Spinal Burkitt's Lymphoma Mimicking Dumbbell Shape Neurogenic Tumor: A Case Report and Review of the Literature

Non-Hodgkin's lymphoma (NHL), a disease which may involve the spine, is frequently associated with advanced disease. Radiculopathy caused by spinal root compression as the initial presentation in patients with NHL is very rare and thought to occur in less than 5% of cases. A 69-year-old woman complained of a history of low back pain with right sciatica for 1 month prior to admission. Computed tomography and magnetic resonance imaging of the lumbar spine showed a dumbbell-shape epidural mass lesion extending from L2 to L3, which was suggestive of a neurogenic tumor. After paraspinal approach and L2 lower half partial hemilaminectomy, total excision of the tumor was achieved, followed by rapid improvement of back pain and radiating pain. The lesion was confirmed to be Burkitt's lymphoma by histopathological examination. We then checked whole-body PET-CT, which showed multifocal malignant lesions in the intestine, liver, bone and left supraclavicular lymph node. Although a rare situation, Burkitt's lymphoma should be considered in the differential diagnosis for patients presenting with back and lumbar radicular pain without a prior history of malignancy. Burkitt's lymphoma could be the cause of dumbbell-shape spinal tumor.

A Dumbbell-shaped Thoraco-lumbar Extradural Ganglioneuroma: Case Report

Ganglioneuromas commonly arise from sympathetic ganglia. These neoplasm may be located wherever ganglion cells are normally found from skull base to pelvis including adrenal gland. Ganglioneuromas in spinal cord are very rare. We report a case of dumbbell-shaped extradural spinal ganglioneuroma. A 7-year-old boy was admitted to our hospital with a 20 day-history of both leg pain and a 10 day-history of progressive paraparesis. On magnetic resonance image, there was a dumbbell-shaped extradural spinal cord tumor in T11-L4 level. Two stage operation(First : Laminoplastic laminotomy of T11-L4 to remove the extradural portion of the tumor in the spinal canal, Second : Right retroperitoneal approach for the removal of paraspinal tumor located in L2-3 level) was performed. Pathologic diagnosis was a ganglioneuroma and paraparesis improved postoperatively.

Modified Transcondylar Approach for a Case of Hypoglossal Neurinoma: Technique

Hypoglossal neurinomas are very rare and those which simultaneously involve the intracranial and extracranial portions are extremely unusual. Using the modified transcondylar approach, the authors successfully removed a dumbbell-shaped hypoglossal neurinoma at the intracranial portion and extending to the anterior upper portion of the axis through the hypoglossal canal. After dividing the cervical musculatures into layers, the vertebral artery was mobilized by opening the foramen transversarium and removing the postero-lateral part of the right occipital condyle, the lateral mass of the atlas and the mastoid tip by means of a small lateral suboccipital craniotomy. This approach offers a wide surgical field and a direct approach to the skull base and upper anterior cervical spine. After total removal of the hypoglossal neurinoma, a very simple supplementary autogenous bone graft was performed between the occipital bone and the lateral mass of the atlas, using the corticocancellous bone fixed with small screws. Postoperatively, the tumor was removed totally and there was no limitation on the cervical rotatory movement. A review of cases of hypoglossal neurinomas and the surgical approaches employed is included in this paper.