Extranodal classical Hodgkin lymphoma involving the spinal cord: case report and review of the literature

Abstract

Primary CNS involvement is very rare in Hodgkin lymphoma. Here we present two cases of spinal cord dissemination. Two women of 40 and 65 years of age presented symptoms of spinal cord injury; imaging showed an intramedullary mass in T10 and T2, respectively, without vertebral involvement and upper diaphragmatic lymph nodes. Lymph-node biopsy confirmed the diagnosis of classical Hodgkin lymphoma in both patients. The first patient received four cycles of chemotherapy (escalated BEACOPP and ABVD) with intrathecal therapy, and the second four cycles of doxorubicin, vinblastine, dacarbazine (AVD) and local irradiation after surgery decompression. Complete metabolic response was obtained at the end of treatment. After 5 and 7 years of follow-up respectively, neurological deficits persisted in both.

Plain language summary

Lymph-node infiltration is the most common presentation in Hodgkin lymphoma at diagnosis. Primary extranodal involvement is rare and spinal cord infiltration exceptional. Back pain, tingling and vesico-sphincter dysfunctions are the main symptoms. 18F-fluorodeoxyglucose (FDG) PET and MRI can detect the location and extension of neurological involvement. We present here two cases of tumoral myelitis and a review of the literature. Local treatment (surgery/radiotherapy) is often administered together with chemotherapy to optimize local control and to avoid long-term sequelae.

Keywords::

• 18F-FDG PET
• case report
• classical Hodgkin lymphoma
• radiotherapy
• spinal cord infiltration
• surgery

Author contributions

K Le Dû worked on the literature review and wrote the manuscript. C Rossi revised the final version. The other authors transmitted imaging and histologic results and were involved in the preparation and revisions of the manuscript, and approved the final version of the manuscript for submission.

Acknowledgments

The authors thank the patients and their families for their participation. The authors would like to thank Enago (www.enago.com) for the English language review.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Informed consent disclosure

All the data were de-identified and both patients gave informed consent after oral medical information. Their agreement was recorded in the medical file.