Lymphoma

Clinical history
This 40-year-old HIV-positive male was referred to the hospital for paresthesias of the lower extremities and progressive gait disturbance.

Neurological examination disclosed a Brown-Sequard syndrome with paresis and pyramidal tract signs in the left lower leg, with loss of pain and temperature sensation in the contralateral right leg.

Pre-operative MRI
MR examination of the spinal cord diagnosed a hypointense, enhancing intramedullary lesion at the C7 level.

Image 1: Sagittal T1WI. C7 hypointense intramedullary lesion.
Image 2: Sagittal PD. C7 hypointense intramedullary lesion.
Image 3: Sagittal Gd T1WI. Gd enhanced intramedullary lesion.
Image 4: Axial Gd T1WI.

Surgery
A slightly vascular, gray, infiltrative lesion was subtotally resected.

Histology
Malignant non-Hodgkin lymphoma with large immunoblastic cells.

Post-operative course
The patient had gradual sensorimotor improvement. However, he developed HIV-related pneumonia, and died one year later.

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