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Neurolymphomatosis as a single sign of tumour recurrence in a patient with diffuse large B-cell lymphoma of the testis
Präsentation/Vortrag - 01.04.2007
Vehoff Jochen
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A 40-year-old man presented with progressive asymmetric brachialgia and peripheral paresis of the right arm over 6 weeks.The pain was of neuropathic origin with burning sensations and deterioration at night time. Moreover, he suffered from weight loss and extensive sweating. One year ago, he was diagnosed as having a diffuse large B-cell lymphoma of the testis and was treated with hemotherapy until remission. On examination we found an axonal polyneuropathy and a painful radicular syndrome of the spinal roots C6 and C7. CSF showed elevated cell count, elevated protein and high lactate value, suggestive of leptomeningeal metastasis. MRI- and FDGPET-scans revealed infiltration of the right brachial plexus and concomitant lymph node enlargement. Multiple biopsies of the
lymph nodes confirmed the diagnosis of malignant and non-malignant infiltration of the right brachial plexus leading to the diagnosis of neurolymphomatosis. As diffuse large B-cell lymphomas harbour a high tropism to peripheral nerves and the CNS, the rare diagnosis of neurolymphomatosis should be kept in mind in tumour patients with neuropathic pain syndromes beside other conditions like
borreliosis and varicella zoster infection.