Case Presentation:
- A 61-year-old man presented to our institution with a hoarse voice and progressively worsening difficulty with swallowing solids then liquids leading to a substantial weight loss over the past four months.
- An exam confirmed the presence of multiple cranial neuropathies (CN 5, 9, 10, 11) and a right-sided L4-5 radiculopathy.
- Lab work was notable for pancytopenia and imaging revealed a large anterior mediastinal mass.
- He had multiple large, bilateral axillary lymph nodes as well as a subcutaneous anterior chest mass.
- The chest wall mass was biopsied, confirming a diagnosis of T-Cell acute lymphoblastic lymphoma (ALL).
- He was started on high-dose systemic corticosteroids (methylprednisolone 1 gram IV daily for 5 days).
- A bone marrow biopsy was positive for a T-Cell receptor (TCR) gene rearrangement, confirming the diagnosis of a systemic T-Cell ALL.
- His CSF profile was unremarkable possibly because he had already started the methylprednisolone treatment prior to the LP.
- His neurological symptoms rapidly improved with the methylprednisolone treatment, while his systemic workup was ongoing.Following diagnosis, an Ommaya reservoir was placed for therapeutic treatment of the central nervous system, given the cranial nerve and peripheral nerve involvement and he was started on the Hyper-CVAD regimen with therapeutic intrathecal chemotherapy, After 4 cycles of treatment, he had achieved remission
Discussion:
- T-Cell acute lymphoblastic lymphoma is a rare entity, and in our case, the diagnosis was made after the patient initially presented with cranial neuropathies. His neurological function was restored due to rapid initiation of treatment and there was an excellent clinical response of the ALL to the treatment.
Conclusions:
- Lymphoma is associated with different neurologic manifestations, which can include cranial and peripheral neuropathy. Due to the small number of cases, no definite guidelines on diagnosis and management have been made. In this case immediate treatment led to a good outcome and should be considered for future cases.
To cite this abstract:
T-CELL ACUTE LYMPHOBLASTIC LYMPHOMA WITH CNS INVOLVEMENT.
Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev..
Abstract 402Journal of Hospital Medicine Volume 12 Suppl 2.
https://shmabstracts.org/abstract/t-cell-acute-lymphoblastic-lymphoma-with-cns-involvement/.
October 21st 2026.