere in the body. Conclusions and importance Our patient is only the second histological demonstration of ciliary nerve involvement by NL, and the first, to our knowledge, of primary NL spreading secondarily from the ciliary nerves into the choroid. Our patient demonstrates that NL, though rare, should be included in the differential diagnosis of ocular cranial nerve palsies and ophthalmoplegia.
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Affiliation(s)
- Katy C Liu
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Chad M McCall
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Alan D Proia
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
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Bourque PR, Warman Chardon J, Bryanton M, Toupin M, Burns BF, Torres C. Neurolymphomatosis of the Brachial Plexus and its Branches: Case Series and Literature Review. Can J Neurol Sci 2018; 45:137-43. [PMID: 29307326 DOI: 10.1017/cjn.2017.282] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Neurolymphomatosis is a process of neoplastic endoneurial invasion, most strongly associated with non-Hodgkin's lymphoma. It must be distinguished from paraneoplastic, metabolic, nutritional and treatment-related causes of neuropathy that are common in this patient population. METHODS This brief case series illustrates the protean manifestations of neurolymphomatosis of the brachial plexus, ranging from focal distal mononeuropathy to multifocal brachial plexopathy, either as the index manifestation of lymphoma or as a complication of relapsing disease. RESULTS Prominent asymmetry, pain and nodular involvement on neuroimaging may help distinguish neurolymphomatosis from paraneoplastic immune demyelinating radiculoneuropathy. MR neurography criteria for the diagnosis of neurolymphomatosis include hyperintensity on T2 and STIR sequences, focal and diffuse nerve enlargement with fascicular disorganization and gadolinium enhancement. No specific anatomical distribution within the brachial plexus has, however, been found to be characteristic. Fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging is the imaging modality with the highest sensitivity for detection of nodal or extranodal spread in lymphoma. CONCLUSIONS Brachial plexus neuropathy in neurolymphomatosis is highly protean in its distribution, semiology and relation to lymphoma staging. Dedicated MRI and PET-CT imaging are leading diagnostic modalities.
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Jiménez Zapata HD, Rojas Medina LM, Carrasco Moro R, Martínez Rodrigo A, García-Cosio Piqueras M. Cauda equina syndrome secondary to neurolymphomatosis: Case report and literature review. Neurocirugia (Astur) 2017; 29:138-142. [PMID: 28941783 DOI: 10.1016/j.neucir.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/26/2017] [Accepted: 07/03/2017] [Indexed: 10/18/2022]
Abstract
Neurolymphomatosis is a rare disorder characterised by infiltration of neoplastic lymphocytes into the peripheral nervous system. A wide variety of symptoms can manifest depending on its nature and location, making its diagnosis a real challenge. Treatment is based on methotrexate, although various chemotherapy regimens are currently available for patients with systemic disease. We present the case of a male patient with neurolymphomatosis of the cauda equina, together with a review of all cases published to date.
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Byun JM, Kim KH, Kim M, Kim TM, Jeon YK, Park JH, Paik JH, Lee JM, Lee HY, Lee JS, Heo DS, Lee JO. Diagnosis of secondary peripheral neurolymphomatosis: a multi-center experience. Leuk Lymphoma 2017; 58:2624-2632. [PMID: 28482727 DOI: 10.1080/10428194.2017.1312376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Here, we describe our experience with secondary neurolymphomatosis (NL) in non-Hodgkin lymphoma patients, with the emphasis on the diagnosis process. A retrospective chart review of 12 patients from 3 tertiary academic centers between January 2005 and December 2015 was conducted. Secondary NL was diagnosed within a median interval of 10 months (range 5-41 months) after initial diagnosis of NHL. Painful neuropathy was present in 66.7%, but the diagnosis of NL was delayed in nine out of 12 patients (75.0%) by median of 2 months. Diagnostic modalities included CSF analysis performed in nine patients (75.0%), electrodiagnostic studies in seven (58.3%), radiologic studies in all, and nerve biopsy in two (16.7%). The diagnostic yield was 100.0% (15/15) for FDG-PET/CT and 75.0% (9/12) for MRI. Our experience emphasizes the importance of clinical suspicion of NL in patients with previous history of NHL and selection of diagnostic modality with the greatest clinical utility.
