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Published on: November 26, 2018
Lumbar intervertebral disc involvement in chronic lymphocytic leukemia. A case report
T U Jiya1, B J Van Royen, S Sugihara
1Department of Orthopaedic Surgery, Free University Hospital, Amsterdam, The Netherlands.
Insights
This study reports a rare case of chronic lymphocytic leukemia (CLL) affecting an intervertebral disc, presenting diagnostic challenges. Early consideration of CLL is crucial for patients with back pain and neurological symptoms.
Area of Science:
- Oncology
- Hematology
- Spinal Surgery
Background:
- Chronic lymphocytic leukemia (CLL) typically affects lymphoid organs and bone marrow.
- Spinal involvement in CLL is uncommon, with few reported cases of extradural masses causing spinal cord compression.
- Intervertebral disc involvement by CLL has not been previously documented.
Observation:
- A patient with a history of CLL presented with symptoms suggestive of spinal pathology.
- Imaging revealed vertebral collapse and intervertebral disc destruction at L2-L3 with dural compression.
- Histological examination confirmed leukemic cell infiltration of the intervertebral disc.
Findings:
- The case demonstrates a novel presentation of CLL with discovertebral involvement.
- Treatment involved radiotherapy, surgical resection, and spinal stabilization.
- The patient achieved remission and full mobilization 20 months post-treatment.
Implications:
- Intervertebral disc involvement should be considered in CLL patients with back pain and neurological deficits.
- Distinguishing CLL disc infiltration from infectious spondylodiscitis can be challenging.
- Histopathological confirmation is essential for accurate diagnosis and management.
Study Design:
Report of a patient with a rare location of a solid chronic lymphocytic leukemic mass of an intervertebral lumbar disc.
Objectives:
To illustrate the previously undescribed discovertebral involvement of chronic lymphocytic leukemia and to discuss the diagnostic difficulties.
Summary Of Background Data:
Chronic lymphocytic leukemia primarily involves lymph nodes, spleen, liver, and bone marrow. Bone lesions are rare in chronic lymphocytic leukemia and usually consist of areas of osteopenia. Spinal involvement in chronic lymphocytic leukemia is rare, and only two cases of spinal cord compression attributable to an extradural solid mass composed of leukemic cells have been reported. Intervertebral disc involvement in chronic lymphocytic leukemia has not been reported previously.
Methods:
The clinical findings, radiographs, histology, treatment, and follow-up results are presented.
Results:
Radiographs and magnetic resonance imaging studies showed partial collapse of vertebrae L2 and L3, with destruction and protrusion of the intervertebral disc L2-L3 with dura compression. Treatment consisted of radiotherapy followed by en bloc resection of vertebrae L2 and L3 stabilized with stackable cages and anterior fixation with Kaneda bars. Intervertebral disc infiltration with leukemic cells of B-cell origin was confirmed through histologic examination and immunohistochemical studies of a biopsy and resection specimen. Twenty months after treatment the patient was still in remission and fully mobilized.
Conclusions:
Intervertebral disc involvement in cases of chronic lymphocytic leukemia is rare. Its presence should be considered in patients with back pain and neurologic symptoms who had been treated for this form of leukemia in the past. Differentiation with infectious spondylodiscitis can be difficult. Histology is necessary to confirm diagnosis.
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