Malignant Lymphoma Mimicking Spinal Degenerative Disorders : Difficulties in Differential Diagnosis

Abstract

The authors diagnosed five cases of malignant lymphoma that mimicked degenerative spinal disorders. This article describes how the differential diagnosises were made in the five cases.
The patients were 3 women and 2 men, whose ages ranged from 55 to 77 years. Symptoms were leg pain diagnosed as radiculopathy in three cases and paraplegia in two cases. Only one patient had a history of malignant lymphoma. Using these symptoms and MR images, the authors had to differentiate malignant lymphoma from disc herniation in three cases, lumbar canal stenosis in one, and ossification of the yellow ligament in one.
In three cases with leg pain, the mass was detected in the retroperitoneal space, using additional MR images in two cases, which were ordered to resolve a contradiction between clinical findings and images in two cases, and on a post operative CT scan in one case, which had been ordered due to a suspicion of acute peritonitis. Autopsy was required to obtain a definitive diagnosis of intramedullary malignant lymphoma of the spinal cord in the two cases with paraplegia that had intramedullary signal changes on MR images.
In two cases, operations had been performed as a result of the misdiagnosis. Four patients received non-operative treatment for malignant lymphoma ; radiation for one ; both radiation and chemotherapy for three. All five cases finally died of malignant lymphoma.
The physicians treating spinal disorders would do well to be aware of the possible existence such a rare condition when making differential diagnosises.