[Malignant lymphoma of the spinal epidural space. Report of three cases]

Three patients with non-Hodgkin's lymphoma involving the spinal epidural space are reported. All three patients, a 3-year-old boy (Case 1), a 63-year-old female (Case 2), and a 64-year-old male (Case 3), manifested signs and symptoms of neurological involvement before the diagnosis of malignant lymphoma was established by tissue examination. The tumors were located in the thoracic (Case 3) and thoracolumbar regions (Cases 1 and 2). The initial signs and symptoms of all cases were low back pain and progressing myelopathies. Bony abnormalities of the vertebrae, seen on both plain X-rays and computed tomographic scans, were unremarkable except for bilateral L1 pedicle erosion observed in Case 2. Total or subtotal tumor removal was followed by radiation therapy with or without chemotherapy in all cases. The primary lesion in Case 1 was a paravertebral lymphoma that had invaded the adjacent thoracolumbar epidural space through the intervertebral foramina. In Case 2, the primary lesion, documented by post-mortem examination, was a submucosal lymphoma of the stomach. In Case 3, the site of primary lesion could not be determined, although splenic and retroperitoneal nodal involvement was found at autopsy. The authors take a skeptical view of the existence of "primary" spinal epidural lymphoma, which has been reported a few times. Each of the three patients reported here presented with an epidural mass as the initial clinical manifestation of malignant lymphoma.