Abdominal Pain That Is Not in the Abdomen — An Unusual Presentation of Non‐Hodgkin B‐Cell Lymphoma

1RAHC/UTHSCSA and VBMC, Harlingen, TX
2RAHC/UTHSCSA, Harlingen, TX

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 137

Case Presentation:

The epidural space is a well‐known, albeit uncommon, location for lymphomatous involvement. We present a Hispanic man with an initial complaint of upper abdominal pain that progressed to a posterior spinal canal compression syndrome caused by B‐cell non‐Hodgkin lymphoma.

Discussion:

A 55‐year‐old Hispanic man presented with 3 months of intermittent severe epigastric pain radiating bilaterally to his upper back. Extensive evaluation with CT and abdominal ultrasound demonstrated only fatty liver and a 1‐mm stone in the right kidney. The patient had positive serology for H. Pylori and was treated. He now presented with 2 weeks of progressive ataxia, lower extremity tingling, and proprioception loss. He had no history of fever or weight loss. Physical examination was remarkable for bilateral decreased sensory level below T5 and patchy, nondermatomal areas of sensory loss to pain and temperature. A Romberg test was positive. Deep tendon reflexes were slightly hyperreflexive on the patella and ankles. The patient could ambulate with sensory ataxia. T‐spine MRI demonstrated tumor involving the T2 and T5 vertebra with a 6.2 × 2.5 × 1.6 cm posterior spinal canal mass from the level of T4 to the T6‐T7 disc space causing cord compression. CBC and chemistries were normal. CSF analysis demonstrated RBC 15, WBC 13, SEG 89, LDH 13, protein 24, glucose 77, with no abnormalities on gram stain, culture, or cytology. Final pathology from thoracic laminectomy diagnosed B‐cell non‐Hodgkin lymphoma of follicle center cell origin.

Conclusions:

Abdominal pain is often a difficult diagnostic conundrum. Our patient initially presented with nonspecific abdominal pain. The only positive finding on extensive workup was positive H. pylori serology. The diagnosis was delayed until further progression of the disease with symptoms of spinal cord compression. As in previous case reports, CSF cytology revealed no malignant cells. The existence of unrecognized preexisting retroperitoneal disease in such patients, despite clinical, laboratory, and radiographic evidence to the contrary, is possible. Primary spinal epidural lymphoma has been considered “rare.” On reviewing the literature, we found a few case reports describing B‐cell epidural tumors as an uncommon cause of spinal cord injury. Spinal cord injury caused by cancer is increasing in incidence as the mean age of our patient population increases. Understanding the prognosis and functional outcome requires knowledge of diseases of the spinal column.

Author Disclosure:

L. De Oliverira, none.

To cite this abstract:

Oliveira L, Hanley J. Abdominal Pain That Is Not in the Abdomen — An Unusual Presentation of Non‐Hodgkin B‐Cell Lymphoma. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 137. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/abdominal-pain-that-is-not-in-the-abdomen-an-unusual-presentation-of-nonhodgkin-bcell-lymphoma/. Accessed March 20, 2019.

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