98 World Spinal Column Journal, Volume 2 / No: 3 / September 2011 WScJ 2: 98-101, 2011 Primary Cranial Central Nervous System Lymphoma with Seeding Metastasis to the Spinal Cord Mehdi Sasani 1 , Ahmet Levent Aydin 2 , Tunc Oktenoglu 1 , Ihsan Solaroglu 3 , Ali Fahir Ozer 3 , Ali Cetin Sarioglu 1 1 Department of Neurosurgery, American Hospital, Istanbul, Turkey 2 Department of Neurosurgery, Istanbul Physical Therapy and Rehabilitation Hospital, Istanbul, Turkey 3 Department of Neurosurgery, Koc University, School of Medicine, Istanbul, Turkey INTRODUCTION P rimary cerebral nervous system lymphoma (Primary CNS Lymphoma, PCNSL) is an aggressive non-Hodgkin’s lymphoma that originates from the central nervous system (CNS) without any other evidence of lymphoma at the time of diagnosis. These rare tumors account for 1% to 3% of CNS neoplasms (12). PCNSL may occur in all areas of the brain; however, primary lymphomas of the spinal cord are extremely rare. We present a patient who developed a massive lymphoma encompassing the entire spinal cord that exhibited seeding metastasis after comprehensive treatment of a primary cerebral lymphoma and cerebral relapse. CASE PRESENTATION An 81-year-old male patient presented with progressive weakness in all extremities, complaining of back pain, as well as transient confusion and loss of consciousness. The patient’s complaints had started two weeks before his admission to the hospital. The medical history of the patient was obtained from family members. The irst complaint was headache and nausea starting 4 months before clinical presentation, when the patient was being followed up with a diagnosis of primary brain lymphoma. Cranial magnetic resonance imaging (MRI) revealed a frontal periventricular lesions. At that time, whole spinal cord MRI was normal. A positron emission tomography scanning (PET/CT) showed a pathological accumulation ABSTRACT Primary cerebral nervous system lymphoma is an aggressive non-Hodgkin’s lymphoma, accounting for 1% to 3% of central nervous system (CNS) neoplasms. We present an 81-year-old male patient who developed a massive lymphoma encompassing the entire spinal cord that exhibited seeding metastasis after comprehensive treatment of a primary cerebral lymphoma and relapse. The patient family members refused all further treatment other than palliative treatment to resolve myelitis; the patient was treated with 500mg intravenous prednisolone per day. The patient died 4 months after histological diagnosis. Needle biopsy of the spinal cord was performed postmortem. Histological examination showed lymphoblastic deposits. Primary central nervous system lymphoma has a tendency to seed. Therefore, in order to avoid late diagnosis and unsuccessful treatment, a gadolinium-enhanced magnetic resonance imaging of whole spinal cord should be performed as part of a routine staging assessment in patients with primary central nervous system lymphoma. KEY WORDS: Central nervous system lymphoma, Intramedullary spinal tumor, Lymphoma, Neoplasm