Lumbar intervertebral disc involvement in chronic lymphocytic leukemia. A case report. 1998

T U Jiya, and B J Van Royen, and S Sugihara, and P Y Van Diest, and R A Manoliu, and P I Wuisman
Department of Orthopaedic Surgery, Free University Hospital, Amsterdam, The Netherlands.

METHODS Report of a patient with a rare location of a solid chronic lymphocytic leukemic mass of an intervertebral lumbar disc. OBJECTIVE To illustrate the previously undescribed discovertebral involvement of chronic lymphocytic leukemia and to discuss the diagnostic difficulties. BACKGROUND Chronic lymphocytic leukemia primarily involves lymph nodes, spleen, liver, and bone marrow. Bone lesions are rare in chronic lymphocytic leukemia and usually consist of areas of osteopenia. Spinal involvement in chronic lymphocytic leukemia is rare, and only two cases of spinal cord compression attributable to an extradural solid mass composed of leukemic cells have been reported. Intervertebral disc involvement in chronic lymphocytic leukemia has not been reported previously. METHODS The clinical findings, radiographs, histology, treatment, and follow-up results are presented. RESULTS Radiographs and magnetic resonance imaging studies showed partial collapse of vertebrae L2 and L3, with destruction and protrusion of the intervertebral disc L2-L3 with dura compression. Treatment consisted of radiotherapy followed by en bloc resection of vertebrae L2 and L3 stabilized with stackable cages and anterior fixation with Kaneda bars. Intervertebral disc infiltration with leukemic cells of B-cell origin was confirmed through histologic examination and immunohistochemical studies of a biopsy and resection specimen. Twenty months after treatment the patient was still in remission and fully mobilized. CONCLUSIONS Intervertebral disc involvement in cases of chronic lymphocytic leukemia is rare. Its presence should be considered in patients with back pain and neurologic symptoms who had been treated for this form of leukemia in the past. Differentiation with infectious spondylodiscitis can be difficult. Histology is necessary to confirm diagnosis.

