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  • Title: Non-hodgkin lymphoma presenting with tetraparesis in a 3-year-old child.
    Author: Kombogiorgas D, Hobin D, Sgouros S.
    Journal: Pediatr Neurosurg; 2007; 43(4):348-50. PubMed ID: 17627158.
    Abstract:
    INTRODUCTION: Spinal cord compression (SCC) is a rare presentation of non-Hodgkin lymphoma (NHL) which requires early diagnosis and prompt treatment to avoid devastating events and permanent neurological deficits. MATERIAL: We report a 3-year-old boy with a history of rapidly progressive tetraparesis. MRI revealed a large mass in the left side of the neck extending from the skull base into the supraclavicular fossa with extra- and intra-dural extension of this mass, causing cervical SCC from C1/2 to C7/T1 level. Liver and right kidney lesions were present as well. A 'tru-cut' needle biopsy was performed under general anaesthetic and histological examination showed a high-grade B cell lymphoma. In light of the extensive CNS involvement, chemotherapy was commenced with prednisolone, cyclophosphamide, vincristine, doxorubicin, methotrexate, cytarabine and etoposide. Patient neurological status started to improve clinically 1 week after commencement of chemotherapy. He made good neurological recovery and after 6 months was fully mobile without any neurological deficits. Six-month MRI showed complete resolution of the intraspinal-extradural disease, which unfortunately recurred 1 year after the initial diagnosis, involving the cervical and upper thoracic spinal cord. DISCUSSION: In view of the satisfactory neurological outcome that treatment with chemotherapy can achieve, and bearing in mind the potential complications and late adverse consequences of decompressive laminectomy or radiotherapy in a very young child, biopsy of the extraspinal part of the tumour causing SCC should be considered first, before more aggressive therapeutic measures are decided.
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