Primary neurolymphomatosis diagnosed by spinal nerve root biopsy

Samantha Louise Saunders; Samantha M Giang; Sangruthai Sriweerawanidchakun; Anna Schutz

doi:10.1136/pn-2023-003977

Primary neurolymphomatosis diagnosed by spinal nerve root biopsy

Pract Neurol. 2024 Feb 22:pn-2023-003977. doi: 10.1136/pn-2023-003977. Online ahead of print.

Authors

Samantha Louise Saunders^{1

2}, Samantha M Giang³, Sangruthai Sriweerawanidchakun⁴, Anna Schutz⁵

Affiliations

¹ Gosford Hospital, Gosford, New South Wales, Australia Samantha.Saunders@health.nsw.gov.au.
² School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
³ Gosford Hospital, Gosford, New South Wales, Australia.
⁴ Neurology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.
⁵ Neurology, Gosford Hospital, Gosford, New South Wales, Australia.

PMID: 38388433
DOI: 10.1136/pn-2023-003977

Abstract

Primary neurolymphomatosis is the direct infiltration of lymphomatous neoplastic cells into nerve roots and/or peripheral nerves. A 67-year-old man had a 24-month history of progressive and severe left lower limb neuropathic pain, ipsilateral ankle dorsiflexion weakness and gait disturbance. Gadolinium-enhanced MRI showed thickening and enhancement of the cauda equina, L5, S1 and S2 nerve roots. ¹⁸Fluorodeoxyglucose positron emission tomography showed concordant hypermetabolism. L5 nerve root biopsy confirmed diffuse large B-cell lymphoma. One cycle of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) chemotherapy resulted in remission, but this was not sustained. Primary neurolymphomatosis is rare and diagnostically challenging, and often the diagnosis is delayed. While biopsy is the gold standard for diagnosis, neuroimaging helps to characterise lesions and to determine the feasibility of biopsy.

Keywords: NEUROONCOLOGY; NEUROPATHY; PAIN; PET.