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The present lymphoma was confined to a segment of the sciatic nerve and it was not associated with systemic lymphoma at the time of presentation. CASE PRESENTATION ...

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    Slide 1:“LYMPHOMAS IN PERIPHERAL NERVE” by Alfredo Quinones, B.S. Joseph Middraji, M.D. Tracy Batchelor, M.D. E. Antonio Chiocca, M.D., Ph.D.

    Slide 2:A solitary extranodal (Burkitt’s—like) lymphoma of the sciatic nerve is described in a 50-year old man. The present lymphoma was confined to a segment of the sciatic nerve and it was not associated with systemic lymphoma at the time of presentation.

    Slide 3:Mr. WP is a 50 y.o. patient with progressive weakness and sensory disturbance in the right leg. June of ’96 he noticed intermittent radiating pain on his right leg. In the fall of ’96 he noticed severe sciatic pain on his right leg and he eventually developed a right foot drop and an edematous leg.

    Slide 4:absence of café au lait spots. Numbness along the medial aspect of his R. calf, R. Toes, and the bottom of his R. foot. lost completely ankle dorsiflexion and ankle inversion. An electromyogram on 1/97 revealed a peripheral nerve lesion, which was attributed to a right-sided sciatic nerve mass. An MRI on 2/97 revealed a fusiform tumor involvement of the sciatic nerve beginning 10 cm below the lesser trochanter and extending 6 cm below the knee in the tibial nerve.

    Slide 5:3/97 by Dr. Chiocca. Final pathology described the tissue as a non-Hodgkin’s lymphoma with an apparent high grade appearance, Burkitt’s-like, with a starry sky appearance, B-cell positive. Staging studies including abdominal, pelvic and chest CT scans, bone marrow bx and lumbar puncture were all negative.

    Slide 6:CHEMOTHERAPY: 4 cycles of CHOP. 3 wks after his last cycle (7/97), he presented with a right facial nerve palsy. At this time LP revealed a WBC of 390. All other staging studies were again negative including bone marrow bx. IRRADIATION AND ARA-C: Omaya reservoir was placed and underwent cranial irradiation with intrathecal biweekly ARA-C, 40 mg, for three weeks as well as PO decadron. His CSF cleared and had a slight improvement of his right sided facial nerve weakness.

    Slide 7:As plans were being made for additional chemotherapy with bone marrow transplant, the patient expired on 9/97 after multisystem organ failure began to develop.

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