title: The Diagnostic Dilemma of Neurolymphomatosis.
abstract: Neurolymphomatosis (NL) defined as infiltration of the central nervous system or the peripheral nervous system (PNS) by malignant lymphoma cells is a rare clinical entity. However, the increasing use of fluorodeoxyglucose positron-emission tomography (FDG-PET) and magnetic resonance imaging in evaluating PNS disorders is resulting in; this condition being recognized more frequently. Here; we report five NL patients and review the current literature. We report five patients with non-Hodgkin's lymphoma (NHL) and NL, all of whom were men aged 47-69 years. The clinical presentation varied from symmetrical peripheral neuropathy to mononeuropathy. Peripheral neuropathy was the presenting manifestation of a systemic lymphoma in two patients (40%). Neuroimaging as well as whole-body FDG-PET helped in determining the correct diagnosis in all of the patients. NL is an unusual presentation of NHL resulting from infiltration of the PNS by malignant lymphomatous cells. While evaluating peripheral neuropathy, a high degree of suspicion of NL is required since the presenting symptoms vary, conventional radiology has only modest sensitivity, and a pathological diagnosis is often difficult. FDG-PET helps in the early diagnosis and treatment of this condition.
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Ritu
authors.initials: R
authors.lastname: Shree
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. goyal_mk@yahoo.com.
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Goyal
authors.affiliation: Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Modi
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Balan Louis
authors.initials: BL
authors.lastname: Gaspar
authors.affiliation: Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Bishan Dass
authors.initials: BD
authors.lastname: Radotra
authors.affiliation: Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Chirag Kamal
authors.initials: CK
authors.lastname: Ahuja
authors.affiliation: Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Bhagwant Rai
authors.initials: BR
authors.lastname: Mittal
authors.affiliation: Department of Clinical Hematology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Prakash
keywords: diffuse large-B-cell lymphoma; fluorodeoxyglucose positron-emission tomography; mononeuropathy; neurolymphomatosis