Lumbar intervertebral disc involvement in chronic lymphocytic leukemia. A case report.
METHODS
Report of a patient with a rare location of a solid chronic lymphocytic leukemic mass of an intervertebral lumbar disc.


OBJECTIVE
To illustrate the previously undescribed discovertebral involvement of chronic lymphocytic leukemia and to discuss the diagnostic difficulties.


BACKGROUND
Chronic lymphocytic leukemia primarily involves lymph nodes, spleen, liver, and bone marrow. Bone lesions are rare in chronic lymphocytic leukemia and usually consist of areas of osteopenia. Spinal involvement in chronic lymphocytic leukemia is rare, and only two cases of spinal cord compression attributable to an extradural solid mass composed of leukemic cells have been reported. Intervertebral disc involvement in chronic lymphocytic leukemia has not been reported previously.


METHODS
The clinical findings, radiographs, histology, treatment, and follow-up results are presented.


RESULTS
Radiographs and magnetic resonance imaging studies showed partial collapse of vertebrae L2 and L3, with destruction and protrusion of the intervertebral disc L2-L3 with dura compression. Treatment consisted of radiotherapy followed by en bloc resection of vertebrae L2 and L3 stabilized with stackable cages and anterior fixation with Kaneda bars. Intervertebral disc infiltration with leukemic cells of B-cell origin was confirmed through histologic examination and immunohistochemical studies of a biopsy and resection specimen. Twenty months after treatment the patient was still in remission and fully mobilized.


CONCLUSIONS
Intervertebral disc involvement in cases of chronic lymphocytic leukemia is rare. Its presence should be considered in patients with back pain and neurologic symptoms who had been treated for this form of leukemia in the past. Differentiation with infectious spondylodiscitis can be difficult. Histology is necessary to confirm diagnosis.
Department of Orthopaedic Surgery, Free University Hospital, Amsterdam, The Netherlands.
T U
TU
Jiya
B J
BJ
Van Royen
S
S
Sugihara
P Y
PY
Van Diest
R A
RA
Manoliu
P I
PI
Wuisman
D000368:Aged; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology* / Q000601:surgery; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000473:pathology*; D017254:Leukemic Infiltration / Q000473:pathology* / Q000601:surgery; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D013123:Spinal Fusion