Lymphoma with Intraspinal Extramedullary Involvement as Initial Presentation

Purpose: To review the treatment results of lymphoma with initial presentation of spinal cord or cauda equina compression.Materials and Methods: Lymphoma with cord or cauda equina compression as initial presentation were seen in 9 patients in our hospital between 1977 to 1996. Among them, six patients presented with stage IE primary spinal epidurl involvement, whereas the others has stage ⅡE, ⅢE and ⅣE disease (1 patient each). Except for one Hodgkin's lymphoma and one lymphosarcoma, all of the other patients were non-Hodgkin's lymphoma with unfavorable histologic grading, mostly were the intermediate grade classification according to the Warking Formulation. After decompression surgery, the subsequent treatments of these patients were radiotherapy (2 patients), chemotherapy (1 patient), and combination of both treatment modalities (6 patients).Results: A prodromal phase of local back pain occurred in all patients, with duration from 1 to 10 months, followed by a second phase of rapidly progressive signs of cord compression. After treatment, 5 patients achieved complete remission: among with, one died of chemotherapy complication, one died of intercurrent disease, one had distant metastasis, and only 2 patients remained disease free. The other 4 patients who got partial remission were all dead of this disease.Conclusion: Lymphoma with spinal epidural or intradural involvement at initial presentation is an aggressive disease. An intensive treatment combination with irradiation, chemotherapy, and surgery, is suggested in order to achieve good local control and longterm survival.