Non-Hodgkin Lymphoma Relapse Presenting as Isolated Neurolymphomatosis of the Brachial Plexus - A Case Report

Abstract

Neurolymphomatosis is a rare manifestation of non-Hodgkin's lymphoma (NHL) and is characterized by infiltration of the nerves by neoplastic lymphoid cells and is seen in up to 0.2% of all NHL cases. Diagnosing this syndrome is quite a challenge to the hematologists given the vague symptoms and signs and the low incidence. Newer imaging modalities such as positron emission tomography–computed tomography and magnetic resonance imaging have enabled early diagnosis with a sensitivity reaching up to 100%. Despite a variety of therapies reported in the literature for the treatment, the prognosis is very poor. We report a 46-year-old male diagnosed to have NHL–diffuse large B-cell lymphoma and treated with rituximab, cyclophosphamide, vincristine, and prednisolone (R-CHOP) therapy who presented with left brachial plexus neurolymphomatosis as the initial feature of disease relapse.

Keywords

Brachial plexus - chemotherapy - neurolymphomatosis - non-Hodgkin's lymphoma

• References

• 1 Hughes RA, Britton T, Richards M. Effects of lymphoma on the peripheral nervous system. J R Soc Med 1994; 87: 526-30
• 2 Baehring JM, Damek D, Martin EC, Betensky RA, Hochberg FH. Neurolymphomatosis. Neuro Oncol 2003; 5: 104-15
• 3 Cheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E. et al. Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: The Lugano classification. J Clin Oncol 2014; 32: 3059-68
• 4 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: 5005-11
• 5 Sideras PA, Matthews J, Sakib SM, Ofikwu F, Spektor V. Neurolymphomatosis of the peripheral nervous system: A case report and review of the literature. Clin Imaging 2016; 40: 1253-6
• 6 Swarnkar A, Fukui MB, Fink DJ, Rao GR. MR imaging of brachial plexopathy in neurolymphomatosis. AJR Am J Roentgenol 1997; 169: 1189-90
• 7 Liang R, Kay R, Maisey MN. Brachial plexus infiltration by non-Hodgkin's lymphoma. Br J Radiol 1985; 58: 1125-7
• 8 Kamiya-Matsuoka C, Shroff S, Gildersleeve K, Hormozdi B, Manning JT, Woodman KH. Neurolymphomatosis: A case series of clinical manifestations, treatments, and outcomes. J Neurol Sci 2014; 343: 144-8
• 9 Choi YJ, Shin JA, Kim YH, Cha SJ, Cho JY, Kang SH. et al. Neurolymphomatosis of brachial plexus in a patient with non-Hodgkin's Lymphoma. Case Rep Oncol Med 2013; 2013: 492329
• 10 Bourque PR, Warman Chardon J, Bryanton M, Toupin M, Burns BF, Torres C. Neurolymphomatosis of the brachial plexus and its branches: Case series and literature review. Can J Neurol Sci 2018; 45: 137-43
• 11 Thawait SK, Chaudhry V, Thawait GK, Wang KC, Belzberg A, Carrino JA. et al. High-resolution MR neurography of diffuse peripheral nerve lesions. AJNR Am J Neuroradiol 2011; 32: 1365-72
• 12 Lagarde S, Tabouret E, Matta M, Franques J, Attarian S, Pouget J. et al. Primary neurolymphomatosis diagnosis and treatment: A retrospective study. J Neurol Sci 2014; 342: 178-81