Hematolymphoid Malignancies Presenting with Spinal Epidural Mass and Spinal Cord Compression: A Case Series with Rare Entities.

The epidural space is an uncommon site for involvement by hematolymphoid malignancies, and may present unexpectedly with neurological symptoms related to spinal cord compression. Our objective was to review the clinical and pathologic features of cases with initial presentations of cord compression, subsequently diagnosed as a hematolymphoid malignancy after pathologic examination. Review of the Department of Pathology's archives revealed 15 patients who presented with spinal cord compression due to epidural hematolymphoid malignancies between 2008-2019. These cases involved five primary epidural lymphomas, including an ALK-negative anaplastic large T-cell lymphoma previously not reported at this site, three diffuse large B cell lymphomas, one B-lymphoblastic lymphoma, four cases of myeloid sarcoma, one case with a previous history of acute myeloid leukemia, five cases with plasma cell neoplasms and epidural lesions as the initial presentation of plasma cell myeloma, one case showing aberrant T-cell marker expression, and one case being a histiocytic sarcoma that is rarely reported in the spine. A hematolymphoid malignancy was suspected clinically or radiologically in only five of these cases. These cases represent the spectrum of hematolymphoid malignancies that can involve the epidural space and present for the first time with cord compression, resulting in clinical, radiological and pathologic diagnostic challenges. Their diagnoses require a high degree of awareness, suspicion, and thorough histologic evaluation with ancillary studies for appropriate disease classification and therapeutic intervention. To our knowledge, this is one of the largest and most diverse of such series in the English language literature.