Primary Spinal Intramedullary Lymphoma:A Case Report And Review Of The Literature

Objective:A 47 year-old man with primary intramedullary spinal B-cell non-Hodgkin’s lymphoma was reported.Review of literature yielded 27 cases with primary intramedullary lymphoma and clinical and radiological characteristics of these 27 cases were evaluated.Method:Report the diagnosing process of a 47 year-old man with primary intramedullary spinal B-cell non-Hodgkin’s lymphoma.Review of the case reports of primary intramedullary spinal lymphoma in the net of China National Knowledge Infrastructure and pubmed database from 1976 to date and evaluate the clinical,cerebral spinal fluid and radiological characteristics.Results:Case Report:A 47 year-old man admitted to our hospital with pain in the neck and numbness below right T4 for a week.MRI showed cervical spinal cord hyperintensity in T2WI.With a tentative diagnosis of neuromyelitis optica,the patient was treated with high dose prednisolone and IVIG.But the patient got worsen after treatment and the lesion enlarged.PET-CT then showed spinal cord and thalamus FDG positive,and not revealed extraneural disease.A biopsy finally showed a B-cell non-Hodgkin’s lymphoma.The patient was treated with high dose methotrexate and Rituximab,but the effect was poor.Literature Review:Male/female ratio was 14:13 for all the 27 cases.Median age of the patients was 52 years.67%of the cases presented with weakness of lower extremities or quadriplegia,22%with hemiplegia or single extremity weakness;85%of the patients had kakesthesia including extremities or perineal numbness and back pain;41%of the cases presented with dysautonomia.89%of the lesions were localized in the cervical and thoracic segments,11%in the lumbar segments or below.T2 hyperintensity lesion was seen in 91%patients,100%with contrast enhancement and 76%with spinal cord enlargement.91%patients presented with evaluated CSF protein levels and 83%with increased white cell counts.85%of tissue sampling was performed with biopsy and 48%of it was B-cell lymphoma.Patients were treated with various types of chemotherapy,radiotherapy or combination of them.Conclusion:Primary intramedullary spinal lymphoma is a rare disease with non-specific symptoms and MRI findings which leads to misdiagnosis at the first time.To some spinal cord demyelinating myelopathy patients,when steriod and IVIG don’t get good results,should keep primary intramedullary spinal lymphoma in mind.