nach oben

Erschienen in:

01.07.2015 | Scientific Article

Tumefactive appearance of peripheral nerve involvement in hematologic malignancies: a new imaging association

verfasst von: Stepan Capek, Marie-Noëlle Hébert-Blouin, Ross C. Puffer, Carlo Martinoli, Matthew A. Frick, Kimberly K. Amrami, Robert J. Spinner

Erschienen in: Skeletal Radiology | Ausgabe 7/2015

Einloggen, um Zugang zu erhalten

Abstract

Objective

In neurolymphomatosis (NL), the affected nerves are typically described to be enlarged and hyperintense on T2W MR sequences and to avidly enhance on gadolinium-enhanced T1WI. This pattern is highly non-specific. We recently became aware of a “tumefactive pattern” of NL, neuroleukemiosis (NLK) and neuroplasmacytoma (NPLC), which we believe is exclusive to hematologic diseases affecting peripheral nerves.

Materials and methods

We defined a “tumefactive” appearance as complex, fusiform, hyperintense on T2WI, circumferential tumor masses encasing the involved peripheral nerves. The nerves appear to be infiltrated by the tumor. Both structures show varying levels of homogenous enhancement. We reviewed our series of 52 cases of NL in search of this pattern; two extra outside cases of NL, three cases of NLK, and one case of NPLC were added to the series.

Results

We identified 20 tumefactive lesions in 18 patients (14 NL, three NLK, one NPLC). The brachial plexus (n = 7) was most commonly affected, followed by the sciatic nerve (n = 6) and lumbosacral plexus (n = 3). Four patients had involvement of other nerves. All were proven by biopsy: the diagnosis was high-grade lymphoma (n = 12), low-grade lymphoma (n = 3), acute leukemia (n = 2), and plasmacytoma (n = 1).

Conclusions

We present a new imaging pattern of “tumefactive” neurolymphomatosis, neuroleukemiosis, or neuroplasmacytoma in a series of 18 cases. We believe this pattern is associated with hematologic diseases directly involving the peripheral nerves. Knowledge of this association can provide a clue to clinicians in establishing the correct diagnosis. Bearing in mind that tumefactive NL, NLK, and NPLC is a newly introduced imaging pattern, we still recommend to biopsy patients with suspicion of a malignancy.

Grisariu S, Avni B, Batchelor TT, van den Bent MJ, Bokstein F, Schiff D, et al. Neurolymphomatosis: an International Primary CNS Lymphoma Collaborative Group report. Blood. 2010;115(24):5005–11.CrossRefPubMedCentralPubMed

Baehring JM, Damek D, Martin EC, Betensky RA, Hochberg FH. Neurolymphomatosis. Neuro Oncol. 2003;5(2):104–15.CrossRefPubMedCentralPubMed

Gan HK, Azad A, Cher L, Mitchell PL. Neurolymphomatosis: diagnosis, management, and outcomes in patients treated with rituximab. Neuro Oncol. 2010;12(2):212–5.CrossRefPubMedCentralPubMed

Yazawa S, Ohi T, Shiomi K, Takashima N, Kyoraku I, Nakazato M. Brachial plexus neurolymphomatosis: a discrepancy between electrophysiological and radiological findings. Intern Med. 2007;46(8):533–4.CrossRefPubMed

Rosso SM, de Bruin HG, Wu KL, van den Bent MJ. Diagnosis of neurolymphomatosis with FDG PET. Neurology. 2006;67(4):722–3.CrossRefPubMed

Rahmani M, Birouk N, Amarti A, Loukili Idrissi A, Marnissi F, Belaidi H, et al. T-cell lymphoma revealed by a mononeuritis multiplex: case report and review of literature. Rev Neurol (Paris). 2007;163(4):462–70.CrossRef

Kim JH, Jang JH, Koh SB. A case of neurolymphomatosis involving cranial nerves: MRI and fusion PET-CT findings. J Neurooncol. 2006;80(2):209–10.CrossRefPubMed

Reddy CG, Mauermann ML, Solomon BM, Ringler MD, Jerath NU, Begna KH, et al. Neuroleukemiosis: an unusual cause of peripheral neuropathy. Leuk Lymphoma. 2012;53(12):2405–11.CrossRefPubMed

Mahan MA, Ladak A, Johnston PB, Seningen JL, Amrami KK, Spinner RJ. Unique occurrence of mucosa-associated lymphoid tissue lymphoma disseminated to peripheral nerves. J Surg Orthop Adv. 2013;22(4):321–5.CrossRefPubMed

10.

