title: Primary spinal epidural mantle cell lymphoma: case report.
abstract: OBJECTIVE
  Mantle cell lymphoma is a distinct clinicopathological type of non-Hodgkin's lymphoma that often presents at an advanced stage, with systemic spread. Spinal involvement is uncommon and generally occurs as part of advanced disease or generalized relapses. Primary spinal epidural lymphoma is a rare initial manifestation of non-Hodgkin's lymphoma, and mantle cell lymphoma with initial presentation in the spinal epidural space is extremely rare, having been previously reported in only two cases.
  
  
  METHODS
  We report a case of a 71-year-old man who presented with increasing weakness and numbness of the legs. Magnetic resonance imaging revealed a spinal epidural mass in the lumbosacral region.
  
  
  METHODS
  The patient underwent a partial L4 and L5-S1 laminectomy, with incomplete resection of the mass for spinal decompression and tissue diagnosis. Mantle cell lymphoma was diagnosed in the pathological examination.
  
  
  CONCLUSIONS
  After radiotherapy, the disease recurred with a soft-tissue mass in the anterior maxillary area of the face. The patient underwent restaging and was treated with chemotherapy, with only a partial response. Mantle cell lymphoma with primary spinal epidural presentation is rare. This diagnosis can be established and other causes of spinal cord compression can be ruled out by obtaining tissue for proper histopathological examinations. Because of its aggressive behavior and poor prognosis, mantle cell lymphoma should be treated using a combined-modality approach.
authors.affiliation: Department of Anatomic Pathology, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Barnard
authors.forename: B
authors.initials: B
authors.lastname: Perez-Ordoñez
authors.forename: D W
authors.initials: DW
authors.lastname: Rowed
authors.forename: L C
authors.initials: LC
authors.lastname: Ang
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D015174:Epidural Neoplasms / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007796:Laminectomy; D008161:Lumbosacral Region; D020522:Lymphoma, Mantle-Cell / Q000175:diagnosis* / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male