Malignant lymphoma of the posterior mediastinum with transverse myelopathy

A case of malignant lymphoma in the thoracic paravertebral region with a severe spinal cord compression syndrome is presented. The patient was a 59-year-old female who had had right hypochondralgia as initial symptoms for more than one year. Chest radiograph and computed tomographic (CT) scanning on admission to another hospital had demonstrated a mass lesion in the thoracic paravertebral area. Due to the subsequent occurrence of progressive cord compression syndrome, she was transferred to our institution for the purpose of surgical treatment. Myelography demonstrated an obstruction of the spinal canal at the level of the 8th thoracic vertebra. CT-myelography showed a paravertebral tumour which extended through the intervertebral foramen into the epidural space and also spread to the posterior thoracic wall in succession. Tumour extirpation and decompressive laminectomy by single stage operation were performed. The pathological diagnosis was extranodal malignant lymphoma, diffuse, medium-sized cell type, with immunohistological demonstration of B-cell markers. Postoperatively, she was given a combination chemotherapy with VEPA (vincristine, cyclophosphamide, prednisone and doxorubisin), and the functional disorder has improved to some extent. To our knowledge, this is the first case of soft tissue malignant lymphoma in the posterior mediastinum.