Nerve root biopsy in intramedullary spinal cord lymphoma: Technical note and case report

A case of primary lymphomatosis of the central nervous system, with involvement of the spinal cord and a spinal nerve root is described, where the diagnosis was confirmed by biopsy of the infiltrated nerve root rather than the conus medullaris. A 57-year-old male presented to our clinic due to new-onset left lower extremity weakness. Magnetic resonance imaging revealed an intramedullary enhancing lesion at the T12-L1 level, and a small area of enhancement in a nerve root at the L4 vertebral body level. Clinical, imaging and laboratory investigations showed no evidence of extraspinal lesions, and comprehensive studies including twice-repeated lumbar puncture cytology were non-diagnostic. The patient proceeded with L2-L5 laminectomy for nerve root biopsy. Under microscope view, the involved nerve root was successfully identified and resected. Pathology confirmed the diagnosis of neurolymphomatosis with large B-cell lymphoma. The patient received chemotherapy with complete tumor resolution, one year after surgery. Primary involvement of the spinal cord in malignant lymphoma is rare. Accounting for the high risk of neurologic deficits after conus medullaris or spinal cord biopsy, we demonstrate that biopsy of the affected nerve root can be considered a safer candidate in clinically suitable cases.