J Korean Soc Spine Surg.  2017 Mar;24(1):49-54. 10.4184/jkss.2017.24.1.49.

Epidural Lymphoma Mimicking Hematoma: A Case Report

• Lee DY
• Jeong ST
• Kim KT
• Yang JW
• Kim DH

• KMID: 2402843
• DOI: http://doi.org/10.4184/jkss.2017.24.1.49

Abstract

STUDY DESIGN: Case report.
OBJECTIVES
To present a rare case of a spinal epidural lymphoma mimicking a hematoma. SUMMARY OF LITERATURE REVIEW: The incidence of extranodal invasion of lymphoma is very low, and spinal compression as a clinical symptom rarely occurs in extranodal lymphoma.
MATERIALS AND METHODS
A 37-year-old woman who complained of neck pain that had lasted for the past 3 months with no underlying disease visited the hospital and was treated conservatively with medication and physical therapy. Even though the patient was given an epidural injection 1 month prior to visiting our hospital, the pain lingered and the cervical myelopathy became aggravated, so the patient was initially diagnosed with epidural hematoma. This predisposed the patient to treatment strategies such as laminectomy and fusion, but the patient was ultimately diagnosed with non-Hodgkin lymphoma.
RESULTS
The patient underwent a laminectomy with excision of the lesion and fusion. The patient was diagnosed with non-Hodgkin lymphoma as a result of this, and the patient's radicular pain and numbness improved immediately following surgery, except for mild weakness in both hands.
CONCLUSIONS
Although spinal epidural lymphoma is similar to hematoma, and is a very rare disease, surgeons should take it into consideration in the differential diagnosis of patients with a spinal epidural lesion.

Keyword

Myelopathy; Epidural; Lymphoma; Non-Hodgkin lymphoma; Hematoma

MeSH Terms

Adult
Diagnosis, Differential
Female
Hand
Hematoma*
Humans
Hypesthesia
Incidence
Injections, Epidural
Laminectomy
Lymphoma*
Lymphoma, Non-Hodgkin
Neck Pain
Rare Diseases
Spinal Cord Diseases
Surgeons

Figure

• 

  Fig. 1. Sagittal images of (A) T1-weighted, (B) T2-weighted, and (C) contrast-enhanced magnetic resonance imaging showed intermediate signal intensity on T1- and T2-weighted images, and homogeneous high signal intensity on contrast-enhanced images. An epidural spinal tumor was located at the C5-T1 level.

• 

  Fig. 2. Gross picture of the epidural mass. Soft, red-colored, gel-like materials were obtained from the epidural space. (A) Anterior to the C5-C7 lamina, adhesion of the soft mass was observed, and (B) marginal excision of the mass surrounding the dura was performed.

• 

  Fig. 3. Histology and immunohistochemistry. (A) Tumor cells infiltrated diffusely except for a very focal area (arrow), which showed a follicular structure (×12.5). (B) On a high-power view (×400), the tumor cells consisted of centrocytes (white arrow head) and centroblasts (black arrow head). There were more than 15 centroblasts per high-power field.

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