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Affiliation(s)
- Ja Min Byun
- a Department of Internal Medicine , Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Korea.,b Department of Internal Medicine , Seoul Metropolitan Government Seoul National University Boramae Medical Center , Seoul , Korea.,c Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Korea
| | - Ki Hwan Kim
- b Department of Internal Medicine , Seoul Metropolitan Government Seoul National University Boramae Medical Center , Seoul , Korea
| | - Miso Kim
- a Department of Internal Medicine , Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Korea
| | - Tae Min Kim
- a Department of Internal Medicine , Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Korea
| | - Yoon Kyung Jeon
- d Department of Pathology, College of Medicine , Seoul National University , Seoul , Korea
| | - Jeong Hwan Park
- d Department of Pathology, College of Medicine , Seoul National University , Seoul , Korea
| | - Jin Ho Paik
- e Department of Pathology , Seoul National University Bundang Hospital , Seongnam , Korea
| | - Jung Min Lee
- f Department of Nuclear Medicine , Seoul National University Bundang Hospital , Seongnam , Korea
| | - Ho-Young Lee
- g Department of Nuclear Medicine , Seoul National University, College of Medicine , Seoul , Korea
| | - Jong Seok Lee
- c Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Korea
| | - Dae Seog Heo
- a Department of Internal Medicine , Seoul National University College of Medicine, Seoul National University Hospital , Seoul , Korea
| | - Jeong-Ok Lee
- c Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Korea
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Sideras PA, Matthews J, Sakib SMN, Ofikwu F, Spektor V. Neurolymphomatosis of the peripheral nervous system: a case report and review of the literature. Clin Imaging 2016; 40:1253-1256. [PMID: 27636384 DOI: 10.1016/j.clinimag.2016.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 01/25/2023]
Abstract
Neurolymphomatosis is a rare neurological syndrome in lymphomas. It is reported as infiltration of peripheral nerves by lymphoma. It is important to distinguish neurolymphomatosis from other types of neuropathies, particularly infectious and inflammatory conditions. However, it is difficult to isolate a cancer-related inflammatory vasculitis and mononeuritis multiplex without definitive histopathologic examination. In this report, we describe a case of non-Hodgkin's lymphoma involving the peroneal nerve and presenting as neurolymphomatosis.
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He W, Wang W, Gustas C, Malysz J, Kaur D. Isolated sciatic neuropathy as an initial manifestation of a high grade B-cell lymphoma: A case report and literature review. Clin Neurol Neurosurg 2016; 149:147-53. [PMID: 27540756 DOI: 10.1016/j.clineuro.2016.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/13/2016] [Accepted: 07/30/2016] [Indexed: 11/28/2022]
Abstract
Sciatic nerve neuropathy due to infiltrating of a high grade B-cell lymphoma is a very rare situation and has not often been reported. We report a case with a previous history of indolent lymphoma who presented with isolated sciatic nerve neuropathy and was found to have diffuse large B cell lymphoma involving the sciatic nerve. Although the current case is not a primary sciatic nerve lymphoma given the systematic involvement shown on MRI and PET/CT scan, the case represents a neurolymphomatosis of the sciatic nerve given the direct invasion of the lymphoma cells into the sciatic nerve. Due to the rarity of this condition, we subsequently reviewed related literatures.
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Affiliation(s)
- Wenzhuan He
- Department of Neurology, Penn State Hershey Medical Center, PA 17033, United States.
| | - Weizhen Wang
- Department of Neurology, New Jersey Medical School, Newark, NJ 07101, United States.
| | - Cristy Gustas
- Department of Radiology, Penn State Hershey Medical Center, PA 17033, United States.
| | - Jozef Malysz
- Department of Pathology, Penn State Hershey Medical Center, PA 17033, United States.
| | - Divpreet Kaur
- Department of Neurology, Penn State Hershey Medical Center, PA 17033, United States.
