A 27 year old man presented to emergency department for 2 month history of chest and backpain. One month history of progressive weakness, paresthesia of his legs,
ataxic walking difficulty developed for 3 days before his admittance. The presenting complaint of our patient was backpain and treatment with non-steroidal anti-inflammatory drugs (NSAID) complaints resolved at first. No neurological deficit were mentioned in his previous medical records. He mentioned about loss of 10 kg with in the last 2 months.
Neurological examination assessed (manuel muscle test) bilateral lower extremites muscular strength were 3/5. Babinski sign was positive. There was clonus bilaterally. Her gait was ataxic with searching steps and romberg's sign was present. Sensation was decreased to light touch pinprick in and below the Thoracic vertebra (Th) 9 dermatome level. Vibration sense was decreased. Ankle reflexes were decreased bilaterally.
Magnetic resonance imaging (MRI) and Computer tomography (CT) showed diffuse involvement of dorsal and lombar vertebrae. There was involvement of the paravertebral soft tissue of the Th 9, 10, 12 and lumbar 1, 2,-5 and pathologic compression fractures with retropulsion of the posterior vertebral bodies (Figure 1, 2). Multiple osteolytic bone lesions with cortical destruction vertabrae. After surgery, abdominal ultrasonographic (USG) examination was performed. Hepato-splenomegaly, mild nephromegaly, several lymph nodes around sternoclavicular muscle were found. Thorax and abdominal CT scans were performed, mediastinal and hilar lymphadeopathies were found on scannings.
The day his admittance, emergent surgery was done. Decompression of thoracal 9, 10, 12 and lumbar 1, 2, 5 vertabrae with laminectomy and excission of paravertebral mass lesion, lumbar 5 vertebra transpediculer percutaneus corpus biopsy was done. Tumor was soft suckable, moderately vascular. High dose corticosteroid was postoperatively given but neurological examination was not improved.
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Figure 1: CT showing cord compression secondary to vertebral involvement of lymphoma. |
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Figure 2: MRI showing cord compression secondary to vertebral involvement of lymphoma. |
Material was evaluated by hematoxyline-eosin stainning and immuno-histochemistry. LCA CD19 were pozitive. CD3, EMA, Desmin, S100, CD30, CD34, 68, 56, 117 were negative. The pathological diagnosis was extranodal B cell lymphoma (Figure 3).
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Figure 3: Hematoxyline-eosin stainning and immuno-histochemistry LCA CD19 showing extranodal B cell lymphoma. |
After pathological diagnosis, the patient was treated with both radiotheraphy and chemotherapy. He died 2 months after operation because of infection.
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