A case of rapidly progressive cervical primary spinal epidural lymphoma

Primary spinal epidural lymphoma (PSEL) is rare, accounting for just 0.1-6.5% of all extranodal lymphomas and 9% of all primary spinal epidural tumors. They are mostly located in the thoracic spine, with only occasional cervical spine involvement. Here, a 74-year-old male presented with a cervical epidural diffuse large B-cell lymphoma (DLBCL) that was successfully managed with an emergent surgical decompression.

A 74-year-old male presented with the acute onset of quadriparesis. The magnetic resonance imaging (MRI) revealed thickening of the posterior longitudinal ligament at C2-3, an epidural mass posterior to the spinal cord from C3-5, causing spinal cord compression, maximal at the C4-5 level. Six days after admission, the patient underwent a C2 partial and full C3-4 laminectomy; it resulted in improvement of quadriparesis. Pathology confirmed the diagnosis of CD20-positive DLBCL, and he subsequently received appropriate chemotherapy/radiotherapy.

Spinal cord compression is the sole presenting symptom in <5% of malignant lymphoma cases. Here, a 74-year-old male developed an acute quadriparesis attributed to a C3-C5 DLBCL that was successfully managed with a C2-C4 laminectomy, followed by appropriate chemotherapy and radiation.