AI Article Synopsis
- - A 43-year-old male with a history of T-cell lymphoma and high-risk polycythemia vera (PCV) experienced severe lower-back pain that radiated to his legs, along with weakness and an enlarged spleen.
- - MRI scans showed multiple epidural lesions causing severe spinal canal stenosis, leading to surgical decompression, which relieved his leg pain and weakness.
- - Biopsy indicated extramedullary hematopoiesis (EMH) resembling a spinal tumor; he received palliative radiation and other treatments, highlighting the rarity and lack of standard treatment for EMH in the spine associated with PCV.
Article Abstract
Background: Here the authors present the case of a 43-year-old male with a history of T-cell lymphoma, which was treated with azacitidine plus cyclophosphamide, doxorubicin, vincristine, and prednisone and autologous hematopoietic cell transplant, and high-risk polycythemia vera (PCV) presenting with severe lower-back pain radiating to the bilateral legs with associated lower-extremity weakness and splenomegaly.
Observations: T2-weighted magnetic resonance imaging revealed multilevel epidural lesions involving T1-10 and S1-2. Because of severe spinal canal stenosis, the patient underwent surgical decompression of T5-7, with immediate postoperative alleviation of the lower-extremity pain and complete resolution of the lower-leg weakness. Biopsy results revealed extramedullary hematopoiesis (EMH) mimicking a spinal epidural tumor. EMH is radiosensitive and displays a rapid response to low dosages, so the patient was further treated with palliative radiation therapy for residual tumors and symptom alleviation, as well as hydroxyurea and corticosteroids as indicated for cytoreduction.
Lessons: EMH associated with PCV or myeloproliferative conditions occurring within the spine is a rare phenomenon without a standard treatment approach. https://thejns.org/doi/10.3171/CASE23659.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11284665 | PMC |
| http://dx.doi.org/10.3171/CASE23659 | DOI Listing |
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