Page 187 - Read Online

Case Report

Complete recovery from paraplegia following

total spondylectomy for a primary diffuse B‑cell

lymphoma of the lumbar spine

Atef Ben Nsir , Mohamed Boughamoura , Rym Hadhri , Mouroug Mahfoudh , Nejib Hattab 1
2
1
1
1
1 Department of Neurosurgery, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia.
2 Department of Pathology, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia.
ABSTRA CT

Primary non‑Hodgkin lymphoma of the spine is very rare and occurs mostly in adults with strong male predominance. Here, we
present the case of a 24‑year‑old girl harboring a primary diffuse B‑cell lymphoma of L2 vertebral body, who was admitted in an
emergency with cauda equina syndrome and completely recovered after total spondylectomy and adjuvant chemotherapy. Such
findings have never been previously reported.

Key words: Bone lymphoma, diffuse large B‑cell lymphoma, lumbar vertebra, management, prognosis

INTRODUCTION history was consistent for neither prior pathologies nor
prior trauma.
Primary lymphoma of bone (PLB) accounts for 2.8-5.9%
of non-Hodgkin lymphomas and affects essentially On admission, a physical examination disclosed flaccid
adults with strong male predominance. Long paraplegia, with very weak tendon reflexes in both
[1]
extremity bones such as the femur represent the most sides and T12 sensory level. Bladder retention was also
frequent locations, and single vertebral involvement present. Lymphadenopathy, mass, and organomegaly
[2]
is observed in only 1.7% of all cases. At presentation, were not detected, and blood analyses were also normal.
[3]
the disease may resemble traumatic fracture or mimic
inflammatory, neuropathic, or infectious conditions. X-rays of the spine showed lytic changes of L2 vertebral
[4]
body in the vertebra plana shape and magnetic
We present the case of a 24-year-old girl harboring
a primary diffuse B-cell lymphoma of L2 (BCL-2) resonance imaging (MRI), realized in emergency,
showed a T1-weighted hypo intense, T2-weighted
vertebral body, who was admitted in emergency with hypo intense and enhanced lesion of L2 vertebral body
cauda equina syndrome and completely recovered extending posteriorly into the spinal canal and causing
after total spondylectomy and adjuvant chemotherapy.
major thecal sac compression [Figure 1].
CASE REPORT Surgery was advised in emergency, and a two-stage
complete spondylectomy was decided starting with
A 24-year-old girl presented to our emergencies in a posterior decompressive approach, and following
January 2014 for 2 months’ history of severe back by a lateral lobotomy approach for the removal of the
pain recently aggravated to incapacity of walking and vertebral body. Stability was ensured by costal rib grafts
sphincter disturbances for the past 3 days. Her medical and posterior spinal instrumentation [Figure 2].

Access this article online
During the surgery, the tumor was grayish and
Quick Response Code: moderately hemorrhagic. L2 posterior arch and the
Website:
www.nnjournal.net surrounding soft tissues were macroscopically intact.

DOI: Pathologic examination made on multiple tissue
10.4103/2347-8659.157962 samples showed infiltration by lymphocytes with
relatively large and irregular shaped nuclei [Figure 3].

Corresponding Author: Dr. Atef Ben Nsir, Department of Neurosurgery, Fattouma Bourguiba University Hospital, Farhat Hached
Street, 5000 Monastir, Tunisia. E‑mail: atefbn@hotmail.fr

PB Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 Neuroimmunol Neuroinflammation | Volume 2 | Issue 3 | July 15, 2015 179