Hanna R, Di Primio GA, Schweitzer M, Torres C, Sheikh A, Chakraborty S. Progressive neurolymphomatosis with cutaneous disease: response in a patient with mycosis fungoides. Skelet Radiol. 2013;42(7):1011–5.CrossRef

11.

Agrawal S, Gi MT, Ng SB, Puhaindran ME, Singhania P. MRI and PET-CT in the diagnosis and follow-up of a lymphoma case with multifocal peripheral nerve involvement. Diagn Interv Radiol. 2013;19(1):25–8.PubMed

12.

Kanamori M, Matsui H, Yudoh K. Solitary T-cell lymphoma of the sciatic nerve: case report. Neurosurgery. 1995;36(6):1203–5.CrossRefPubMed

13.

Baehring JM, Batchelor TT. Diagnosis and management of neurolymphomatosis. Cancer J. 2012;18(5):463–8.CrossRefPubMed

14.

Choi YJ, Shin JA, Kim YH, Cha SJ, Cho JY, Kang SH, et al. Neurolymphomatosis of brachial plexus in patients with non-Hodgkin's lymphoma. Case Rep Oncol Med. 2013;2013:492329.PubMedCentralPubMed

15.

Peruzzi P, Ray-Chaudhuri A, Slone WH, Mekhjian HS, Porcu P, Chiocca E. Reversal of neurological deficit after chemotherapy in BCL-6-positive neurolymphomatosis. Case report. J Neurosurg. 2009;111(2):247–51.CrossRefPubMed

16.

Roncaroli F, Poppi M, Riccioni L, Frank F. Primary non-Hodgkin's lymphoma of the sciatic nerve followed by localization in the central nervous system: case report and review of the literature. Neurosurgery. 1997;40(3):618–21. discussion 621–612.PubMed

17.

Descamps MJ, Barrett L, Groves M, Yung L, Birch R, Murray NM, et al. Primary sciatic nerve lymphoma: a case report and review of the literature. J Neurol Neurosurg Psychiatry. 2006;77(9):1087–9.CrossRefPubMedCentralPubMed

18.

Ye BS, Sunwoo IN, Suh BC, Park JP, Shim DS, Kim SM. Diffuse large B-cell lymphoma presenting as piriformis syndrome. Muscle Nerve. 2010;41(3):419–22.CrossRefPubMed

19.

Quinones-Hinojosa A, Friedlander RM, Boyer PJ, Batchelor TT, Chiocca EA. Solitary sciatic nerve lymphoma as an initial manifestation of diffuse neurolymphomatosis. Case report and review of the literature. J Neurosurg. 2000;92(1):165–9.CrossRefPubMed

20.

Eusebi V, Bondi A, Cancellieri A, Canedi L, Frizzera G. Primary malignant lymphoma of sciatic nerve. Report of a case. Am J Surg Pathol. 1990;14(9):881–5.CrossRefPubMed

21.

Wadhwa V, Thakkar RS, Maragakis N, Hoke A, Sumner CJ, Lloyd TE, et al. Sciatic nerve tumor and tumor-like lesions—uncommon pathologies. Skelet Radiol. 2012;41(7):763–74.CrossRef

22.

Suresh S, Saifuddin A, O'Donnell P. Lymphoma presenting as a musculoskeletal soft tissue mass: MRI findings in 24 cases. Eur Radiol. 2008;18(11):2628–34.CrossRefPubMed

23.

Wai JWC, Chan MK, Tang KW, Chan SCH. Neurogenic tumour mimicker: two cases of neurolymphomatosis. Hong Kong J Radiol. 2012;15:187–91.

