Spinal lymphoma


  • A 45 years old lady with no known underlying medical illness
  • Presented with progressive numbness of bilateral lower limb for one year.
  • She also had progressive loss of motor power for the past 3 months.
  • There was no associated constitutional symptom.
  • Clinically loss of power and sensation noted at the level of T6.
MRI of thoracic spine (a-d) Sagittal plane in T1, T1+Gado, T2 and T2TIRM
MRI of spine (e-g) axial plane in T1, T1+Gado and T2-weighted images
MRI of spine in serial axial (h-i) T1+Gadolinium images

MRI findings:

  • It showed an intraspinal epidural mass (yellow arrows) which is isointense to spinal cord on T1 and T2-weighted images with marked homogenous enhancement on post contrast images.
  • The mass displaces the cord to the left side and anteriorly.
  • There is right neural foramina extension (red arrow) to the right paravertebral and retrocrural region.
  • Abnormal bone marrow signal (blue block arrows) of a few thoracic vertebrae is also seen.
  • This patient also had right pleural effusion (blue arrows) .
  • CT thorax and abdomen showed no other lesion except the effusion (images not shown).

Diagnosis: B-cell lymphoma (HPE proven).


  • An epidural location of lymphoma is observed in 0.1-6.5% of all lymphomas.
  • Patient clinically present most commonly in the fifth to seventh decade of life with more than 80% being older than 40 years.
  • Thoracic spine is most commonly involved and has been reported in 75% of cases.
  • Symptoms occur due to spinal cord and nerve root compression. Within the spinal canal, the location of the tumour is usually dorsal than ventral.
  • MRI appearance is isointense on T1-weighted images, iso to hyperintense on T2-weighted images with marked contrast enhancement.
  • Mean longitudinal extension of the lesion was 2.6 vertebral bodies.
  • In majority of patients, diffuse changes in vertebral body marrow were seen adjacent to or at distance from the lesion.
  • Cortical destruction or vertebral collapsed is rarely seen.
  • The differential diagnoses include tuberculous spondylitis, epidural abscess, metastasis and malignant peripheral nerve sheath tumours.
Author: radhianahassan