LUMBAR INTERVERTEBRAL DISC INVOLVEMENT IN CHRONIC LYMPHOCYTIC-LEUKEMIA - A CASE-REPORT

Study Design. Report of a patient with a rare location of a solid chro nic lymphocytic leukemic mass of an intervertebral lumbar disc. Object ives. To illustrate the previously undescribed discovertebral involvem ent of chronic lymphocytic leukemia and to discuss the diagnostic diff iculties. Summary of Background Data. Chronic lymphocytic leukemia pri marily involves lymph nodes, spleen, liver, and bone marrow. Bone lesi ons are rare in chronic lymphocytic leukemia and usually consist of ar eas 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 reporte d. Intervertebral disc involvement in chronic lymphocytic leukemia has not been reported previously. Methods. The clinical findings, radiogr aphs, histology, treatment, and follow-up results are presented. Resul ts. Radiographs and magnetic resonance imaging studies showed partial collapse of vertebrae L2 and L3, with destruction and protrusion of th e 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 origi n was confirmed through histologic examination and immunohistochemical studies of a biopsy and resection specimen. Twenty months after treat ment the patient was still in remission and fully mobilized. Conclusio ns. Intervertebral disc involvement in cases of chronic lymphocytic le ukemia is rare. Its presence should be considered in patients with bac k pain and neurologic symptoms who had been treated for this form of l eukemia in the past. Differentiation with infectious spondylodiscitis can be difficult. Histology is necessary to confirm diagnosis.