PMC8312505_01
(A) Gadolinium enhanced sagittal and coronal T1 MRI showing diffuse involvement of cauda equina with encasement of conus medullaris (arrows). (B) Staging whole-body 18F-FDG PET-CT coronal and sagittal views showing hypermetabolic mass in the cauda equina and lumbar nerve root sleeves (arrows).
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Initial magnetic resonance imaging (MRI) of the lumbar spine identified a homogeneously enhancing mass diffusely infiltrating the cauda equina and filum terminale, superiorly encasing the conus medullaris (Figure 1A). PET-CT scan of the whole body revealed a markedly hypermetabolic tumor occupying the spinal canal and nerve root sleeves from T12 to S1 with no evidence of the disease outside the spine (Figure 1B).
(A) Pathology examination by H&E staining revealing diffusely infiltrating large atypical lymphocytes dissecting through the nerve bundles (arrow indicating residual nerve). IHC studies showed that the neoplastic lymphocytes were positive for (B) CD20, (C) BCL2, (D) BCL6, (E) MUM1, (F) with a high proliferate rate (>90%) by Ki-67.
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Hematoxylin and eosin (H&E) sections of the tumor demonstrated diffusely infiltrating large atypical lymphocytes encasing the lumbar nerve (Figure 2A). TdT, cyclin D1, and MYC. The proliferative rate by ki-67 was also high (>90%) (Figure 2F).
Follow up MRI (A) and PET-CT (B) after chemotherapy showing complete resolution of the hypermetabolic cauda equina lesion. Linear FDG uptake in the posterior lumbar dura (arrows) is postoperative in nature.
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Restaging following MATRIX therapy with PET-CT, MRI of the brain, and MRI of the spine revealed complete resolution of the original lesion with no evidence of disease elsewhere in the body (Figure 3).