Research

The Paraneurium and the Tumefactive Appearance of Peripheral Nerve Neurolymphomatosis: Illustrative Case

Research-May-2024-The-Paraneurium-and-the-Tumefactive-Inset
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Damiano G Barone, Ryan W Kendziora, Stephen M Broski, David J Schembri Wismayer, Robert J Spinner

Abstract

Background

Peripheral neurolymphomatosis (NL) is an often-misdiagnosed condition characterized by lymphomatous infiltration within the peripheral nerves. Its rarity and complexity frequently result in delayed diagnosis and suboptimal patient outcomes. This study aims to elucidate the role of the paraneurium (circumneurium) in NL, emphasizing its diagnostic and therapeutic significance.

Observations

A 72-year-old man presented with lesions on his right lower eyelid. Initial diagnostics were inconclusive until an excisional biopsy confirmed extranodal marginal zone lymphoma. Following a complete metabolic response to rituximab treatment, the patient relapsed 14 months later with progressive lymphoma and bilateral sciatic nerve involvement, as confirmed by positron emission tomography-computed tomography and magnetic resonance imaging.

Lessons

This paper underscores the critical role of the paraneurium in NL, enhancing understanding of its pathophysiology. Integrating advanced imaging techniques have proved essential in accurately identifying neurolymphomatous involvement within the paraneurium. This study paves the way for more effective management strategies in NL and similar conditions, focusing on improving patient care and outcomes.

Benefits of Membership

“The AANS/CNS Spine Section brings together neurosurgeons, orthopedic spine surgeons, spine surgery fellows, as well as residents and advanced practice providers focused on spinal surgery. The Spine Section advances our interests, represents us in national advocacy, and disseminates science. Becoming a member means joining this exceptional community and helping it grow.” ...Read More >