A case of intravascular lymphoma with a longitudinal spinal lesion diagnosed by multiple biopsies

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  • Shirai Shinichi
    Department of Neurology, Hokkaido University Graduate School of Medicine
  • Takahashi Ikuko
    Department of Neurology, Hokkaido University Graduate School of Medicine Current Address; Department of Neurology, Obihiro Kosei General Hospital
  • Kanoh Takahiro
    Department of Neurology, Hokkaido University Graduate School of Medicine
  • Sato Kazunori
    Department of Neurology, Hokkaido University Graduate School of Medicine Current Address; Department of Neurology, Obihiro Kosei General Hospital
  • Kubota Kanako C.
    Department of Surgical Pathology, Hokkaido University Hospital
  • Yabe Ichiro
    Department of Neurology, Hokkaido University Graduate School of Medicine
  • Murayama Shigeo
    Department of Neuropathology, Tokyo Metropolitan Institute of Gerontology
  • Sasaki Hidenao
    Department of Neurology, Hokkaido University Graduate School of Medicine

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Other Title
  • 長大な脊髄病変をともないmultiple biopsiesにて組織診断された血管内リンパ腫の1例
  • 症例報告 長大な脊髄病変をともないmultiple biopsiesにて組織診断された 血管内リンパ腫の1例
  • ショウレイ ホウコク チョウダイ ナ セキズイ ビョウヘン オ トモナイ multiple biopsies ニテ ソシキ シンダン サレタ ケッカン ナイ リンパ シュ ノ 1レイ

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Description

A 45-year-old man was admitted to our hospital with flaccid paraplegia. Neurological examination at a local hospital, 2 months before admission to our hospital, showed sensory impairment of the right posterior surface of the thigh and a decreased Achilles tendon reflex. Spinal magnetic resonance imaging (MRI) showed a T2 weighted high-intensity area at the Th10-11 level that was more pronounced in the gray matter. The patient developed flaccid paraparesis and urinary retention. No improvement was observed after 2 rounds of methylprednisolone (mPSL) pulse therapy. Spinal cord biopsy showed demyelinated axons and myelinophagia without any tumorous lesion. Myelopathy exacerbated, and hence, plasma exchange was performed. However, this was ineffective. We suspected that myelopathy was caused by intravascular lymphoma (IVL) because of the presence of a low-grade fever, weight loss, and elevated serum soluble IL-2 receptor titers. Random biopsies, including skin, rectal, bone marrow, muscle, and renal biopsies, and splenectomy were performed to make a definite diagnosis of IVL myelopathy. Among these biopsies, the diagnosis of IVL myelopathy was confirmed from the renal specimen. The patient underwent chemotherapy at our hospital, and the IVL remitted. The results of this study confirm that sufficient systemic investigation by using tissue biopsy specimens should be performed in order to confirm the diagnosis of IVL myelopathy.<br>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 52 (5), 336-343, 2012

    Societas Neurologica Japonica

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