Primary spinal Non-Hodgkin Lymphoma presenting as impending cauda equina syndrome: A case report.

Introduction: Malignant lymphoma (ML) can involve the central nervous system either primarily or by secondary spread, which tends to occur late in the disease as part of widespread dissemination. Lymphoma presenting as primary tumors of the spinal cord is extremely uncommon. Primary spinal lymphoma if detected early can have a good prognosis with no relapse after effective treatment. Case presentation: A 32 years old male patient presented with the symptoms of impending cauda equina syndrome which was managed with surgery and chemotherapy. The patient was successfully treated without the relapse of his condition at his 6 months follow-up scan.Discussion: Primary spinal non-Hodgkin lymphoma is a rare entity among extranodal non-Hodgkin lymphoma. MRI is usually non-confirmatory and needs immunohistochemistry for the correct diagnosis. R-CHOP regimen is the standard chemotherapy regimen. Surgical decompression is required in cases of impending neurological injury along with radiotherapy. Conclusion: Primary spinal epidural diffuse large B-cell lymphoma should be considered as a differential diagnosis in patients presenting with back pain and symptoms of impending cauda equina syndrome. It is important to early detect and treat the disease to prevent permanent neurological injury and metastasis.

Lipofibromatous hamartoma of sciatic nerve: A case report.

Introduction: Lipofibromatous hamartoma of the nerve is the fibro-fatty overgrowth within the nerve. Most commonly they occur in the median nerve, ulnar nerves, and a few other nerves but the involvement of the sciatic nerve is very rare. The fibro-fatty infiltration causes palpable neurogenic mass and clinically presents lump, moderate numbness, tingling sensation, and pain in its territory. Magnetic resonance imaging is the gold standard for diagnosis. Case presentation: We present a case of a 65 years old female, who presented to OPD with a tingling sensation which progressed to pain in the gluteal region and was associated with a tender swelling. MRI showed a giant space-occupying lesion in the sciatic nerve course. The mass was excised and then sent to the histopathological examination which designated the mass as lipofibromatous hamartoma. Discussion: Unless debilitating, lipomatosis of the nerve doesn't require any intervention as it is a benign condition. Lipofibromatous hamartoma is attributed to the accumulation of fatty and fibrous tissue in the epineurium. Diffusion-weighted imaging in association with conventional magnetic resonance imaging has increased diagnostic yield. The lesion was iso-intense to the subcutaneous fat and there were fine fibrillar appearances inside of it. Simple mass excision was performed on our patient without complications. Conclusion: Lipofibromatous hamartoma of the nerve are rare soft tissue tumors of nerves and sciatic nerve involvement is even rarer. Correct and careful interpretation of the MRI findings can lead to diagnosis with ease and help prevent unnecessary biopsies.