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Título

From otolaryngology to haematology: a bond chained by neurology

RESUMO

CASE REPORT:
A 49-year-old man presenting a growing left neck mass was under etietiological investigation by otorhinolaryngology for two months before he became bedridden. Upon neurological evaluation, he had upper limbs paralysis, lower limbs paresis, urinary retention and sensitive level at T10 dermatome. Diagnostic work up disclosed chronic anemia and a hypodense cervical mass associated to bilateral pleural thickening and left pleural effusion on chest CT. The Queckenstedt’s manoeuvre was positive for spinal block and the CSF analysis revealed significant hyperproteinorachia. Spine MRI unveiled incursion of the cervical mass into the spinal canal through the neural foramen from C2 to C7, compressing the cervical and dorsal cord. Surgical biopsy of the mass was conclusive for nodular sclerosing Hodgkin lymphoma. Steroids had been previously prescribed and had led to some motor improvement. Chemotherapy was initiated and further progress was achieved, especially for upper limbs segments and for left lower limb. After four months of follow-up, however, trunk balance is still unsatisfying.
DISCUSSION:
Hodgkin’s Lymphoma (HL) is a hematological malignancy that represents 0.5 to 1% of adult cancers. Spinal cord compression (SCC) is usually a late complication by lymphoma. Moreover, it is three times more frequent in non-Hodgkin’s disease. In HL, it occurs only in 5% of cases. In the present report, there is probably a direct spread from cervical lymph nodes, although the cervical spine tends to be the least involved segment. The epidural mass infiltrated the spinal canal via the left neural foramen and spared the vertebral bodies. A retrospective study carried out between 1987-2002 gathered only 12 patients (11 males) with SCC, of which half with vertebral body destruction and only two with cervical compression. Cervical involvement is advantageous in terms of time for diagnosis, since the mass may be promptly noticed and the diagnosis procedures are favored. Differential diagnosis includes: non-Hodgkin’s lymphoma, squamous cell carcinoma,tuberculosis and eosinophilic granuloma.
FINAL COMENTS:
We present a case of unusual manifestation of Hodgkin lymphoma, that exemplified the need of multidisciplinary integration in order to establish the diagnosis. The neurological propaedeutic was able to predict the large extension of SCC and supported the celerity in the investigation and intervention.

Palavras Chave

Hodgkin's lymphoma - Spinal cord compression - Neck mass

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