most patients with hodgkin 's disease and spinal epidural involvement either present with concurrent neurological and nodal disease or develop neurological disease after being diagnosed with hodgkin 's disease .
a case of a 30-year - old male patient with primary thoracic epidural lymphoma who presented with back pain is presented in this paper .
the severity of pain was associated with the inability to perform the activities of daily living .
the patient did not have any lymphoma - related b - type symptoms , including body weight loss , fever and sweat at night .
a magnetic resonance imaging ( mri ) scan of the thoracic spine demonstrated an epidural tumor at the t911 level ( figs  13 ) .
histological examination revealed the polymorphous cellular infiltration by histiocytes , large mononuclear cells and lacunar reed 
sternberg cells with folded multi - lobed nuclei and small nucleoli ( fig .  4 ) .
immunohistochemical staining was positive for cd15 and cd30 and negative for cd3 , cd20 , cd79a or cd45ro .
these features were most frequently observed in the mixed cellularity type of hodgkin 's lymphoma .
the results of all other examinations ( f-18 fluorodeoxyglucose positron emission tomography ( f-18 fdg pet / ct ) , bone marrow biopsy and computed tomography ( ct ) of the chest , abdomen and pelvis ) were negative for an occult disease .
six courses of chemotheraphy containing abvd regimen ( adriamycin , bleomycin , vinblastine and dacarbazine ) were given to the patient .
postoperative mri scan did not reveal any evidence of hodgkin 's disease ( fig . 
5 ) , f-18 fdg pet / ct , ct of the chest , abdomen and pelvis were obtained in 24 months and did not reveal any evidence of hodgkin 's disease . 

figure  1:t2 weighted mri revealed a mass at the t9 - 11 level . 

figure  2:t1 weighted mri revealed a mass at the t9 - 11 level . 

figure  3:axial t1 weighted mri revealed at the epidural space . 
 figure  4:histological examination revealed mixed cellularity type of hodgkin 's lymphoma . 

figure  5:postoperative mri scan did not reveal any evidence of hodgkin 's disease . t2 weighted mri revealed a mass at the t9 - 11 level .
patients with hodgkin 's disease develop spinal cord compression caused by epidural hodgkin 's lymphoma and usually observed in the presence of an advanced disease [ 1 , 2 ] .
there are six case reports in the literature that describe patients with primary spinal epidural hodgkin 's lymphoma [ 16 ] ( table  1 ) .
samadian et al .   reported a case of primary and isolated spinal epidural hodgkin 's lymphoma at l1l3 level .
al - khayat et al .   reported a hodgkin 's lymphoma case with epidural involvement at c7t1 level .
reported a case with primary extranodal hodgkin 's disease who underwent decompressive surgery accompanied with stabilization and radiotheraphy . reported cases with primary spinal epidural hodgkin 's lymphoma ( s : surgery , rt : radiotheraphy , ct : chemotheraphy
e : epidural , v : vertebral , p : paraspinal ) moridaira et al .  
rao et al .  published a case with primary spinal epidural hodgkin 's lymphoma .
our case is apparently the seventh case to be diagnosed with hodgkin 's disease who presented with spinal cord compression due to epidural space without lymphoma elsewhere .
the abnormal mri marrow signal of the t9 and t10 vertebral bodies can be seen in fig . 
maybe the tumor in fact originated within the abnormal t9 or t10 bone marrow and spread to the epidural space via the epidural venous plexus .
surgery is the first therapeutic approach in malignancies compressing the spinal cord . because hodgkin 's lymphoma is a very chemosensitive and radiosensitive tumor , the indications for surgery were reduced and limited to laminectomy or even biopsy only , leaving the major role to chemotheraphy and radiotheraphy .
the combination of chemotheraphy and involved - field radiotheraphy is the most common treatment strategy ; two to four cycles of abvd are considered as the international gold standard for early - stage hodgkin 's lymphoma in combination with 2030 gy of involved - field radiotheraphy [ 7 , 8 ] .
we chose the first therapeutic approach for this patient who underwent gross total resection of the tumor , because the tumor type was unknown at the time of initial presentation .
the present case demonstrated that physicians should include primary spinal epidural hodgkin 's lymphoma in the differential diagnosis of spinal tumors .
treatment of hodgkin 's lymphoma will almost always include in the acute phase a form of emergency decompressive surgery , with or without resection , followed by chemotheraphy and/or radiotheraphy .
 primary spinal epidural hodgkin 's lymphoma is very rare . we will discuss the clinical features and treatment of primary spinal epidural hodgkin 's lymphoma . in this paper , a 30-year - old male patient who presented with spinal epidural tumor at the t911 level 
 is reported . 
 subtotal resection of the tumor was performed and the histological examination of the tumor specimen revealed hodgkin 's lymphoma . 
 all other examinations were negative for an occult disease . 
 six courses of chemotheraphy containing adriamycin , bleomycin , vinblastine and dacarbazine were given to the patient . 
 surgery is the first therapeutic approach in malignancies compressing the spinal cord . 
 hodgkin 's lymphoma is a very chemo- and radio - sensitive tumor . 
 the indications for surgery were reduced and limited to laminectomy or even biopsy only , leaving the major role to chemo- and radiotheraphy . 