{"id":"7ba8b991-e960-4460-9c98-fc8b1e9e5b85","slug":"essentials-for-early-diagnosis-of-primary-intramedullary-spinal-cord-lymphoma-how-to-suspect-primary-intramedullary-spinal-cord-lymphoma-early-and-proceed-to-invasive-biopsy-a-case-report-and-litera","title":"Essentials for early diagnosis of primary intramedullary spinal cord lymphoma. How to suspect primary intramedullary spinal cord lymphoma early and proceed to invasive biopsy? A case report and literature review","authors":["Seiji Shigekawa","Akihiro Inoue","Yukihiro Miyazaki","Mashio Taniwaki","Kota Kanehisa","Sayaka Matsumoto","Yoko Okada","Riko Kitazawa","Takeharu Kunieda"],"abstract":"Background: Primary intramedullary spinal cord lymphoma (PISCL) is an extremely rare condition. Early diagnosis is very difficult due to the nonspecific clinical and imaging findings. A biopsy is essential for a definitive diagnosis, but courage is required to perform the surgery. Here, we present a case of PISCL and suggest useful indicators for accurate diagnosis of this pathological entity. Case Description: A 70-year-old woman presented with subacute bilateral lower-limb paralysis, disturbance of warm and pain sensations, and vesicorectal disturbance. Magnetic resonance imaging showed a contrast-enhanced mass from C7 to Th2 and large, edematous lesions from the upper cervical to lower thoracic spinal cord. Elevated uptake of 18F-fluoro-2-deoxy-D-glucose (FDG) was identified in the enhanced regions on FDG-positron emission tomography (PET). Cerebrospinal fluid (CSF) analysis revealed highly elevated levels of β2-microglobulin (β2-MG). Steroid pulse therapy and therapeutic plasma exchange were performed for suspected myelitis, but symptoms did not improve. Spinal cord biopsy was, therefore, performed for treatment-resistant myelopathy. Histopathological examination revealed diffuse large B-cell lymphoma, which was diagnosed as PISCL because systemic examination showed no other findings suggestive of malignant lymphoma. Conclusion: In cases with poor response to treatment and a progressive course, PISCL should be considered, and spinal cord biopsy should be performed if PET shows increased 18F-FDG uptake and β2-MG is elevated in CSF.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/7ba8b991-e960-4460-9c98-fc8b1e9e5b85/featured/hero-1781559770446.png","publishDate":"2024-02-09T00:00:00.000Z","doi":"10.25259/SNI_8_2024","categories":["General Neurosurgery","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2024/02/12734/SNI-15-41.pdf"}