J Korean Orthop Assoc JKOA Journal of the Korean Orthopaedic Association 1226-2102 The Korean Orthopaedic Association 10.4055/jkoa.2007.42.5.679 Case Report Neurolymphomatosis Involving Sciatic Nerve - A Case Report - Kang Ki-Ser M.D. Lee Eun Woo M.D. Jung Ho-Joong M.D. Jung Young-Bok M.D. Jang Eui-Chan M.D. Song Kwang-Sup M.D. Yoo Jae-Hyun M.D. Department of Orthopaedic Surgery, Medical Center of Chung-Ang University, Seoul, Korea. Address reprint requests to Ho-Joong Jung, M.D. Department of Orthopaedic Surgery, Medical Center of Chung-Ang University, 224-1, Heukseok-dong, Dongjak-gu, Seoul 156-755, Korea. Tel: +82.2-6299-1588, Fax: +82.2-822-1710, sunu@cau.ac.kr 10 2007 31 10 2007 42 5 679 683 Copyright © 2007 The Korean Orthopaedic Association 2007

The term "Neurolymphomatosis" includes the infiltration of the peripheral nervous system by lymphoma and nontumor lymphocytes. A neurolymphomatosis has not been classified as a distinct entity. Hence, its characteristic symptoms are often missed, and oncologists or neurological consultants fail to obtain an accurate diagnoses. We encountered a case of non-Hodgkins lymphoma involving the sciatic nerve, which has never been reported in the orthopedic literature in Korea. We report a case of neurolymphomatosis with a brief review of the literature.

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(A, B) Axial MR image of the distal femur shows that a diffuse enlarged sciatic nerve (arrow head) appears to invade and surround the involved nerve. Epineurium and perineurium of the sciatic nerve shows an iso-signal in the T1 images and a high-signal in the T2 images. Diffuse enhancement of lesion suggests nerve infiltration of the lymphoma. (C) T1 axial fat suppression Gd enhancement at the proximal femur. (D) T1 axial fat suppression Gd enhancement at the distal femur.

(A) Enlarged lymph node is shown beside the peroneal nerve (black arrow). The peroneal nerve appears normal (white arrow), but the enlarged tibial nerve portion of the sciatic nerve occupies 4/5 of the sciatic nerve. (B) After removing the epineurium, diffuse infiltrations of tumor cells were observed between the nerve fascicle, which showed axonal degeneration.

Malignant lymphoma invades the peripheral nerve. Large lymphoid cells are present with pleomorphic, often with horseshoe-shaped nuclei, and abundant cytoplasm.

Anaplastic large cell lymphoma with the involvement of the soft tissue, an unlabeled muscle, tibia nerve LCA (+), T-cell (+), Ki-1 (+), B-cell (-).