Metastatic Lymphoma and Spinal Cord Compression

Abstract

A 46-year-old black woman has been treated for stage IV diffuse mixed cell lymphoma of the right tonsil with cyclophosphamide, Adriamycin (doxorubicin), Oncovin (vincristine) (CHOP), cyclophosphamide, Oncovin, procarbazine, and prednisone (C-MOPP), 1,3-bis-(2-chlorethyl)-1 -nitrosourea (BCNU), and methotrexate over a period of 11 years. At age 43 and 45 she was irradiated to the left axillary supraclavicular region and to the right axillary-supraclavicular region, respectively. Six months ago (now age 46) she suffered back pain which was treated with chlorambucil (Leukeran) and steroids subsequent to a negative magnetic resonance imaging (MRI) scan. However, over the last 3 days, the pain has increased. Leg weakness and a high lumbar sensory level and bowel and bladder dysfunction prompted an MRI which showed spinal cord compression at T12-L1, marrow replacement in T12 and a paraspinal mass. While on steroids, which is also aggravating her type II diabetes mellitus, she can wiggle her toes and legs, but she needs a Foley catheter and has not had a bowel movement since her new symptoms appeared. Her back pain is relieved, however, with bed rest and opiates.