Intravascular lymphoma presenting as progressive paraparesis

Area of Science:

• Neurology
• Oncology
• Pathology

Background:

• Intravascular lymphoma (IVL) is a rare extranodal non-Hodgkin lymphoma characterized by proliferation of malignant lymphocytes within small blood vessels.
• Spinal cord involvement by IVL is exceptionally rare, often presenting with non-specific neurological deficits.
• Diagnosis can be challenging due to the insidious onset and limitations of conventional imaging and laboratory studies.

Observation:

• A patient presented with subacute progressive paraparesis, indicating weakness in both legs.
• Initial diagnostic workup, including laboratory tests and spinal imaging (MRI/CT), failed to identify the cause of the myelopathy.
• The clinical presentation suggested a spinal cord lesion, but the etiology remained elusive.

Findings:

• Despite inconclusive initial investigations, a systematic diagnostic approach was pursued.
• A spinal cord biopsy was performed, revealing the definitive diagnosis of intravascular lymphoma confined to the spinal cord.
• Histopathological examination confirmed the presence of malignant lymphocytes within the spinal vasculature of the affected cord segment.

Implications:

• This case underscores the importance of considering rare diagnoses like intravascular lymphoma in patients with unexplained myelopathy.
• Spinal cord biopsy, though invasive, can be a critical diagnostic tool for rare neurological conditions when less invasive methods are unrevealing.
• Early and accurate diagnosis of spinal cord IVL is essential for initiating timely and appropriate treatment, potentially leading to favorable outcomes in this rare but treatable malignancy.