Solitary Lymphoblastic Lymphoma of the Thoracic Spine
A 27-year-old man had progressively worsening back pain for 2 months. He had a history of mild back pain over the previous 2 years but the back pain had progressively worsened without any traumatic episode. The back pain worsened with activity, and he achieved relief by lying down. He also complained of night sweats and progressive weight loss of more than 10 kg over 4 months. A physical examination revealed no paresthesia or muscle weakness of the legs, no bowel or bladder symptoms, and the patient was able to straighten and raise his legs. Blood tests including erythrocyte sedimentation rate and C-reactive protein were within normal range. A computed tomography (CT) scan of the thoracolumbar spine showed lytic destruction in the body and right pedicle of T11. However, canal compromise by bony fragment was not detected (). Magnetic resonance imaging of the spine showed abnormally high signal changes in the T11 vertebral body and right pedicle with spinal cord compression by soft tissue extension (). Under a preliminary diagnosis of a primary bone tumor or metastasis, radionuclide bone scintigraphy (99m TC MDP) and positron emission tomography (PET)-CT were performed, but failed to depict an extraspinal lesion (). Cerebrospinal fluid examination revealed no abnormality. The patient then proceeded to surgery. Posterior decompression and fixation with instrumentation were performed. Histological specimen analysis findings were consistent with an aggressive lymphoblastic lymphoma of premature B-cell origin (). The tumor was CD10+ and CD99+ but negative for other markers. Postoperatively, marked pain relief was achieved and early mobilization while wearing a thoracolumbosacral orthosis was encouraged. The patient was transferred to our hematology and medical oncology department for chemo- and radiotherapy. He was performed 4 cycles of chemotherapy using Hyper CAVD regimen, followed by radiotherapy. At one year after surgery, he was pain free and able to return to full time work.