title: Primary epidural lymphocyte-depleted Hodgkin's lymphoma of the thoracic spine - presentation of a rare disease variant.
abstract: BACKGROUND
  Lymphocyte-depleted Hodgkin's lymphoma is the rarest form of classical Hodgkin's lymphoma, accounting for < 1% of all cases. Patients often have advanced-stage disease at the time of presentation with an aggressive clinical course. Even more uncommon is primary extranodal disease and rarely it will be presenting with spinal cord compression.
  
  
  METHODS
  An 88-year-old Caucasian female presented with a history of upper back pain for several months and new onset bilateral leg numbness and weakness. MRI of the spine showed a dorsal epidural lesion with cord compression at T1-T4 with involvement of the paraspinal muscles. The patient received urgent surgical decompression, with final histopathology showing a lymphocyte-depleted Hodgkin's lymphoma. Systemic work-up did not show evidence of nodal disease. Following surgery, she received a course of radiotherapy with good outcome.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first reported case of primary lymphocyte-depleted Hodgkin lymphoma presenting as epidural spinal cord compression. Our report, in conjunction with a review of the literature, suggests that surgical intervention is clearly indicated in de novo disease followed by radiotherapy.
authors.affiliation: Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. ekasper@bidmc.harvard.edu
authors.forename: Ekkehard M
authors.initials: EM
authors.lastname: Kasper
authors.forename: Fred C
authors.initials: FC
authors.lastname: Lam
authors.forename: Markus M
authors.initials: MM
authors.lastname: Luedi
authors.forename: Pascal O
authors.initials: PO
authors.lastname: Zinn
authors.forename: German A
authors.initials: GA
authors.lastname: Pihan
mesh_terms: D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D015174:Epidural Neoplasms / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006689:Hodgkin Disease / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology*; D013904:Thoracic Vertebrae / Q000473:pathology*