Abstract
Introduction
Patients with neurolymphomatosis (NL) often present with one primarily symptomatic limb but can be found to have bilateral upper or bilateral lower limb disease during workup. We sought to explain the finding of bilateral disease and understand if there was a connection to the initial, symptomatic side of disease.
Methods
We reviewed imaging studies of patients with bilateral upper or bilateral lower limb disease from a previously published cohort from our institution, as well as more recent patients seen at our institution. We reviewed demographics (sex and age), clinical data (primary or secondary disease and biopsy-proven diagnosis), and imaging findings (primary involved nerve, contralateral nerve(s) affected, and location of circumdural extension).
Results
We identified 8 cases with evidence of bilateral disease out of 22 cases of tumefactive NL. All eight cases were found to have circumdural extension of disease to the corresponding contralateral nerve.
Conclusion
We describe the pathomechanism of spread in our cases of bilateral upper or bilateral lower limb disease, where NL spreads along a dominant nerve toward the spinal canal and moves circumdurally to affect the corresponding contralateral nerve. We believe this information is useful to further understand the spread of NL, as well as offering important diagnostic and prognostic information for patients.
Similar content being viewed by others
References
Baehring JM, Damek D, Martin EC, Betensky RA, Hochberg FH (2003) Neurolymphomatosis. Neuro-Oncology 5:104–115. https://doi.org/10.1093/neuonc/nop021
Capek S, Hebert-Blouin MN, Puffer RC, Martinoli C, Frick MA, Amrami KK, Spinner RJ (2015) Tumefactive appearance of peripheral nerve involvement in hematologic malignancies: a new imaging association. Skelet Radiol 44:1001–1009. https://doi.org/10.1007/s00256-015-2151-3
Capek S, Howe BM, Tracy JA, Garcia JJ, Amrami KK, Spinner RJ (2015) Prostate cancer with perineural spread and dural extension causing bilateral lumbosacral plexopathy: case report. J Neurosurg 122:778–783. https://doi.org/10.3171/2014.12.JNS141339
Hebert-Blouin MN, Amrami KK, Loukas M, Spinner RJ (2011) A proposed anatomical explanation for perineural spread of breast adenocarcinoma to the brachial plexus. Clin Anat 24:101–105. https://doi.org/10.1002/ca.21079
Tawfik B, Brown L, Fuda F, Chen W, Niu S, Sailors J, Sadeghi N (2018) Utility and proposed algorithm of CSF flow cytometry in hematologic malignancies. Ann Hematol 97:1707–1716. https://doi.org/10.1007/s00277-018-3336-3
Acknowledgments
The authors appreciate the illustration by David Factor, MS.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Mayo Clinic) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Additional information
Comments
A very interesting and well documented and illustrated study of a relatively rare peripheral nerve disorder.
Michel Kliot
CA, USA
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Peripheral Nerves
Rights and permissions
About this article
Cite this article
Murthy, N.K., Amrami, K.K. & Spinner, R.J. Circumdural extension of perineural spread leading to bilateral disease in neurolymphomatosis. Acta Neurochir 162, 3197–3200 (2020). https://doi.org/10.1007/s00701-020-04417-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-020-04417-3