A patient with two episodes of thoracic spinal cord compression caused by primary lymphoma and metastatic carcinoma of the prostate, 11 years apart.
We report a 75-year-old man with two spinal tumors, primary epidural lymphoma and metastatic carcinoma of the prostate, which caused thoracic spinal cord compression, with a long symptom free interval between episodes. The patient presented with back pain and progressive weakness and numbness in his lower limbs for 3 months. Eleven years earlier, he had a symptomatic T8-10 primary spinal epidural lymphoma that was treated successfully with surgery and he made a full recovery. Magnetic resonance imaging of the thoracic and lumbar spines revealed multiple thoracic and lumbar vertebral osteolytic lesions. Extraosseous extension of a lesion at T1-4 resulted in severe spinal cord compression. In consideration of recurrent lymphoma, emergent cord decompression was achieved via posterior T1-4 decompressive laminectomy, and the patient's neurological status improved rapidly after surgery. Pathological examination confirmed metastatic carcinoma of the prostate. After several courses of chemotherapy, the patient improved neurologically and could walk independently. Three years after surgery, magnetic resonance imaging showed complete resolution of cord edema at T1-4 and T8-9, and the high signal intensity at unoperated levels largely regressed. This report emphasizes that other newly developed lesions should be included in the differentiation of recurrent primary spinal epidural lymphoma, especially in patients who have long-term, disease-free intervals between episodes.
Tai
Shih-Huang
SH
Neurosurgical Service, Department of Surgery, National Cheng Kung University Medical Center and Medical School, Tainan, Taiwan.
Hung
Yu-Chang
YC
Chen
Jian-Chin
JC
Jin
Ying-Tai
YT
Lee
E-Jian
EJ
D000368:Aged; D002277:Carcinoma / Q000150:complications* / Q000473:pathology; D019299:Decompression, Surgical; D006801:Humans; D008223:Lymphoma / Q000150:complications* / Q000473:pathology; D008297:Male; D009362:Neoplasm Metastasis; D011471:Prostatic Neoplasms / Q000150:complications* / Q000556:secondary; D013117:Spinal Cord Compression / Q000209:etiology* / Q000601:surgery