Clinical Neurology and Neurosurgery 108 (2006) 168–173 Case report Primary spinal extranodal Hodgkin’s disease at two levels Ferda C ¸a˘ gavi ∗ , Murat Kalaycı, ˙ Ishak ¨ Ozel Tekin, Gamze Numano˘ glu, Zeynep C ¸a˘ gavi, S ¸ anser G ¨ ul, Bektas ¸ Ac ¸ıkg¨ oz Zonguldak Karaelmas ¨ Universitesi, Tıp Fak¨ ultesi Hastanesi N ¨ oro¸ sir¨ urji AD, Zonguldak 67600, Turkey Received 30 January 2004; received in revised form 18 October 2004; accepted 26 November 2004 Abstract About 90% of Hodgkin’s disease cases originate from lymph nodes whereas 10% from extranodal regions. Patients rarely present with spinal cord compression due to epidural Hodgkin’s disease. Primary spinal extradural Hodgkin’s disease which does not have any other organ involvement in the body is even rarer. A 39-year-old male patient who complained of lumbar pain had normal findings upon neurological examination. Radiological examination revealed a mass on the epidural space at level L3 and the involvement of the vertebral corpus accompanied by the involvement of C6 vertebral body. Primary focus could not be identified despite further investigation. The patient underwent L3 laminectomy and posterior decompression and biopsy was obtained from the lesion extending to epidural space. The pathological result was reported as lymphocyte dominant type Hodgkin’s disease. Flow cytometry was performed to the lesion, also. The patient was evaluated as Stage 4A according to Ann Arbor classification. Postoperative radiotherapy was applied to lumbar and cervical region. In the literature we have not come across any case of primary spinal extranodal Hodgkin’s disease with involvement at two levels. In conclusion, although it might be extremely rare, primary spinal extranodal Hodgkin’s disease with involvement at two levels might be observed. © 2004 Elsevier B.V. All rights reserved. Keywords: Hodgkin’s disease; Primary extranodal lymphoma; Spinal cord 1. Introduction Hodgkin’s disease constitutes 0.5–1% of all adult tumors [1]. Spinal involvement is observed in 5.8% of all Hodgkin’s cases [2]. The 90% of Hodgkin’s disease cases originate from lymph nodes whereas 10% from extranodal regions [3]. Epidural space is one of the extranodal regions. Patients rarely present with spinal cord compression due to epidural Hodgkin’s disease. Limited cases with such presentation have been reported in the literature [2,4–13]. Primary spinal ex- tradural Hodgkin’s disease with no further organ involvement is extremely rare. Four publications and ten case reports are available in the literature reporting such cases [5,8,10,12]. ∗ Corresponding author. Tel.: +90 372 261 0169/1588; fax: +90 372 261 0155. E-mail address: cagavif@yahoo.com (F. C ¸a˘ gavi). We present a 39-year-old male patient, with lumbar pain and diagnosed as Hodgkin’s disease at lumbar and cervical regions without any other organ involvement. We have not come across any case in the literature with two level involve- ments due to primary spinal extranodal Hodgkin’s disease as observed in our patient. 2. Case report A 39-year-old male patient with a complain of lumbar pain for the last 2 months is presented in this case report. He had normal neurological examination and did not reveal any pathology in two-dimensional lumbosacral films. Rou- tine laboratory tests were normal: WBC: 5400 l -1 , ESR: 5 mm/h, Brucella agglutination negative. So, he received con- servative treatment. As his complaints did not resolve, lum- bar magnetic resonance images were obtained and involve- 0303-8467/$ – see front matter © 2004 Elsevier B.V. All rights reserved. doi:10.1016/j.clineuro.2004.11.023