Epidural lymphoma - Review of literature

H. S. Ballal, A. R. Mahale, R. Shetty, M. S. Bhavikatti

Research output: Contribution to journalLetterpeer-review


The spinal epidural space is an uncommon presenting site for lymphomas. The occurrence of spinal epidural disease ranges from 0.1- 0.6% among cases of non-Hodgkin's lymphoma (NHL) [1].

A twelve-year-old boy presented with low-grade fever for one and a half months which was intermittent initially and became high grade with chills for a week. The child had weakness in the lower limbs with back pain and was unable to walk for the last two days. On examination, there was Grade 0 power in the lower limbs.

A myelogram and CT myelogram (CTM) were performed. Myelogram showed evidence of minimal hold-up, thinning and anterior displacement of contrast in the thecal sac at T8. CTM showed a hypodense posterior epidural lesion causing thinning of the contrast column in the thecal sac with obliteration posteriorly at T7 and postero- laterally at T8.

Round cell sarcomas of the spinal epidural space have been recognized for years. They predominantly affect individuals above the age of 40 years, though younger individuals may also be affected. A male predominance is seen. Myelography usually shows complete obstruction of the thecal contrast column [1]. The early diagnosis and treatment of epidural lymphoma has an excellent prognosis. MRI helps in demonstrating the whole spinal canal, including extraspinal spread and is useful for follow-up [2].

The most common location is the mid-thoracic spine. These patients have a less favorable prognosis because of fewer radicular arteries to the spinal cord at this level and an increased chance of cord ischemia following epidural compression [3]. Extranodal presentation occurs in 15- 30 % of lymphomas. NHL is more likely to involve the epidural space than Hodgkin 's disease. Lack of bony involvement on plain radiographs provides a clue to the diagnosis of lymphoma. The overall mean survival of patients is 8-9 months with less than 10% surviving one year. Decompression with laminectomy and tissue diagnosis is mandatory [4].

Epidural lymphomas account for 9% of spinal tumors. Primary epidural NHL, "PENLS" is of unknown origin. Rubinstein believes that it derives from epidural lymphatic tissue. Both mass effect and compression contribute to symptomatology [5].
Original languageEnglish
Pages (from-to)112-113
Number of pages2
JournalIndian Journal of Radiology and Imaging
Issue number2
Publication statusPublished - 13-07-2000

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging


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