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Primary intramedullary spinal cord lymphoma
The Spine Journal 12 (2012) 527–528
Primary intramedullary spinal cord lymphoma A 75-year-old woman presented with progressively ascending paraparesis and stool incontinence for over a week. Examination revealed spastic paraplegia, hypoesthesia with upper level at C5. Magnetic resonance (MR) imaging demonstrated a well-enhanced intramedullary lesion from C1 to T5 spinal cord, more prominent dorsally (Fig. 1). The diffusionweighted imaging and apparent diffusion coefficient MR sequences showed diffusion restriction within the lesion (Fig. 2). Excisional biopsy was performed, and the pathology report indicated lymphoma (Fig. 3). Negative results of the chest and abdominal computed tomography excluded the possibility of secondary lymphoma involving the spinal cord. Clinical presentation and conventional MR findings of primary spinal cord lymphoma can mimic demyelinating disease [1]. The diffusion-weighted imaging and apparent diffusion coefficient sequence can not only effectively differentiate lymphoma from demyelinating disease by the characteristic diffusion restriction caused by compact cellularity of lymphoma but also identify the ideal location for biopsy [2,3]. Fig. 2. (Left) Diffusion-weighted imaging (DWI) reveals mild hyperintensity (arrow) at the area of enhanced intramedullary tumor at postgadoliniumenhanced T1-weighted magnetic resonance. (Right) Apparent diffusion coefficient imaging demonstrated mild hypointensity (arrow) at corresponding hyperintense area at DWI, indicating diffusion restriction.
Fig. 1. Gadolinium-enhanced sagittal T1-weighted magnetic resonance sequence demonstrates a slightly infiltrated intramedullary lesion along C1 to T5 spinal cord. 1529-9430/$ - see front matter Ó 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2012.05.028
Fig. 3. Histologic pattern demonstrates spinal cord tissue infiltrated by medium to large sized atypical lymphoid cells, which are not cohesive, contain little cytoplasm, pleomorphic nuclei, and prominent nucleoli (hematoxylin-eosin, 400).
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Y.-Y. Lin et al. / The Spine Journal 12 (2012) 527–528
References [1] Flanagan EP, O’Neill BP, Porter AB, et al. Primary intramedullary spinal cord lymphoma. Neurology 2011;77:784–91. [2] Haldorsen IS, Espeland A, Larsson EM. Central nervous system lymphoma: characteristic findings on traditional and advanced imaging. Am J Neuroradiol 2011;32:984–92. [3] Abul-Kasim K, Thurnher MM, McKeever P, Sundgren PC. Intradural spinal tumors: current classification and MRI features. Neuroradiology 2007;50:301–14.
Yi-Yang Lin, MDa,b Chung-Jung Lin, MDa,b Donald Ming-Tak Ho, MD, FCAPa,b Wan-Yuo Guo, MD, PhDa,b Cheng-Yen Chang, MDa,b a Department of Radiology Taipei Veterans General Hospital
No.201, Sec. 2 Shipai Rd Beitou District Taipei City, Taiwan b School of Medicine National Yang-Ming University No.155, Sec. 2 Linong St Taipei, Taiwan FDA device/drug status: Not applicable. Author disclosures: Y-YL: Nothing to disclose. C-JL: Nothing to disclose. DM-TH: Nothing to disclose. W-YG: Nothing to disclose. C-YC: Nothing to disclose.
Primary intramedullary spinal cord lymphoma A 75-year-old woman presented with progressively ascending paraparesis and stool incontinence for over a week. Examination revealed spastic paraplegia, hypoesthesia with upper level at C5. Magnetic resonance (MR) imaging demonstrated a well-enhanced intramedullary lesion from C1 to T5 spinal cord, more prominent dorsally (Fig. 1). The diffusionweighted imaging and apparent diffusion coefficient MR sequences showed diffusion restriction within the lesion (Fig. 2). Excisional biopsy was performed, and the pathology report indicated lymphoma (Fig. 3). Negative results of the chest and abdominal computed tomography excluded the possibility of secondary lymphoma involving the spinal cord. Clinical presentation and conventional MR findings of primary spinal cord lymphoma can mimic demyelinating disease [1]. The diffusion-weighted imaging and apparent diffusion coefficient sequence can not only effectively differentiate lymphoma from demyelinating disease by the characteristic diffusion restriction caused by compact cellularity of lymphoma but also identify the ideal location for biopsy [2,3]. Fig. 2. (Left) Diffusion-weighted imaging (DWI) reveals mild hyperintensity (arrow) at the area of enhanced intramedullary tumor at postgadoliniumenhanced T1-weighted magnetic resonance. (Right) Apparent diffusion coefficient imaging demonstrated mild hypointensity (arrow) at corresponding hyperintense area at DWI, indicating diffusion restriction.
Fig. 1. Gadolinium-enhanced sagittal T1-weighted magnetic resonance sequence demonstrates a slightly infiltrated intramedullary lesion along C1 to T5 spinal cord. 1529-9430/$ - see front matter Ó 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2012.05.028
Fig. 3. Histologic pattern demonstrates spinal cord tissue infiltrated by medium to large sized atypical lymphoid cells, which are not cohesive, contain little cytoplasm, pleomorphic nuclei, and prominent nucleoli (hematoxylin-eosin, 400).
528
Y.-Y. Lin et al. / The Spine Journal 12 (2012) 527–528
References [1] Flanagan EP, O’Neill BP, Porter AB, et al. Primary intramedullary spinal cord lymphoma. Neurology 2011;77:784–91. [2] Haldorsen IS, Espeland A, Larsson EM. Central nervous system lymphoma: characteristic findings on traditional and advanced imaging. Am J Neuroradiol 2011;32:984–92. [3] Abul-Kasim K, Thurnher MM, McKeever P, Sundgren PC. Intradural spinal tumors: current classification and MRI features. Neuroradiology 2007;50:301–14.
Yi-Yang Lin, MDa,b Chung-Jung Lin, MDa,b Donald Ming-Tak Ho, MD, FCAPa,b Wan-Yuo Guo, MD, PhDa,b Cheng-Yen Chang, MDa,b a Department of Radiology Taipei Veterans General Hospital
No.201, Sec. 2 Shipai Rd Beitou District Taipei City, Taiwan b School of Medicine National Yang-Ming University No.155, Sec. 2 Linong St Taipei, Taiwan FDA device/drug status: Not applicable. Author disclosures: Y-YL: Nothing to disclose. C-JL: Nothing to disclose. DM-TH: Nothing to disclose. W-YG: Nothing to disclose. C-YC: Nothing to disclose.