J Korean Soc Radiol.  2016 Nov;75(5):399-403. 10.3348/jksr.2016.75.5.399.

Primary Neurolymphoma of the Tibial Nerve: A Case Report with Characteristic MRI Findings

• Lee JE
• An JY
• Park JS
• Ryu KN
• Moon SK

• KMID: 2355995
• DOI: http://doi.org/10.3348/jksr.2016.75.5.399

Abstract

Primary neurolymphoma (NL) involving the peripheral nervous system is a rare disease that involves the invasion of a nerve or nerve plexus by neoplastic lymphocytes. Although there have been a few reported clinical and pathological cases presenting as primary NL involving the peripheral nerve, the detailed radiological features of NL have not yet been discussed. In this report, we present a case of primary NL involving the tibial nerve and describe the detailed imaging findings on MRI including features used for differential diagnosis.

MeSH Terms

Diagnosis, Differential
Lymphocytes
Lymphoma
Magnetic Resonance Imaging*
Peripheral Nerves
Peripheral Nervous System
Rare Diseases
Tibial Nerve*

Figure

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  Fig. 1 Coronal T1-weighted (A), fat-suppressed T2-weighted (B), and fat-suppressed enhanced T1-weighted (C) images show a well-defined, peripherally enhancing mass (short black arrows on A) involving the tibial nerve at the popliteal fossa. The lesion extended cranially to the distal sciatic nerve and the proximal part of the common peroneal nerve manifesting as diffuse fusiform thickening of the nerve with mild homogeneous enhancement. On T2-weighted axial image scanning the level of fusiform thickening (D), multiple dot-like dark signal foci within the lesion suggest displaced nerve fascicles (black arrows) by interspersed tumor infiltration. These foci appear as dark signal striation (black arrows) along the nerve course on coronal image (B). On T2-weighted axial image scanning at the level of mass formation (E), numerous irregular low signal foci (white arrows also seen on B) scattered within the mass are observed, suggesting fibrous components. Note the distended epineurium (blank arrows on D and E) with a low signal peripheral rim. The popliteal vessels are totally encased and severely collapsed, but thrombosis was absent. CPN = common peroneal nerve, SN = sciatic nerve

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  Fig. 2 18F-fluorodeoxyglucose (FDG)-positron emission tomography shows marked FDG uptake at the lesion involving the tibial nerve (black arrow), corresponding to enhancing portions on MRI. Note additional FDG activity of the left external iliac and porta hepatis lymph nodes suggestive of metastases (white arrows).

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