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T-cell lymphoma mimicking schwannoma of a cervical nerve root

Neurosurgical Review volume 32, Article number: 117 (2009) Cite this article

Abstract

T-cell lymphoblastic lymphoma is a rare form of non-Hodgkin lymphoma, which shows preponderance for young men. Most common symptoms are painless swelling of lymph nodes, accompanied by B symptoms and large mediastinal masses. Most often, an involvement of the nervous system is due to paraneoplastic symptoms or side effects of treatment. In a literature research, we could not find a case with affection of a cervical nerve root as the first symptom for T-cell lymphoblastic lymphoma. A 39-year-old man presented with right-sided C8 radiculopathy, including pareses and paresthesia. Since the magnetic resonance image disclosed a right-sided mass lesion in the region of the neuroforamen C8, compressing the corresponding nerve root, a schwannoma was suspected. The tumor was removed using a dorsal approach. Neuropathological examination revealed the diagnosis of T-cell lymphoblastic lymphoma. The patient underwent diagnostic staging and received further treatment. He experienced a very grim course and succumbed to his disease 12 months after surgery. T-cell lymphoblastic lymphoma is a rare disease, and tropism of lymphoma cells to neural structures is seldom encountered. However, the presence of radiculopathy, together with signs, referring to B symptoms, should prompt the physician to consider this coincidence in the differential diagnosis of schwannoma.

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Acknowledgment

We thank Prof. Dr M.-L. Hansmann, Senckenbergisches Institut für Pathologie, Johann Wolfgang Goethe University, Frankfurt am Main, for his diagnostic expertise.

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Affiliations

  1. Department of Neurosurgery, Justus Liebig University, Giessen, Germany

    D. Wachter, D.-K. Böker & U. Nestler

  2. Department of Internal Medicine, Justus Liebig University, Giessen, Germany

    S. Tschischka

  3. Department of Neuroradiology, Justus Liebig University, Giessen, Germany

    M. Huegens-Penzel

  4. Institute of Neuropathology, Justus Liebig University, Giessen, Germany

    K. Kuchelmeister

  5. Institute of Pathology, Justus Liebig University, Giessen, Germany

    R. M. Bohle

  6. Neurochirurgische Klinik, Universitätsklinikum Giessen und Marburg GmbH, Klinikstraße 29, 35385, Giessen, Germany

    D. Wachter

Authors
  1. D. Wachter
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  2. S. Tschischka
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  3. M. Huegens-Penzel
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  4. K. Kuchelmeister
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  5. R. M. Bohle
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  6. D.-K. Böker
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  7. U. Nestler
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Correspondence to D. Wachter.

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Comments

Dietmar Krex, Dresden, Germany

The authors present an unusual case with radiculopathy including pareses and paresthesia because of a cervical compressing mass lesion as initial symptoms of T-cell lymphoblastic lymphoma. This is an informative presentation of an interesting case making the reader alert to this rare differential diagnosis. Although a spinal involvement is seen in only 1–10% in patients with non-Hodgkin lymphoma, it is important to keep this kind of manifestation in mind to perform further diagnostics timely in those severely ill patients. This case also underlines that a thorough histological evaluation is mandatory even when the diagnosis seems obvious according to clinical and radiological presentation.

Uwe Spetzger, Karlsruhe, Germany

This paper is interesting for neurosurgeons dealing with spinal tumors and demonstrates that lymphomas could be located everywhere within the central nervous system. High-grade lymphomas should be taken into consideration in the preoperative discussion, especially when MR imaging of the lesion shows such an inhomogeneous contrast enhancement and the clinical signs and symptoms in young patients are as rapidly deteriorating as demonstrated.

Despite aggressive multimodal treatment, central nervous lymphomas usually have a bad prognosis. Therefore, the discussion of the surgical strategy and particularly the timing of surgery are very important, especially to force the histological diagnosis early enough, allowing an immediate systemic treatment in this devastating disease. The controversy is to recommend and perform an open biopsy or a gross total resection. In addition, the infiltrative growing of those lesions within the nerve fascicles makes the radical resection of extra-axial high-grade lymphomas nearly impossible, without a significant risk of a permanent neurological deficit. Therefore, this report makes an important contribution for the differential diagnosis and the preoperative planning of suspect peripheral spinal nerve tumors.

The manuscript is submitted on behalf of all authors and all named authors have participated in this work.

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Wachter, D., Tschischka, S., Huegens-Penzel, M. et al. T-cell lymphoma mimicking schwannoma of a cervical nerve root. Neurosurg Rev 32, 117 (2009). https://doi.org/10.1007/s10143-008-0169-x

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  • DOI: https://doi.org/10.1007/s10143-008-0169-x

Keywords

  • Schwannoma
  • T-cell lymphoblastic lymphoma
  • Radiculopathy
  • Peripheral and central nervous system