Female, 52 years old, with diffuse large B-cell lymphoma, presenting with weakness and tingling sensation no signs. Assess for compressive lesions. Extensive enhancing soft tissue infiltration of the dorsal and lateral epidural space is seen beginning at the C5 level and extending caudally down to the T4 level. The bulkiest disease is seen between C6 and T2 where it causes complete or near complete effacement of the CSF space and slight flattening of the dorsal spinal cord. No evidence of cord signal abnormality is seen.Tumor infiltrates the left C7-T1 neural foramen; the bilateral T1-2 neural foramina with extensive extraforaminal tumor on the right; and the left T2-3 neural foramen.Spinal alignment is anatomic. Vertebral body height and morphology are preserved. No definite areas of pathologic marrow replacement are seen. Mild marrow heterogeneity is evident within the T1 and the T12 vertebral bodies without obvious edema or pathologic enhancement.Very mild spondylosis is seen at C4-5 and C5-6 without significant spinal canal stenosis or foraminal narrowing. The remaining disc levels are preserved without significant disc degeneration, spinal canal or neuroforaminal narrowing. Right paracentral annular fissuring is seen at L5-S1.Patchy marrow heterogeneity is seen within the right iliac bone, partially visualized on this examination.
1.Extensive tumor infiltration of the dorsal and lateral epidural space beginning at C5 and continuing caudally to the T4 level. The bulkiest disease exists between C6 and T2 where it causes complete thecal sac effacement and slight flattening of the dorsal spinal cord. No evidence of spinal cord edema is seen.2.Elsewhere, the spinal cord is unremarkable. No evidence of pathologic intrathecal enhancement is seen to suggest leptomeningeal disease.3.No definite evidence of marrow space disease is seen in the spine. Mild marrow heterogeneity at two vertebral body levels as discussed above is nonspecific. More significant marrow heterogeneity involving the right iliac bone is, however, concerning for tumor involvement.4.Findings discussed with Dr. Patel at 11:15 AM on 8/7/2015