Primary spinal extranodal Hodgkin's disease at two levels

Area of Science:

• Oncology
• Neurology
• Pathology

Background:

• Hodgkin's disease typically originates in lymph nodes, with extranodal involvement being less common.
• Primary spinal extradural Hodgkin's disease without other organ involvement is exceptionally rare.
• Spinal cord compression from epidural Hodgkin's disease is an infrequent presentation.

Observation:

• A 39-year-old male presented with lumbar pain and was found to have an epidural mass at L3 with vertebral involvement.
• Radiological imaging also revealed involvement of the C6 vertebral body.
• Despite investigations, the primary focus of the disease remained unidentified.

Findings:

• Biopsy confirmed lymphocyte-dominant type Hodgkin's disease of the epidural lesion.
• Flow cytometry analysis was performed on the lesion.
• The patient was staged as 4A (Ann Arbor classification) and received postoperative radiotherapy to the lumbar and cervical regions.

Implications:

• This case represents a unique instance of primary spinal extranodal Hodgkin's disease involving two distinct vertebral levels.
• The findings underscore the importance of considering rare diagnoses in the presence of unexplained spinal lesions.
• Further research into the pathogenesis and optimal management of such rare presentations is warranted.