The great mimicker at thoracolumbar spine: Non-Hodgkin's lymphoma

To report two cases with Non-Hodgkin's Lymphoma (NHL) in thoracolumbar spine with very different presentation.

Case 1; An 84-year-old female patient was admitted to our emergency clinic with paraparesis in both lower extremities. Magnetic resonance imaging (MRI) revealed an epidural mass at the level of the T12 vertebrae. She was operated immediately with wide laminectomy and posterior instrumentation because of the paraparesis of both lower extremities. Case 2; An 70-year-old female patient was admitted to our clinic with thoracolumbar back pain. There was a T12 vertebra compression fracture view in the X-ray imaging. MRI revealed multiple infiltrations in medullar canale at thoracolumbar spine with lytic lesion. She underwent eight cycles of chemotherapy.

Multiple bone involvement was detected in both cases in PET-CT (Positron emission tomography-computed tomography) scans. Additionally it was found that there were nodal involvements accompanying these involvements in case 1. Because radiological examinations were not spesific enough to diagnose, it was necessary to perform a biopsy. The histopathological diagnosis of these patients revealed diffuse large B cell non-Hodgkin's lymphoma.

Diagnosis of the non-Hodgkin's lymphomas that are localized in thoracolumbar spine is often missed or delayed due to lack of specific findings and presence similarities to other diseases. Diagnosis is made by histopathologic examination. Although the main treatment is chemotherapy for these patients, surgery is necessary for patients with neurological deficite.