Epidural Lymphoma Mimicking Hematoma - A Case Report -

Dong-Yeong Lee; Soon-Taek Jeong; Kun-Tae Kim; Jung-Wook Yang; Dong-Hee Kim

doi:10.4184/jkss.2017.24.1.49

Journal List > J Korean Soc Spine Surg > v.24(1) > 1076155

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee, Jeong, Kim, Yang, and Kim: Epidural Lymphoma Mimicking Hematoma - A Case Report -

Case Report

Journal of Korean Spine Surg 2017;24(1):49-54.

Published online: 31 March 2017

DOI: https://doi.org/10.4184/jkss.2017.24.1.49

Epidural Lymphoma Mimicking Hematoma - A Case Report -

Dong-Yeong Lee, M.D., Soon-Taek Jeong, M.D., Kun-Tae Kim, M.D., Jung-Wook Yang, M.D.^∗, Dong-Hee Kim, M.D.

Department of Orthopedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea

^∗Department of Pathology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea

Corresponding author: Dong-Hee Kim, M.D. Department of Orthopedic Surgery, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, 15, Jinju-daero 816beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 52727 TEL: +82-55-750-8669, FAX: +82-55-761-9477 E-mail: dhkim8311@gnu.ac.kr

Received 28 November 201630 November 2016 Accepted 5 January 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Case report.

Objectives

To present a rare case of a spinal epidural lymphoma mimicking a hematoma.

Summary of Literature Review

The incidence of extranodal invasion of lymphoma is very low, and spinal compression as a clinical symptom rarely occurs in extranodal lymphoma.

Materials and Methods

A 37-year-old woman who complained of neck pain that had lasted for the past 3 months with no underlying disease visited the hospital and was treated conservatively with medication and physical therapy. Even though the patient was given an epidural injection 1 month prior to visiting our hospital, the pain lingered and the cervical myelopathy became aggravated, so the patient was initially diagnosed with epidural hematoma. This predisposed the patient to treatment strategies such as laminectomy and fusion, but the patient was ultimately diagnosed with non-Hodgkin lymphoma.

Results

The patient underwent a laminectomy with excision of the lesion and fusion. The patient was diagnosed with non-Hodgkin lymphoma as a result of this, and the patient's radicular pain and numbness improved immediately following surgery, except for mild weakness in both hands.

Conclusions

Although spinal epidural lymphoma is similar to hematoma, and is a very rare disease, surgeons should take it into consideration in the differential diagnosis of patients with a spinal epidural lesion.

Keywords: Myelopathy, Epidural, Lymphoma, Non-Hodgkin lymphoma, Hematoma

REFERENCES

1. Freeman C, Berg JW, Cutler SJ. Occurrence and prognosis of extranodal lymphomas. Cancer. 1972; 29:252–60.

2. Aabo K, Walbom-Jorgensen S. Central nervous system complications by malignant lymphomas: radiation sched-ule and treatment results. Int J Radiat Oncol Biol Phys. 1986; 12:197–202.

3. Lim CC, Chong BK. Spinal epidural non-Hodgkin's lymphoma: case reports of three patients presenting with spinal cord compression. Singapore Med J. 1996; 37:497–500.

4. Cho JH, Cho DC, Sung JK, et al. Primary malignant lym-phoma in a spinal cord presenting as an epidural mass with myelopathy: a case report. Korean J Spine. 2012; 9:265–8.

5. Mally R, Sharma M, Khan S, et al. Primary Lumbosacral Spinal Epidural Non-Hodgkin's Lymphoma: A Case Report and Review of Literature. Asian Spine J. 2011; 5:192–5.

6. Kapoor R, Kumar V, Sharma SC. Primary extradural non-Hodgkin's lymphoma. JK Science. 2006; 8:45–8.

7. Braunistein EM, White SJ. Non-hodgkin's lymphoma of bone. Radiology. 1980. 59–63.

8. Mascalchi M, Torselli P, Falaschi F, et al. MRI of spinal epidural lymphoma. Neuroradiology. 1995; 37:303–7.

9. Kim JM, Ko YH, Lee SS, et al. WHO Classification of Malignant Lymphomas in Korea: Report of the Third Nation-wide Study. Korean J Pathol. 2011; 45:254–60.

Fig. 1.

Sagittal images of (A) T1-weighted, (B) T2-weighted, and (C) contrast-enhanced magnetic resonance imaging showed intermediate signal intensity on T1- and T2-weighted images, and homogeneous high signal intensity on contrast-enhanced images. An epidural spinal tumor was located at the C5-T1 level.

Fig. 2.

Gross picture of the epidural mass. Soft, red-colored, gel-like materials were obtained from the epidural space. (A) Anterior to the C5-C7 lamina, adhesion of the soft mass was observed, and (B) marginal excision of the mass surrounding the dura was performed.

Fig. 3.

Histology and immunohistochemistry. (A) Tumor cells infiltrated diffusely except for a very focal area (arrow), which showed a follicular structure (×12.5). (B) On a high-power view (×400), the tumor cells consisted of centrocytes (white arrow head) and centroblasts (black arrow head). There were more than 15 centroblasts per high-power field.

TOOLS

Similar articles