2020 Volume 25 Issue 1 Pages 111-118
We report the case of a patient with a dumbbell‒shaped malignant lymphoma of the spinal extradural space and a brain lesion; the patient presented with symptoms of spinal cord compression. The patient was a 66‒year‒old Japanese man who had noticed numbness involving the lower extremities and trunk approx. 2 weeks before seeking medical attention. Spinal MRI revealed a dumbbell‒shaped lesion extending from the spinal canal to the paraspinal space at the T4‒5 level. We made the diagnosis of spinal extradural tumor and then scheduled surgery. Three days before the scheduled surgery, the patient became disoriented and aphasic with right upper limb paralysis. Brain MRI revealed a lesion in the left temporoparietal lobe that was diagnosed as a hemorrhagic infarct; he also developed generalized seizure. The surgery was therefore postponed, and we started treatment for stroke and seizure control. The patient’s paraplegia then progressed rapidly and he developed bladder and rectal dysfunction. A spinal tumorectomy was performed 10 days after the detection of the brain lesion. The tumor was confined to the epidural space, and a gross total resection was successfully performed. The pathological diagnosis was diffuse large B‒cell lymphoma. The brain lesion that was initially diagnosed as a hemorrhagic infarction was biopsied, and the same pathological diagnosis was obtained. Positron emission tomography‒CT revealed multiple lesions. After surgery, chemotherapy was started using methotrexate, and the brain lesions gradually disappeared. Although relief of the spinal cord compression was maintained, the paraplegia persisted and thus the patient was transferred to another center for systemic chemotherapy with the R‒CHOP regimen. A dumbbell‒shaped spinal epidural tumor is generally suspected to be a schwannoma, but early surgery is necessary in some cases (such as our patient’s), and the presence of other malignant lesions should be investigated.
