Objective: We aim to describe a case of follicular lymphoma that presented as a durally-based thoracic spine lesion manifested as rapidly progressive back pain and meningismus.
Background: Follicular lymphoma is one of the most common forms of non-Hodgkin’s lymphoma; however, it is rare for follicular lymphoma to present as a spinal meningeal mass lesion.
Methods: This is a case report and review of literature.
Results: A 38-year-old man developed thoracic back pain that progressed over one month with associated severe focal tenderness over his mid to lower thoracic spine. He developed intermittent numbness of the bilateral lower extremities, nuchal rigidity, difficulty sleeping, and night sweats. An MRI of the thoracic spine demonstrated a dorsal intradural, extramedullary enhancing lesion from T6-T9 extending outside the spinal canal. Dural thickening across the entire circumference of the spinal cord was noted. CT-guided biopsy of the thoracic lesion was performed, and pathology was consistent with follicular lymphoma. FDG PET: CT demonstrated no systemic disease. Bone marrow biopsy was negative for malignancy. Symptoms resolved with dexamethasone therapy. He was treated with bendamustine and rituximab with follow up PET: CT two months later demonstrating a complete response.
Discussion: This case illustrates an unusual presentation of follicular lymphoma as a spinal meningeal mass lesion. Though rare, lymphoma should be included in the differential diagnosis of a dural mass lesion. Prompt diagnosis and initiation of treatment can lead to complete response and resolution of symptoms.