HIV infection can result in neoplasm due to damaged cellular immunity [
3,
4]. Individuals infected with HIV developed lymphoma at a greater rate than the population. Approximately two-thirds of ARL cases are categorized as diffuse large B-cell type, with BL comprising 25% and other histology a much smaller proportion [
5]. Recent clinical trials have demonstrated a better outcome with chemotherapy for ARL since the introduction of combination antiretroviral treatment, termed HAART [
6]. However, the treatment of lymphomas in patients infected with HIV has been less than satisfactory, with a high mortality rate [
4]. The patient in this case was diagnosed with B-UCL with features intermediate between DLBCL and BL. These rare lymphomas, which occur predominantly in adults, have a germinal center phenotype that resembles BL but exhibit atypical cytological features for BL [
7]. On morphological examination, cases of B-UCL have architectural and cytological features intermediate between DLBCL and BL, and are composed of a diffuse proliferation of predominantly medium-sized, centroblast-like cells with numerous tingible-body macrophages admixed. Immunophenotypically, these lymphomas often have a germinal center B-cell phenotype with positivity for CD10 and bcl6, and are frequently bcl2 positive. A case of typical BL with strong bcl2 expression is also placed into this category [
1]. Clinically, B-UCL is generally considered to be an aggressive lymphoma and most patients present with widespread disease. However, there are currently no well-established therapies for these patients. Most studies have reported poor outcomes with the standard therapies used for DLBCL, as well as with more intensive regimens [
1,
8‐
11].
Extranodal involvement of lymphoma commonly involves the gastrointestinal tract, bone marrow, liver, lung and central nervous system. Although survival from ARL has improved significantly with HAART [
12], it is associated with high mortality rates when the epidural space is involved [
13]. Epidural spinal cord compression occurs in 0.1 to 6.5% of patients with non-Hodgkin’s lymphoma (NHL) [
14‐
16], either at the time of recurrence [
17] or at the initial diagnosis [
18]. Lymphoma is thought to involve the paraspinal soft tissues first, such as the paravertebral ganglion or epidural lymphoid tissue, and then invade around the cord via the vertebral foramen without destroying bony structures [
15,
19]. It is important to discriminate whether the paraspinal mass is a primary lesion or secondary metastatic lesion. Molecular imaging by positron emission tomography is helpful to diagnosis, identification of the metabolically active tumor compartment, and prediction of treatment response [
20]. Surgery, radiotherapy, or a combination of both are treatment options for spinal cord compression by lymphoma. Chang
et al.[
21] suggested that surgical decompression can improve recovery from neurological deficits in patients with DLBCL-associated spinal cord compression, but Peng
et al.[
22] recommended nonsurgical rather than surgical treatment because of the high mortality rate after surgery. In the present case, the lymphoma metastasized to the epidural space followed by spinal cord compression. The patient did not respond to CHOP chemotherapy and radiation therapy. We were obliged to perform surgical decompression in this urgent situation.