Primary neurolymphomatosis is the direct infiltration of lymphomatous neoplastic cells into nerve roots and/or peripheral nerves. A 67-year-old man had a 24-month history of progressive and severe left lower limb neuropathic pain, ipsilateral ankle dorsiflexion weakness and gait disturbance. Gadolinium-enhanced MRI showed thickening and enhancement of the cauda equina, L5, S1 and S2 nerve roots. 18Fluorodeoxyglucose positron emission tomography showed concordant hypermetabolism. L5 nerve root biopsy confirmed diffuse large B-cell lymphoma. One cycle of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) chemotherapy resulted in remission, but this was not sustained. Primary neurolymphomatosis is rare and diagnostically challenging, and often the diagnosis is delayed. While biopsy is the gold standard for diagnosis, neuroimaging helps to characterise lesions and to determine the feasibility of biopsy. No data are available.

中文翻译：

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脊神经根活检诊断原发性神经淋巴瘤

原发性神经淋巴瘤病是淋巴瘤肿瘤细胞直接浸润神经根和/或周围神经。一名 67 岁男性，有 24 个月的左下肢进行性严重神经性疼痛、同侧踝背屈无力和步态障碍病史。钆增强 MRI 显示马尾、L5、S1 和 S2 神经根增厚和强化。18氟脱氧葡萄糖正电子发射断层扫描显示一致的代谢亢进。L5神经根活检证实弥漫性大B细胞淋巴瘤。一个周期的利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松 (R-CHOP) 化疗导致病情缓解，但这种情况并未持续。原发性神经淋巴瘤病很少见，诊断具有挑战性，而且诊断常常被延迟。虽然活检是诊断的金标准，但神经影像学有助于表征病变并确定活检的可行性。无可用数据。