Extranodal classical Hodgkin lymphoma involving the spinal cord: case report and review of the literature

CNS Oncology, 2022 · DOI: 10.2217/cns-2021-0011 · Published: June 13, 2022

Cardiovascular Science Oncology Neurology

Simple Explanation

Hodgkin lymphoma typically presents with lymph node involvement, but rarely affects areas outside of the lymph nodes, especially the spinal cord. Patients may experience back pain, tingling, and bladder/bowel dysfunction. Imaging techniques like 18F-FDG PET and MRI are crucial for detecting the location and extent of neurological involvement in these rare cases. Treatment often involves a combination of local therapies (surgery or radiotherapy) and chemotherapy to control the cancer and minimize long-term complications.

Study Duration

Not specified

Participants

Two women, 40 and 65 years old

Evidence Level

Case Report and Literature Review

Key Findings

1
The study presents two cases of extranodal Hodgkin lymphoma involving the spinal cord without contiguous bone involvement, a rare presentation of the disease.
2
Literature review identified 13 similar cases, with variable spinal lesion locations and neurological symptoms, highlighting the rarity and heterogeneity of this condition.
3
Complete metabolic response was achieved in both presented cases with treatment, however, neurological deficits persisted in both patients after 5 and 7 years follow up, respectively.

Research Summary

This case report highlights the rare occurrence of extranodal Hodgkin lymphoma involving the spinal cord, emphasizing the importance of considering this possibility in patients presenting with spinal cord symptoms. The review of literature summarizes characteristics, diagnosis and treatment from 13 similar cases reported between 1985 and 2021. The authors suggest a multidisciplinary approach and early aggressive treatment is important to improve outcomes, but long-term neurological sequelae are common.

Practical Implications

Diagnostic Awareness

Clinicians should be aware of the possibility of extranodal Hodgkin lymphoma in patients presenting with spinal cord symptoms, even in the absence of typical lymph node involvement.

Treatment Strategy

Management should be multidisciplinary including chemotherapy, surgery and radiotherapy when appropriate, and that early, aggressive treatment may improve outcomes.

Rehabilitation

Personalized rehabilitation programs should be offered to patients during and after conventional treatment to address and manage long-term neurological symptoms.

Study Limitations

1
The study is limited by its nature as a case report with only two patients.
2
The review of the literature is limited by the small number of published cases, which makes it difficult to draw definitive conclusions about optimal management strategies.
3
Long-term neurological sequelae are common despite achieving complete metabolic response.

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