Neurolymphomatosis in the Cauda Equina Diagnosed by an Open Biopsy

Ryo Sasaki; Yasuyuki Ohta; Yuto Yamada; Koh Tadokoro; Yoshiaki Takahashi; Kota Sato; Jingwei Shang; Mami Takemoto; Nozomi Hishikawa; Toru Yamashita; Takao Yasuhara; Isao Date; Shuntaro Ikegawa; Nobuharu Fujii; Koji Abe

doi:10.2169/internalmedicine.1049-18

CASE REPORTS

Neurolymphomatosis in the Cauda Equina Diagnosed by an Open Biopsy

Ryo Sasaki, Yasuyuki Ohta, Yuto Yamada, Koh Tadokoro, Yoshiaki Takahashi, Kota Sato, Jingwei Shang, Mami Takemoto, Nozomi Hishikawa, Toru Yamashita, Takao Yasuhara, Isao Date, Shuntaro Ikegawa, Nobuharu Fujii, Koji Abe

Author information

Ryo Sasaki
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Yasuyuki Ohta
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Yuto Yamada
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Koh Tadokoro
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Yoshiaki Takahashi
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Kota Sato
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Jingwei Shang
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Mami Takemoto
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Nozomi Hishikawa
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Toru Yamashita
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Takao Yasuhara
Department of Neurological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Isao Date
Department of Neurological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Shuntaro Ikegawa
Department of Hematology and Oncology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Nobuharu Fujii
Department of Hematology and Oncology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
Koji Abe
Department of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan

Keywords: neurolymphomatosis, cauda equina, spinal biopsy, B-cell lymphoma

JOURNAL OPEN ACCESS

2018 Volume 57 Issue 23 Pages 3463-3465

DOI https://doi.org/10.2169/internalmedicine.1049-18

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Abstract

Neurolymphomatosis is a rare form of extranodal malignant lymphoma defined as the infiltration of malignant lymphocytes into the central or peripheral nerve. We herein report a case of neurolymphomatosis in the cauda equina diagnosed by an open surgical biopsy. He presented with muscle weakness, atrophy, numbness and hypoesthesia in the bilateral lower extremities with the accumulation of ¹⁸fluoro-2-deoxyglucose (FDG) in the bilateral cauda equina. Cerebrospinal fluid cytology (three times) and flow cytometry (two times) and biopsies of the left sural nerve, bone marrow, paranasal sinus and left testis were all negative for malignancy, so finally we performed a surgical open biopsy of the cauda equina by laminectomy and diagnosed him with diffuse large B-cell lymphoma in the cauda equina. He was successfully treated with the disappearance of the FDG accumulation for a long time. The present case suggested that an early open biopsy of the cauda equina may be considered for cases of suspected neurolymphomatosis in the cauda equina for a good outcome.

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