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Kinoshita H, Yamakado H, Kitano T, Kitamura A, Yamashita H, Miyamoto M, Hitomi T, Okada T, Nakamoto Y, Sawamoto N, Takaori-Kondo A, Takahashi R. Diagnostic utility of FDG-PET in neurolymphomatosis: report of five cases. J Neurol 2016; 263:1719-26. [PMID: 27286845 DOI: 10.1007/s00415-016-8190-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
Abstract
Neurolymphomatosis (NL) is a rare condition involving the infiltration of lymphoma cells into the peripheral nervous system. NL can be primary or secondary in the setting of an unknown or known hematologic malignancy, respectively. Here, we report five cases in which F-18 2-fluoro-2-deoxy-glucose positron emission tomography/computed tomography (F-18 FDG-PET/CT) had great value for diagnosing NL. Two cases were rare primary NL, and the other three were secondary NL. Clinical presentations were asymmetric sensorimotor disturbances in the extremities with or without involvement of cranial nerves. Furthermore, all patients experienced spontaneous pain in the face or affected extremities. Cerebrospinal fluid analysis was cytologically negative in two of five cases. Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) detected abnormalities in the cranial nerves, nerve roots, and cauda equina in all cases except case 1 and the recurrent stage of case 2. F-18 FDG-PET/CT showed clear visualization of almost all the lymphomatous involvement of peripheral nerves and other tissues in all patients. Furthermore, F-18 FDG-PET/CT detected abnormalities including asymptomatic lesions that were not detected with MRI, and also identified the appropriate lesion for diagnostic biopsy. However, as in case 3, the lesions in the left oculomotor nerve and the cauda equina were detected only with Gd-enhanced MRI, which has superior spatial resolution. In conclusion, F-18 FDG-PET/CT is a sensitive modality that can suggest the presence of malignancy and identify appropriate places for diagnostic biopsies. It is especially useful when combined with Gd-enhanced MRI, even in patients with primary NL that is usually difficult to diagnose.
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da Rocha AJ, Sobreira Guedes BV, da Silveira da Rocha TMB, Maia Junior ACM, Chiattone CS. Modern techniques of magnetic resonance in the evaluation of primary central nervous system lymphoma: contributions to the diagnosis and differential diagnosis. Rev Bras Hematol Hemoter 2015; 38:44-54. [PMID: 26969774 PMCID: PMC4786762 DOI: 10.1016/j.bjhh.2015.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/30/2015] [Indexed: 11/05/2022] Open
Abstract
In addition to findings from conventional magnetic resonance imaging, modern magnetic resonance imaging techniques have provided important information about tumor metabolism, in vivo metabolite formation, water molecule diffusion, microvascular density, and blood-brain barrier permeability, all of which have improved the in vivo diagnostic accuracy of this method in the evaluation of primary central nervous system lymphoma. These nonconventional magnetic resonance techniques are useful in the clinical practice because they enhance conventional magnetic resonance imaging by reinforcing the possibility of a diagnosis and by allowing the early detection of disease recurrence. This report is a review of the most relevant contributions of nonconventional magnetic resonance techniques to the imaging diagnosis of primary central nervous system lymphoma, the differential diagnosis of this disease, and the prognosis of patients. This paper aims to describe a wide range of presentations of primary central nervous system lymphoma, their appearance in imaging, and the differential diagnoses of this disease.
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Affiliation(s)
- Antonio José da Rocha
- Fleury Medicina e Saúde, São Paulo, SP, Brazil; Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
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Sunami Y, Gotoh A, Hamano Y, Yahata Y, Sakurai H, Shirane S, Edahiro Y, Komatsu N. Various neurological symptoms by neurolymphomatosis as the initial presentation of primary testicular lymphoma. Case Rep Oncol 2015; 8:200-4. [PMID: 26034480 PMCID: PMC4448048 DOI: 10.1159/000381874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Neurological symptoms induced by the infiltration of malignant lymphoma into the nervous systems are subsumed under the term neurolymphomatosis (NL). Here, we report the case of a 30-year-old Japanese man with primary testicular lymphoma complicated, as seen in various neurological findings, by secondary NL prior to testicular swelling. Painless right scrotal enlargement was noticed more than 1 month after the appearance of neurological complications such as right upper extremity numbness, dysarthria, facial palsy, and diplopia. Proactive investigation and biopsies of extranodal sites at high risk of central nervous system infiltration of malignant lymphoma, such as the testes, should be considered when secondary NL is suspected based on imaging findings.