UI MeSH Term Description Entries
D007403 Intervertebral Disc Any of the 23 plates of fibrocartilage found between the bodies of adjacent VERTEBRAE. Disk, Intervertebral,Intervertebral Disk,Disc, Intervertebral,Discs, Intervertebral,Disks, Intervertebral,Intervertebral Discs,Intervertebral Disks
D008159 Lumbar Vertebrae VERTEBRAE in the region of the lower BACK below the THORACIC VERTEBRAE and above the SACRAL VERTEBRAE. Vertebrae, Lumbar
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D008297 Male Males
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D013123 Spinal Fusion Operative immobilization or ankylosis of two or more vertebrae by fusion of the vertebral bodies with a short bone graft or often with diskectomy or laminectomy. (From Blauvelt & Nelson, A Manual of Orthopaedic Terminology, 5th ed, p236; Dorland, 28th ed) Spondylodesis,Spondylosyndesis,Fusion, Spinal,Fusions, Spinal,Spinal Fusions,Spondylodeses,Spondylosyndeses
D015451 Leukemia, Lymphocytic, Chronic, B-Cell A chronic leukemia characterized by abnormal B-lymphocytes and often generalized lymphadenopathy. In patients presenting predominately with blood and bone marrow involvement it is called chronic lymphocytic leukemia (CLL); in those predominately with enlarged lymph nodes it is called small lymphocytic lymphoma. These terms represent spectrums of the same disease. B-Cell Leukemia, Chronic,B-Lymphocytic Leukemia, Chronic,Chronic Lymphocytic Leukemia,Leukemia, B-Cell, Chronic,Leukemia, Lymphocytic, Chronic,Lymphocytic Leukemia, Chronic, B-Cell,Lymphoma, Small Lymphocytic,B-Cell Chronic Lymphocytic Leukemia,B-Cell Malignancy, Low-Grade,Diffuse Well-Differentiated Lymphocytic Lymphoma,Disrupted In B-Cell Malignancy,Leukemia, B Cell, Chronic,Leukemia, Chronic Lymphatic,Leukemia, Chronic Lymphocytic,Leukemia, Chronic Lymphocytic, B-Cell,Leukemia, Lymphoblastic, Chronic,Leukemia, Lymphocytic, Chronic, B Cell,Lymphoblastic Leukemia, Chronic,Lymphocytic Leukemia, Chronic,Lymphocytic Leukemia, Chronic, B Cell,Lymphocytic Lymphoma,Lymphocytic Lymphoma, Diffuse, Well Differentiated,Lymphocytic Lymphoma, Diffuse, Well-Differentiated,Lymphocytic Lymphoma, Well Differentiated,Lymphocytic Lymphoma, Well-Differentiated,Lymphoma, Lymphocytic,Lymphoma, Lymphocytic, Diffuse, Well Differentiated,Lymphoma, Lymphocytic, Diffuse, Well-Differentiated,Lymphoma, Lymphocytic, Well Differentiated,Lymphoma, Lymphocytic, Well-Differentiated,Lymphoma, Lymphoplasmacytoid, CLL,Lymphoma, Small Lymphocytic, Plasmacytoid,Lymphoma, Small-Cell,Lymphoplasmacytoid Lymphoma, CLL,Small-Cell Lymphoma,B Cell Chronic Lymphocytic Leukemia,B Cell Leukemia, Chronic,B Cell Malignancy, Low Grade,B Lymphocytic Leukemia, Chronic,B-Cell Leukemias, Chronic,B-Cell Malignancies, Low-Grade,B-Lymphocytic Leukemias, Chronic,CLL Lymphoplasmacytoid Lymphoma,CLL Lymphoplasmacytoid Lymphomas,Chronic B-Cell Leukemia,Chronic B-Cell Leukemias,Chronic B-Lymphocytic Leukemia,Chronic B-Lymphocytic Leukemias,Chronic Lymphatic Leukemia,Chronic Lymphatic Leukemias,Chronic Lymphoblastic Leukemia,Chronic Lymphoblastic Leukemias,Chronic Lymphocytic Leukemias,Diffuse Well Differentiated Lymphocytic Lymphoma,Disrupted In B Cell Malignancy,Leukemia, Chronic B-Cell,Leukemia, Chronic B-Lymphocytic,Leukemias, Chronic B-Cell,Leukemias, Chronic B-Lymphocytic,Leukemias, Chronic Lymphatic,Leukemias, Chronic Lymphoblastic,Low-Grade B-Cell Malignancies,Low-Grade B-Cell Malignancy,Lymphatic Leukemia, Chronic,Lymphatic Leukemias, Chronic,Lymphoblastic Leukemias, Chronic,Lymphocytic Leukemias, Chronic,Lymphocytic Lymphoma, Small,Lymphocytic Lymphomas,Lymphocytic Lymphomas, Small,Lymphocytic Lymphomas, Well-Differentiated,Lymphoma, CLL Lymphoplasmacytoid,Lymphoma, Small Cell,Lymphoma, Well-Differentiated Lymphocytic,Lymphomas, CLL Lymphoplasmacytoid,Lymphomas, Lymphocytic,Lymphomas, Small Lymphocytic,Lymphomas, Small-Cell,Lymphomas, Well-Differentiated Lymphocytic,Lymphoplasmacytoid Lymphomas, CLL,Malignancies, Low-Grade B-Cell,Malignancy, Low-Grade B-Cell,Small Cell Lymphoma,Small Lymphocytic Lymphoma,Small Lymphocytic Lymphomas,Small-Cell Lymphomas,Well-Differentiated Lymphocytic Lymphoma,Well-Differentiated Lymphocytic Lymphomas
D017254 Leukemic Infiltration A pathologic change in leukemia in which leukemic cells permeate various organs at any stage of the disease. All types of leukemia show various degrees of infiltration, depending upon the type of leukemia. The degree of infiltration may vary from site to site. The liver and spleen are common sites of infiltration, the greatest appearing in myelocytic leukemia, but infiltration is seen also in the granulocytic and lymphocytic types. The kidney is also a common site and of the gastrointestinal system, the stomach and ileum are commonly involved. In lymphocytic leukemia the skin is often infiltrated. The central nervous system too is a common site. Infiltration, Leukemic,Infiltrations, Leukemic,Leukemic Infiltrations

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