Case report: Solitary mass of the sciatic nerve confirmed as a primary extranodal manifestation of diffuse large B-cell lymphoma in a geriatric patient

Hannes Becker; Antonio Vogelsberg; Daniel Feucht; Arne Estler; Deniz Tafrali; Jens Schittenhelm; Jakob Milla; Sylvia Kurz; Falko Fend; Marcos Tatagiba; Martin U Schuhmann; Helene Hurth

doi:10.3389/fonc.2024.1354073

Case report: Solitary mass of the sciatic nerve confirmed as a primary extranodal manifestation of diffuse large B-cell lymphoma in a geriatric patient

Front Oncol. 2024 Mar 22:14:1354073. doi: 10.3389/fonc.2024.1354073. eCollection 2024.

Authors

Hannes Becker^{1

2}, Antonio Vogelsberg³, Daniel Feucht¹, Arne Estler⁴, Deniz Tafrali⁵, Jens Schittenhelm⁵, Jakob Milla³, Sylvia Kurz², Falko Fend³, Marcos Tatagiba¹, Martin U Schuhmann^{1

6}, Helene Hurth¹

Affiliations

¹ Department of Neurosurgery, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.
² Department of Neurology & Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Center for Neuro-Oncology, Comprehensive Cancer Center, University Hospital Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.
³ Department of Pathology and Neuropathology, University Hospital and Comprehensive Cancer Center Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.
⁴ Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital of Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, Germany.
⁵ Department of Neuropathology, University Hospital Tuebingen, Eberhard Karls University Tübingen, Tuebingen, Germany.
⁶ Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.

Abstract

Background: Neoplastic lesions affecting peripheral nerves are rare in the general population and, most often, are benign peripheral nerve sheath tumors. However, a minority of lesions represent high-grade malignancies associated with a poor prognosis, such as malignant peripheral nerve sheath tumors (MPNSTs). Very rarely, these tumors represent peripheral non-nerve sheath tumors (PNNSTs), such as hematological neoplasms that impair nerve function. These can be hard to distinguish from MPNSTs and other lesions arising from the nerve itself. In the present case report, we describe a rare case of direct infiltration of nerves by tumor cells of a hematological neoplasm.

Methods: We report the case of a 90-year-old woman with acute onset of right-sided foot palsy, sensory loss, and pain, caused by an extensive solitary mass of the sciatic nerve in the thigh. We present and discuss the clinical presentation, multimodal diagnostic procedures, and treatment.

Results: MRI of the right thigh and the caudal pelvis revealed a contrast-enhancing lesion infiltrating the sciatic nerve. Additionally performed staging imaging was non-revealing. After multidisciplinary discussion in the neuro-oncology tumor board, a MPNST was suspected and the patient underwent radical tumor resection. However, final histopathology revealed a diffuse large B-cell lymphoma (DLBCL). The patient received adjuvant palliative local radiotherapy which led to acceptable symptom control.

Conclusion: Rare PNNSTs, including extranodal manifestations of DLBCL can have similar clinical and radiological diagnostical features as PNSTs. Comprehensive diagnostic workup of contrast-enhancing lesions affecting peripheral nerves including MRI and metabolic imaging are recommended. Discussion in interdisciplinary tumor boards facilitates finding individual treatment approaches.

Keywords: B-cell lymphoma; extranodal manifestation; peripheral nerves; peripheral non nerve sheath tumor; sciatic nerve.

Publication types

Case Reports

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. We acknowledge support by Open Access Publishing Fund of University of Tübingen). AV was supported by the Junior Clinician Scientist Program of the University Hospital Tuebingen (application number: 516-0-0).