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Affiliation(s)
- Yoshitaka Sunami
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihiko Gotoh
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuharu Hamano
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuriko Yahata
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroko Sakurai
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuichi Shirane
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoko Edahiro
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
| | - Norio Komatsu
- Department of Hematology, Juntendo University School of Medicine, Tokyo, Japan
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Advani P, Paulus A, Murray P, Jiang L, Goff R, Pooley R, Jain M, Garner H, Foran J. A rare case of primary high-grade large B-cell lymphoma of the sciatic nerve. Clin Lymphoma Myeloma Leuk 2015; 15:e117-20. [PMID: 25617034 DOI: 10.1016/j.clml.2014.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/26/2014] [Accepted: 12/06/2014] [Indexed: 11/23/2022]
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Akagi A, Ono K, Hamaguchi T, Samuraki M, Nakada M, Shima Y, Oohata T, Yamada M. Neurolymphomatosis exhibiting repeated exacerbation and remission in both the peripheral and central nervous systems. J Neurol Sci 2014; 345:267-8. [PMID: 25082781 DOI: 10.1016/j.jns.2014.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 06/21/2014] [Accepted: 07/16/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Akio Akagi
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa 920-8640, Japan
| | - Kenjiro Ono
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa 920-8640, Japan
| | - Tsuyoshi Hamaguchi
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa 920-8640, Japan
| | - Miharu Samuraki
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa 920-8640, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa 920-8640, Japan
| | - Yukiko Shima
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan
| | - Tetuya Oohata
- Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan
| | - Masahito Yamada
- Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Science, 13-1, Takara-machi, Kanazawa 920-8640, Japan.
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Kamiya-Matsuoka C, Shroff S, Gildersleeve K, Hormozdi B, Manning JT, Woodman KH. Neurolymphomatosis: a case series of clinical manifestations, treatments, and outcomes. J Neurol Sci 2014; 343:144-8. [PMID: 24928074 DOI: 10.1016/j.jns.2014.05.058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neurolymphomatosis (NL) is a rare clinical entity characterized by infiltration of malignant lymphocytes into the peripheral nervous system. We analyzed the clinicoradiological features, treatments, and outcomes in NL patients. METHODS We identified six patients with NL seen at The University of Texas MD Anderson Cancer Center from 01/2010 to 10/2012. We extracted clinical presentations, imagings, CSF cytology, and electrodiagnostic studies from medical records. One patient had a nerve biopsy. We defined therapy response as clinical improvement of neurological deficits. FINDINGS The mean age at onset was 57.1 years. Most were predominantly men with non-Hodgkin lymphoma. Positron emission tomography (PET) was positive in five patients. Nerve conduction demonstrated mononeuritis multiplex, plexopathy, demyelination, and axonal polyradiculoneuropathy, whereas electromyography was nonspecific. All patients received systemic chemotherapy, four intrathecal chemotherapy, and three intravenous immunoglobulin, plasma exchange or both. One patient who received intravenous immunoglobulin showed mild neurological improvement. Two patients responded, and the median overall survival was 15 months. CONCLUSIONS NL is an increasingly recognized complication of NHL and leukemia. A high clinical suspicion is necessary for correct diagnosis. In the present series, patients with leukemia had mononeuritis multiplex, whereas those with lymphoma had plexopathy. Electrodiagnosis and PET scans were useful diagnostic tools. No factors correlated with poorer prognosis. International collaborative studies will help to better determine the risk factors of NL, response to treatment and outcomes.
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