Diffuse large B-cell lymphoma relapse presenting as extensive neurolymphomatosis

• Published in: The neuroradiology journal Vol. 33; no. 3; pp. 230 - 235
• Main Authors: Nepal, Pankaj, Batchala, Prem P, Rehm, Patrice K, Fadul, Camilo E
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.06.2020
• Subjects: Female; Humans; Imaging of Neoplastic Diseases; Lymphoma, Large B-Cell, Diffuse - pathology; Middle Aged; Neoplasm Recurrence, Local - pathology; Neurolymphomatosis - pathology; Peripheral Nerves - pathology; Neurolymphomatosis; peripheral nervous system; MRI; lymphoma; PET/CT
• ISSN: 1971-4009; 2385-1996
• DOI: 10.1177/1971400920924799

A 56-year-old woman with a history of diffuse large B-cell non-Hodgkin lymphoma (DLBCL-NHL) in remission for two years presented with weight loss and multifocal sensory/motor symptoms. Magnetic resonance imaging (MRI) of the neuraxis and whole-body FDG PET/CT led to a diagnosis of secondary neurolymphomatosis (NL). MRI demonstrated extensive thickening and enhancement of multiple cranial nerves and peripheral nerve plexuses with corresponding elevated metabolism on FDG PET/CT. Treatment with chemotherapy resulted in complete response on FDG PET/CT and subsequently she underwent autologous stem cell transplantation. NL is a rare manifestation of lymphoma affecting the peripheral nervous system. Nonspecific neuropathic symptoms make clinical diagnosis difficult. Though nerve biopsy is considered the gold standard, MRI and FDG PET/CT are accepted alternatives for making the diagnosis. We review imaging findings in NL, describe the differential diagnosis, and discuss the limitations of the imaging modalities.