Lymphoma of the Spine¶

Definition¶

Lymphoma involving the spine can be primary (arising within bone or the epidural space) or secondary (disseminated systemic lymphoma involving the spine). Non-Hodgkin lymphoma is far more common than Hodgkin lymphoma in the spine. Spinal lymphoma can present as vertebral body infiltration, epidural mass, or rarely as an intradural or intramedullary lesion.

Imaging Findings¶

MRI¶

Vertebral body — Homogeneous low T1 signal with marrow replacement, intermediate-to-high T2 signal, diffuse enhancement. May be focal or diffuse.
Epidural mass — Homogeneous, avidly enhancing epidural soft tissue that may surround the thecal sac circumferentially. Lymphoma can produce a large epidural mass with relatively preserved vertebral body height — a useful distinguishing feature from metastatic carcinoma.
Cord compression — Can occur from epidural extension

CT¶

Permeative lytic pattern (most common) or sclerotic (ivory vertebra)
Relative preservation of vertebral body height despite extensive infiltration
Epidural soft tissue mass
Paravertebral soft tissue component may be present

PET/CT¶

Highly FDG-avid; PET/CT is the standard for staging and treatment response assessment in lymphoma

Clinical Pearl

Spinal lymphoma characteristically produces a large epidural soft tissue mass with relatively preserved vertebral body height. This is in contrast to metastatic carcinoma, which often causes significant vertebral body collapse before producing a comparable epidural mass. When you see a large epidural mass out of proportion to the degree of bony destruction, lymphoma should be high on the differential.

Ivory Vertebra¶

Lymphoma is one of the causes of an "ivory vertebra" — a uniformly sclerotic vertebral body on radiograph or CT. The differential includes blastic metastasis (prostate), Paget disease, and lymphoma.

Key Points¶

Lymphoma can produce large epidural masses with relatively preserved vertebral body height
Homogeneous enhancement is typical
Can present as lytic, blastic (ivory vertebra), or mixed pattern
PET/CT is the standard staging modality
Primary spinal lymphoma is rare; secondary involvement is more common

References¶

Mascalchi M, Torselli P, Falaschi F, Dal Pozzo G. MRI of spinal epidural lymphoma. Neuroradiology. 1995;37(4):303-7. PMID: 7666966.
Boukobza M, Mazel C, Touboul E. Primary vertebral and spinal epidural non-Hodgkin's lymphoma with spinal cord compression. Neuroradiology. 1996;38(4):333-7. PMID: 8738091.
Li MH, Holtås S, Larsson EM. MR imaging of spinal lymphoma. Acta Radiol. 1992;33(4):338-42. PMID: 1633044.
Cugati G, Singh M, Pande A, Ramamurthi R, Balasubramanyam M, Sethi SK, et al. Primary spinal epidural lymphomas. J Craniovertebr Junction Spine. 2011;2(1):3-11. PMID: 22013369.
Heyning FH, Kroon HM, Hogendoorn PC, Taminiau AH, van der Woude HJ. MR imaging characteristics in primary lymphoma of bone with emphasis on non-aggressive appearance. Skeletal Radiol. 2007;36(10):937-44. PMID: 17558503.
Lim CY, Ong KO. Imaging of musculoskeletal lymphoma. Cancer Imaging. 2013;13(4):448-57. PMID: 24334414.
Lymphoma of the spinal cord. Radiopaedia.org. Available from: https://radiopaedia.org/articles/lymphoma-of-the-spinal-cord