Aggressive B-Cell Lymphoma with Metastatic Spinal Cord Compression: Treat the Patient, Not the Disease.

Introduction: The management of metastatic spinal cord compression (mSCC) is a demanding task. The main challenges of mSCC include various manifestations and unpredictable outcomes with indiscriminate treatment recommendations. Because of attendant urgency with potentially devastating health consequences, the SCC is an emotionally disturbing experience whose management could take an impulsive rather than rational approach. The treatment strategy is particularly problematic when mSCC is caused by a malignant lymphoma with its protean attributes. Case Report: A 68-year-old female presented with generalized body pain and weight loss. Imaging studies revealed a vast bulk of the disease involving lymph nodes, spleen, visceral organs, musculature, marrow, and bones including vertebrae with extension into the spinal canal. A biopsy of the chest wall mass showed high-grade diffuse large B-cell lymphoma. A magnetic resonance imaging (MRI) of the spine demonstrated diffuse marrow replacement by the tumor of the thoracic and lumbar spine with compression of the cord. The prompt treatment with corticosteroids and immunochemotherapy (ICT) was recommended, but the patient elected to seek a second opinion. After two doses of radiation therapy, the patient's general condition rapidly deteriorated and she was hospitalized for systemic ICT. Despite the treatment, her condition continued to deteriorate, and she died 3 weeks after the presentation. Conclusion: The presented case demonstrates some hitherto unaddressed challenges in evaluation and treatment of mSCC caused by aggressive non-Hodgkin lymphoma (LSSC). The case scrutinizes the role of MRI in uncommon clinical situations. The case has also exposed some ethical issues associated with the proper management of LSCC. Established Facts: Metastatic spinal cord compression (mSCC) can complicate any type of malignancy, most commonly the breast, prostate and lung cancers. Non-Hodgkin lymphoma (NHL), however, demonstrates the highest cancer-specific SCC incidence with the majority being diffuse large B cell lymphomas. Lymphomatous SCC (LSCC) must be distinguished from the primary or secondary CNS lymphomas. The management of LSCC most commonly follows the same strategy as other malignancies and involves decompression surgery, local radiation treatment or both. Chemotherapy as a treatment of LSCC has been introduced as early as the 1970s, but its role and necessity in LSCC management have long remained controversial. The indications for, and the role of, diagnostic MRI in evaluation of LSCC, although well established, could be intricate and difficult to ascertain. [ABSTRACT FROM AUTHOR]