Primary spinal epidural non-Hodgkin's lymphoma: report of eight patients and review of the literature.
Eight patients treated for histologically confirmed primary spinal epidural non-Hodgkin's lymphoma diagnosed between January 1979 and August 1989 (6.6% of all cases of intraspinal lymphoma) were studied. There were six men and two women. The median age was 70 years (range, 43-80 yr). Patients sought treatment for a prodrome of back pain (median duration, 3 mo) followed by an acute neurological deterioration (median duration, 6 d). The most common findings were a discrete sensory level in 5 patients, hyperreflexia in 5 patients, and paraparesis or paraplegia in 5 patients. Radiographically, there was an absence of bony destruction by these tumors. All patients underwent a decompressive laminectomy, subtotal tumor resection, and spinal irradiation (median dose, 3800 cGy). Two patients had low-grade lymphomas (one B cell and one T cell), and 6 patients had intermediate-grade lesions (six B cell). Two patients with B-cell lymphomas (one low-grade and one intermediate-grade) developed metastatic disease 15 and 17 months after the initial diagnosis; no evidence of lymphoma developed in the other 6 patients. The median survival was 22 months (range, 2-71 mo). Lymphoma was the cause of death in only 1 of the 4 patients who died, and the 4 younger patients are alive and well. Primary spinal epidural non-Hodgkin's lymphoma should be a diagnostic consideration in the older patient who seeks treatment for spinal cord compression manifested by a prodrome of back pain, followed by a rapid neurological deterioration, normal plain spine radiographs, and neuroimaging consistent with an extradural compressive lesion. Surgery for this diagnosis followed by spinal irradiation should result in significant neurological improvement.
Lyons
M K
MK
Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.
O'Neill
B P
BP
Marsh
W R
WR
Kurtin
P J
PJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015174:Epidural Neoplasms / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000209:etiology; D013125:Spinal Neoplasms / Q000401:mortality* / Q000601:surgery; D015996:Survival Rate