Ann Clin Neurophysiol.  2022;24(2):79-83. 10.14253/acn.2022.24.2.79.

Diffuse large B-cell lymphoma presenting as transverse myelitis

• Zukhriddin U
• Kang JJ
• Jeong MJ
• Oh SY

• KMID: 2535723
• DOI: http://doi.org/10.14253/acn.2022.24.2.79

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma. Although progressive lymphadenopathy is a typical feature, extranodal involvement may also occur, including the gastrointestinal tract, skin, bone, thyroid, and testes. Central nervous system invasion is rare, so differentiating it from diseases such as inflammatory demyelinating disorder or infection is essential. DLBCL is therefore a challenge to diagnose, especially when the first findings are neurological symptoms. We report an unusual case of DLBCL that presented as transverse myelitis.

Keyword

Diffuse large B-cell lymphoma; Transverse myelitis; Central nervous system involvement

Figure

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  Fig. 1. Magnetic resonance imaging of the spine was performed initially and 15 days after symptom onset. Initial T2-weighted (A) and postcontrast T1-weighted (B) images present mild cord swelling with T2-weighted hyperintensity without enhancement at the T11 and T12 levels (white arrow). Follow-up T2-weighted image (C) and gadolinium-enhanced T1-weighted image (D) demonstrate longitudinally extensive lesions over six vertebral segments (T7 to T12), with accompanying diffuse enhancement (white arrow).

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  Fig. 2. Computed tomography (CT) of the abdomen and pelvic cavity revealed swelling of the right testis (arrow) with heterogeneous enhancement (A). Fluorodeoxyglucose (FDG) positron-emission tomography/CT performed after right orchiectomy demonstrating mild diffuse hypermetabolism (arrow) thought to be due to a postoperative change in the right inguinal area (B) and an intense FDG-avid small lymph node (arrow) in the aortocaval area (C). The pathological findings demonstrate large atypical lymphocytes replacing the testis (D; Hematoxylin and Eosin staining, ×200) and tumor cells expressing CD20 (a B-cell marker), with the Ki-67 labeling index approaching 90% (E; Immunohistochemical stain, ×400).

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