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Intramedullary Secondary Spinal Cord Lymphoma: A Case Illustration

Author(s): C Zachariadi, D Stefanou, D Siakavella, I Alexandratou, G Kourti, V Katsaros

Lymphoma of the Central Nervous System (CNSL) represents a rare subset of non-Hodgkin lymphoma, divided in two subgroups: Primary and secondary CNS lymphoma. The latter refers to systemic non-Hodgkin lymphoma that has disseminated to the CNS.

We present the case of a 73-year-old-male with progressively deteriorating weakness in his left upper extremity over the past month, accompanied by gait disorder with frequent falls. The patient was diagnosed with non-Hodgkin Lymphoma two years prior to his assessment. One and a half years later he was treated with combined immunochemotherapy due to extensive relapse, leading to partial remission. We performed a CSF flow cytometry, which identified monoclonal B-cells at 45% of the CD45+ cells. The Advanced MRI Spine and Brain Protocol performed, including Diffusion, Perfusion and MR-Spectroscopy methods, revealed enhancing lesions of the cervical spinal cord and the brain, after the i.v. administration of gadolinium. It also revealed intense diffusion restriction, typical perfusion histogram for a lymphoma combined with an almost normal spectroscopy, indicative of secondary lymphoma of the CNS. We immediately proceeded to treatment with high dose intravenous corticosteroid, which led to partial remission and the patient was soon able to walk more steadily.

According to our literature search, there is only one other published case that reports Hodgkin’s lymphoma affecting the intramedullary spinal cord and no other case with simultaneously insult of the brain and intramedullary spinal cord.

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