Primary neurolymphomatosis of the cervical nerve root

Abstract

A 74-year-old woman was admitted with muscle weakness and sharp pain in her upper limbs. On ¹⁸FDG-PET, abnormal accumulation was noted on both sides of the brachial plexus at the cervical spinal cord. A diagnosis of primary peripheral nerve neurolymphomatosis was made based on biopsy of the third cervical nerve. Following R-CHOP therapy, the abnormal accumulation of ¹⁸FDG-PET scan disappeared. However, disturbance of consciousness occurred 6 months later and recurrence as multiple brain tumors was detected. Although salvage chemotherapy was performed, the patient died of overwhelming sepsis. Primary peripheral nerve neurolymphomatosis is extremely rare. Early distinct diagnosis using ¹⁸FDG-PET and combination chemotherapy of rituximab and high dose methotrexate may improve the outcome for such patients.