Neurolymphomatosis of the lumbosacral plexus and its branches: case series and literature review

• Published in: BMC cancer 2019-11, Vol.19 (1), p.1149-1149, Article 1149
• Main Authors: Bourque, Pierre R, Sampaio, Marcos Loreto, Warman-Chardon, Jodi, Samaan, Sam, Torres, Carlos
• Format: Article
• Language: English
• Subjects: Age; Aged; Anatomy; Ankle; Autopsy; B-cell lymphoma; Biopsy; Bone marrow; Case Report; Chemotherapy; Computed tomography; Diagnosis; Female; Fluorodeoxyglucose F18; Humans; Literature reviews; Lumbosacral; Lumbosacral Plexus - pathology; Lymphocytes B; Lymphoma; Magnetic Resonance Imaging; Male; Middle Aged; MR neurography; Neoplasm Staging; Neurolymphomatosis; Neurolymphomatosis - diagnosis; Neurolymphomatosis - therapy; Neuropathy; Non-Hodgkin's lymphomas; Peripheral nerves; Positron emission tomography; Positron Emission Tomography Computed Tomography; Radiation therapy; Sciatic nerve; Ultrasonic imaging; Ultrasonography; Ultrasound
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-019-6365-y

Neurolymphomatosis (NL) is a direct process of invasion of peripheral nerves by lymphoma. It occurs in roughly 5% of patients with lymphoma and represents a particularly difficult diagnostic dilemma when it is the presenting focal manifestation of occult lymphoma. We present 3 examples of invasion of the lumbosacral plexus and its branches. These cases demonstrate a protean clinical picture with regards to the time relationship to the clinical course of lymphoma and the neuroanatomical extent of lumbosacral plexus invasion. We demonstrate the complementary role of different imaging modalities. A review of the literature summarizes 23 reports where lumbosacral plexus invasion was the index manifestation, at the time of first diagnosis or recurrence of lymphoma. This series confirms the strong preponderance of B-cell type (92%). There is a marked predilection for involvement of the sciatic nerve (74%), either focally or in a longitudinally extensive fashion, from the ischium to the popliteal fossa. There can also be restricted and discrete involvement of tibial and fibular branches. In recent years, ultrasound and CT have been given a more limited role, as screening tools or as a guide for biopsy. MRI neurography and PET-CT have become leading diagnostic modalities for diagnosis, staging and assessment of treatment response. The diagnosis of NL may be challenging, and it was once only reached at autopsy. Improved diagnostic imaging of focal or even asymptomatic disease offers new hope for earlier diagnosis and successful targeted therapy.