24.

Karam C, Khorsandi A, MacGowan DJ. Clinical reasoning: a 23-year-old woman with paresthesias and weakness. Neurology. 2009;72(2):e5–e10.CrossRefPubMed

25.

Warme B, Sullivan J, Tigrani DY, Fred DM. Chloroma of the forearm: a case report of leukemia recurrence presenting with compression neuropathy and tenosynovitis. Iowa Orthop J. 2009;29:114–6.PubMedCentralPubMed

26.

Bakst R, Jakubowski A, Yahalom J. Recurrent neurotropic chloroma: report of a case and review of the literature. Adv Hematol. 2011;2011:854240.CrossRefPubMedCentralPubMed

27.

Lekos A, Katirji MB, Cohen ML, Weisman Jr R, Harik SI. Mononeuritis multiplex. A harbinger of acute leukemia in relapse. Arch Neurol. 1994;51(6):618–22.CrossRefPubMed

28.

Wang T, Miao Y, Meng Y, Li A. Isolated leukemic infiltration of peripheral nervous system. Muscle Nerve. 2015;51(2):290–93.

29.

Zhu X-Y, Kuo S-H, Wan L-P, Liu Y, Wu Y-C. Isolated peripheral neuropathy as an unusual presentation for an extramedullary relapse of acute leukemia. Neurol Asia. 2014;19(2):203–6.

30.

Hsu JH, Gordon C, Megason G, Majumdar S, Ostrenga A, Herrington B. A rare case of peripheral neuropathy from relapse of acute lymphoblastic leukemia to the brachial plexus. J Pediatr Hematol Oncol. 2012;34(2):e77–9.CrossRefPubMed

31.

Sui XF, Liu WY, Guo W, Xiao F, Yu X. Precursor B-cell lymphoblastic leukemia of the arm mimicking neurogenic tumor: case report. World J Surg Oncol. 2012;10:140.CrossRefPubMedCentralPubMed

32.

Green RA, O'Donnell P, Briggs TW, Tirabosco R. Two malignant peripheral nerve lesions of non-neurogenic origin. J Med Imaging Radiat Oncol. 2012;56(3):305–9.CrossRefPubMed

33.

Okamoto Y, Minami M, Tohno E, Anno I, Kunimatshu A, Ueda T. Multifocal peripheral nerve involvement associated with multiple myeloma. Skelet Radiol. 2007;36(12):1191–3.CrossRef

34.

Misdraji J, Ino Y, Louis DN, Rosenberg AE, Chiocca EA, Harris NL. Primary lymphoma of peripheral nerve: report of four cases. Am J Surg Pathol. 2000;24(9):1257–65.CrossRefPubMed

35.

Kanda T. Biology of the blood–nerve barrier and its alteration in immune mediated neuropathies. J Neurol Neurosurg Psychiatry. 2013;84(2):208–12.CrossRefPubMed

36.

Franco CD. Connective tissues associated with peripheral nerves. Reg Anesth Pain Med. 2012;37(4):363–5.CrossRefPubMed

37.

Kim J, Kim YS, Lee EJ, Kang CS, Shim SI. Primary CD56-positive NK/T-cell lymphoma of median nerve: a case report. J Korean Med Sci. 1998;13(3):331–3.CrossRefPubMedCentralPubMed

38.

Stuart JE, Smith AC. Plasmacytoma of the superficial radial nerve. J Hand Surg [Am]. 2001;26(4):776–80.CrossRef

Titel: Tumefactive appearance of peripheral nerve involvement in hematologic malignancies: a new imaging association
verfasst von: Stepan Capek
Marie-Noëlle Hébert-Blouin
Ross C. Puffer
Carlo Martinoli
Matthew A. Frick
Kimberly K. Amrami
Robert J. Spinner
Publikationsdatum: 01.07.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Skeletal Radiology / Ausgabe 7/2015
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-015-2151-3

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Tumefactive appearance of peripheral nerve involvement in hematologic malignancies: a new imaging association