Primary spinal epidural diffuse large B-cell lymphoma

摘要

Sir,A 32-year-old female patient presented with progressive ill-defined pain at the level of left infra mammary region with a tight band like sensation of 3 weeks duration followed by progressive asymmetric weakness of both lower limb with decreased pain and temperature sensation without any bowel or bladder involvement 1 week before admission. Neurologic examination demonstrated, bilateral lower limb spasticity with asymmetric pyramidal pattern of weakness (right > left) with impaired vibratory and proprioceptive sensation below T4 level. Thoracic magnetic resonance imaging showed Tl hypo and T2 mild hyperintense well defined epidural lesion at T3-T4 level with diffusion restriction and moderate enhancement on contrast with small paraspinal component extending along T3-T4 neural canal on the right side [Figure 1]. The radiologic differential diagnosis included lymphoma, granuloma and bone metastasis. Extensive work-up for malignancy was negative, including bone marrow examination. Open lesion biopsy demonstrated diffuse large B-cell lymphoma with MIB index of 50% and CD20 and bcl-6 positive cells [Figure 2].