Primary spinal epidural Hodgkin's lymphoma
A 30-year-old male patient was admitted to our clinic with back pain. Pain was provoked by movements. 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. He did not have a past and family history. There was no neurological deficit. Routine laboratory test results were normal. A magnetic resonance imaging (MRI) scan of the thoracic spine demonstrated an epidural tumor at the T9–11 level (Figs –). The patient underwent spinal cord decompression via total laminectomy of T9–11 levels. Subtotal resection of the tumor was performed. 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. ). 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. Histological examination of the vertrebral body revealed no abnormality. 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. The patient was referred to the hematology department to undergo staged treatment. 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. ), 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.