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A difficult case
Primary neurolymphomatosis diagnosed by spinal nerve root biopsy
  1. Samantha Louise Saunders1,2,
  2. Samantha M Giang1,
  3. Sangruthai Sriweerawanidchakun3,
  4. Anna Schutz4
  1. 1 Gosford Hospital, Gosford, New South Wales, Australia
  2. 2 School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
  3. 3 Neurology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
  4. 4 Neurology, Gosford Hospital, Gosford, New South Wales, Australia
  1. Correspondence to Dr Samantha Louise Saunders, Gosford Hospital, Gosford, New South Wales, Australia; Samantha.Saunders{at}health.nsw.gov.au

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.

  • NEUROPATHY
  • PAIN
  • PET
  • NEUROONCOLOGY

Data availability statement

No data are available.

https://doi.org/10.1136/pn-2023-003977

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    Data availability statement

    No data are available.

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    Footnotes

    • Contributors SLS contributed to writing the first draft of the manuscript, gathered images of the patient’s neuroimaging and histopathology for inclusion in the manuscript and was the corresponding author. SMG also contributed to writing the first draft of the manuscript. SS consented the patient for the case report, reviewed and edited the manuscript and assisted in project supervision. AS was the senior author.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed by Mary Reilly, London, UK.

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