Solitary manifestations of primary B-lymphoblastic lymphoma of the spine: Systematic literature review with case illustration

• Published in: Clinical neurology and neurosurgery Vol. 212; p. 107064
• Main Authors: Croci, Davide Marco, Gamboa, Nicholas T., Osman, Afaf E.G., Maese, Luke, Mazur, Marcus, Bisson, Erica F., Dailey, Andrew T.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2022; Elsevier Limited
• Subjects: Adolescent; Adult; B-cell precursor; Back pain; Biopsy; Bone marrow; Chemotherapy; Child; Compression; Decompression; Epidural; Female; Humans; Laboratories; Leukemia; Literature reviews; Lymphocytes B; Lymphoma; Lymphoma, B-Cell - diagnosis; Lymphoma, B-Cell - therapy; Magnetic resonance imaging; Male; Medical imaging; Middle Aged; Neurological diseases; Neurology; Osteolysis; Outcomes; Pathology; Patients; Precursor Cell Lymphoblastic Leukemia-Lymphoma - diagnosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Primary-B lymphoblastic lymphoma; Radiation; Remission; Spinal cord; Spinal Neoplasms - diagnosis; Spinal Neoplasms - therapy; Spine; Stem cell transplantation; Systematic review; Tomography; Treatment; Young Adult; Primary-B lymphoblastic lymphoma; Treatment; Spine; B-cell precursor; Outcomes
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2021.107064

Given the locally destructive osteolytic nature of primary B-cell lymphoblastic lymphoma (B-LBL) of the spine, careful attention is needed to identify clinical signs and symptoms as well as radiological findings of spinal instability because these lesions may warrant resection, decompression, and instrumentation with posterolateral fusion. Our objective was to summarize the presenting symptoms, clinical features, potential treatment modalities, and clinical outcome of cases described in the literature. We undertook a systematic literature review to identify all relevant cases and case series describing primary manifestations B-LBL of the spine using Pubmed/Medline. We summarized the findings in accordance with the PRISMA guidelines. We also present a case illustration. Together with our case, 9 cases of primary B-LBL of the spine were identified in 6 male and 3 female patients (age 8–58 years, median 31 years). Back pain was the most common symptom, and five patients also had neurological signs of spinal cord compression. T1-weighted MRI contrast enhancement was seen in 5 cases. Surgery was performed in 5 patients with progression of neurological deficits. Steroid treatment was also given in 3 patients preoperatively. Seven patients had chemotherapy after diagnosis. During follow-up of 1 month to 1 year, 2 cases of recurrence and 4 cases of complete remission were noted; however, with the short follow-up time, patient prognosis overall remains unclear. Primary B-LBL of the spine represents a rare clinical entity whose management mandates a multidisciplinary approach. Careful attention must be paid to the neurological status of the patient, as well as to imaging that may highlight potential local instability of the spine. •Primary localization of B-cell lymphoblastic lymphoma (B-LBL) in the spine is rare.•Back pain is the most common presenting symptom of primary B-LBL of the spine.•Primary B-LBL carries potential for high local instability of the spine.•Primary B-LBL mandates a multidisciplinary approach to treatment.•The prognosis of patients affected by primary B-LBL of the spine remains unclear.