title: Intravascular lymphomatosis presenting as an ascending cauda equina: conus medullaris syndrome: remission after biweekly CHOP therapy.
abstract: A 63 year old man developed dysaesthesia in the legs followed by a subacute ascending flaccid paraparesis with sacral sensory and autonomic involvement. Intravascular lymphomatosis (IVL) was favoured by the presence of low grade fever and raised serum C reactive protein, CSF pleocytosis, raised lymphoma markers (serum LDH, soluble IL-2 receptor), and steroid responsiveness. Only muscle, among several organ biopsies, confirmed IVL. A cytogenetic study of the bone marrow showed chromosome 6 monosomy, as previously reported. The monosomy of chromosome 19, which bears the intercellular cell adhesion molecule-1, newly found in this case, may be related to the unique tumour embolisation of IVL. The CHOP regimen (six courses in 12 weeks) using granulocyte colony stimulating factor (G-CSF) led to gradual resolution of myeloradiculopathy and laboratory supported remission lasting for more than 13 months. The biweekly CHOP with G-CSF support may be a choice of chemotherapy in averting rapidly fatal IVL.
authors.affiliation: Department of Neurology, School of Medicine, Fukushima Medical University, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakahara
authors.forename: T
authors.initials: T
authors.lastname: Saito
authors.forename: A
authors.initials: A
authors.lastname: Muroi
authors.forename: Y
authors.initials: Y
authors.lastname: Sugiura
authors.forename: M
authors.initials: M
authors.lastname: Ogata
authors.forename: Y
authors.initials: Y
authors.lastname: Sugiyama
authors.forename: T
authors.initials: T
authors.lastname: Yamamoto
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002420:Cauda Equina / Q000473:pathology*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage; D019043:Vascular Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone