{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T12:21:43Z","timestamp":1770985303061,"version":"3.50.1"},"reference-count":43,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: We report a rare case of a 66-year-old male with malignant non-germinal center-type large B-cell lymphoma involving the thoracic epidural, cauda equina, and filum terminal simultaneously. Case Presentation: The patient complained of back pain, rapid progressive numbness, and motor palsy in both legs in one month. Neurological examination revealed grade 2 muscle power in both lower limbs, hypesthesia below the T8 dermatome, and bladder and bowel dysfunctions. Magnetic resonance imaging (MRI) with contrast showed a well-defined extradural lesion extending from the T7 to T9 level, with severe spinal cord compression. Additionally, it revealed enlargement of the cauda equina occupying the extradural space from the L1-S1 level. The lesion appeared isointense on T1, mildly hyperintense on T2-weighted images, and exhibited homogeneous enhancement on post-contrast images. To relieve the patient\u2019s spinal cord compression as soon as possible and allow the patient to recover quickly after surgery, we performed unilateral biportal endoscopy (UBE) to completely remove the T7-9 epidural lesion. The immunohistochemical assessment confirmed a histological diagnosis of diffuse large B-cell lymphoma, a non-germinal center type. The patient received radiotherapy to the thoracic and lumbosacral areas (50 Gy) and chemotherapy with six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) after surgery. Follow-up positron emission tomography (PET) scan and MRI performed 4 months after surgery revealed complete remission of the lesion. The patient was able to walk using a walker after therapy. Conclusions: UBE is a favorable option for selected patients requiring immediate chemotherapy or radiotherapy owing to its reduced tissue trauma compared to traditional open surgery.<\/jats:p>","DOI":"10.3390\/reports9010061","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T10:52:21Z","timestamp":1770979941000},"page":"61","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Primary Non-Germinal Center-Type Large B-Cell Lymphoma Involving the Thoracic Epidural Space, Cauda Equina, and Filum Terminal: Diagnosis and Treatment Using Biportal Endoscopic Spine Surgery\u2014A Case Report and Literature Review"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1293-0603","authenticated-orcid":false,"given":"Nan-Fu","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 802, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chien-Yu","family":"Ou","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 802, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.pathol.2017.09.006","article-title":"Diffuse large B-cell lymphoma","volume":"50","author":"Li","year":"2018","journal-title":"Pathology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"162","DOI":"10.4103\/ajns.AJNS_300_19","article-title":"Primary Diffuse Large B-Cell Non-Hodgkin\u2019s Lymphoma of the Thoracic Spine Presented Initially as an Epigastric Pain","volume":"15","author":"Fakhouri","year":"2020","journal-title":"Asian J. Neurosurg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3085","DOI":"10.3892\/ol.2016.4365","article-title":"Primary diffuse large B-cell lymphoma of the central nervous system: A case report and literature review","volume":"11","author":"Chen","year":"2016","journal-title":"Oncol. Lett."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1001\/archneurol.2010.3","article-title":"Primary central nervous system lymphoma","volume":"67","author":"Gerstner","year":"2010","journal-title":"Arch. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e233442","DOI":"10.1136\/bcr-2019-233442","article-title":"Primary spinal epidural lymphoma: A rare entity with an ambiguous management","volume":"13","author":"Rato","year":"2020","journal-title":"BMJ Case Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.prp.2010.02.003","article-title":"Diffuse large B-cell lymphoma in the spinal epidural space: A study of the Osaka Lymphoma Study Group","volume":"206","author":"Wada","year":"2010","journal-title":"Pathol. Res. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"835","DOI":"10.3171\/jns.1988.68.6.0835","article-title":"Primary central nervous system lymphoma","volume":"68","author":"Hochberg","year":"1988","journal-title":"J. Neurosurg."},{"key":"ref_8","first-page":"349","article-title":"Primary cauda equina lymphoma: Case report and literature review","volume":"76","author":"Nakashima","year":"2014","journal-title":"Nagoya J. Med. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"bcr2014205950","DOI":"10.1136\/bcr-2014-205950","article-title":"Diffuse large B-cell lymphoma of the cauda equina","volume":"2014","author":"Broen","year":"2014","journal-title":"BMJ Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1182\/blood-2003-05-1545","article-title":"Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray","volume":"103","author":"Hans","year":"2004","journal-title":"Blood"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1093\/neuonc\/nox187","article-title":"The elderly left behind-changes in survival trends of primary central nervous system lymphoma over the past 4 decades","volume":"20","author":"Mendez","year":"2018","journal-title":"Neuro-Oncology"},{"key":"ref_12","unstructured":"Louis, D.N., Wiestler, O.D., and Cavenee, W.K. (2016). Diffuse large B-cell lymphoma of the CNS. WHO Classification of Tumours of the Central Nervous System, IARC Press. [4th ed.]."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Lauw, M.I.S., Lucas, C.G., Ohgami, R.S., and Wen, K.W. (2020). Primary central nervous system lymphomas: A diagnostic overview of key histomorphologic, immunophenotypic, and genetic features. Diagnostics, 10.","DOI":"10.3390\/diagnostics10121076"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Xiong, L., Liao, L.M., Ding, J.W., Zhang, Z.L., Liu, A.W., and Huang, L. (2017). Clinicopathologic characteristics and prognostic factors for primary spinal epidural lymphoma: Report on 36 Chinese patients and review of the literature. BMC Cancer, 17.","DOI":"10.1186\/s12885-017-3093-z"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5005","DOI":"10.1182\/blood-2009-12-258210","article-title":"Neurolymphomatosis: An International Primary CNS Lymphoma Collaborative Group report","volume":"115","author":"Grisariu","year":"2010","journal-title":"Blood"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E807","DOI":"10.1097\/BRS.0b013e31818441be","article-title":"Isolated neurolymphomatosis of the cauda equina and filum terminale: Case report","volume":"33","author":"Khong","year":"2008","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1097\/PPO.0b013e31826c5ad5","article-title":"Diagnosis and management of neurolymphomatosis","volume":"18","author":"Baehring","year":"2012","journal-title":"Cancer J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1215\/15228517-5-2-104","article-title":"Neurolymphomatosis","volume":"5","author":"Baehring","year":"2003","journal-title":"Neuro-Oncology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.jns.2014.04.030","article-title":"Primary neurolymphomatosis diagnosis and treatment: A retrospective study","volume":"342","author":"Lagarde","year":"2014","journal-title":"J. Neurol. Sci."},{"key":"ref_20","first-page":"623","article-title":"Primary cauda equina lymphoma diagnosed by nerve biopsy: A case report and literature review","volume":"16","author":"Suzuki","year":"2018","journal-title":"Oncol. Lett."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"645","DOI":"10.2147\/JBM.S325264","article-title":"Primary cauda equina lymphoma treated with CNS-centric approach: A case report and literature review","volume":"12","author":"Kuhlman","year":"2021","journal-title":"J. Blood Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1776","DOI":"10.1001\/archneur.62.11.1776","article-title":"Hypertrophy of the nerve roots of the cauda equina as a paraneoplastic manifestation of lymphoma","volume":"62","author":"Kumar","year":"2005","journal-title":"Arch. Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1038\/s41572-023-00439-0","article-title":"Primary central nervous system lymphoma","volume":"9","author":"Ferreri","year":"2023","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e940","DOI":"10.1016\/j.wneu.2023.04.045","article-title":"Comparison of the effect of chemoradiotherapy and chemotherapy on the survival of patients with primary diffuse large B-cell lymphoma of the spine: A SEER-Based Study","volume":"175","author":"Cao","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1016\/j.ijrobp.2018.01.003","article-title":"Radiation therapy as an effective salvage strategy for secondary CNS lymphoma","volume":"100","author":"Milgrom","year":"2018","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"192","DOI":"10.4184\/asj.2011.5.3.192","article-title":"Primary lumbo-sacral spinal epidural non-Hodgkin\u2019s lymphoma: A case report and review of literature","volume":"5","author":"Mally","year":"2011","journal-title":"Asian Spine J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.ijrobp.2006.01.002","article-title":"Primary spinal epidural lymphoma: Patients\u2019 profile, outcome, and prognostic factors: A multicenter Rare Cancer Network study","volume":"65","author":"Monnard","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"265","DOI":"10.14245\/kjs.2012.9.3.265","article-title":"Primary malignant lymphoma in a spinal cord presenting as an epidural mass with myelopathy: A case report","volume":"9","author":"Cho","year":"2012","journal-title":"Korean J. Spine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"513","DOI":"10.2169\/internalmedicine.31.513","article-title":"Primary epidural non-Hodgkin\u2019s lymphoma in clinical stage IEA presenting with paraplegia and showing complete recovery after combination therapy","volume":"31","author":"Tsukada","year":"1992","journal-title":"Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.1002\/1097-0142(197610)38:4<1862::AID-CNCR2820380467>3.0.CO;2-8","article-title":"Lymphoma of the spinal extradural space","volume":"38","author":"Haddad","year":"1976","journal-title":"Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"264","DOI":"10.12968\/hmed.2010.71.5.47906","article-title":"Lymphoma in the immunocompromised","volume":"71","author":"Harris","year":"2010","journal-title":"Br. J. Hosp. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1916","DOI":"10.1200\/JCO.2006.10.5957","article-title":"Lymphoma in older patients","volume":"25","author":"Thieblemont","year":"2007","journal-title":"J. Clin. Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/S0749-8063(96)90069-9","article-title":"Translaminar lumbar epidural endoscopy: Anatomy, technique, and indications","volume":"12","author":"Claro","year":"1996","journal-title":"Arthroscopy"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.wneu.2019.02.038","article-title":"A systematic review of unilateral biportal endoscopic spinal surgery: Preliminary clinical results and complications","volume":"125","author":"Lin","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e684","DOI":"10.1016\/j.wneu.2018.08.144","article-title":"Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study","volume":"120","author":"Heo","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S84","DOI":"10.14444\/8167","article-title":"Biportal endoscopic technique for transforaminal lumbar interbody fusion: Review of current research","volume":"15","author":"Kang","year":"2021","journal-title":"Int. J. Spine Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"E8","DOI":"10.3171\/2017.5.FOCUS17146","article-title":"Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: Technical note and preliminary clinical results","volume":"43","author":"Heo","year":"2017","journal-title":"Neurosurg. Focus"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e779","DOI":"10.3928\/01477447-20170531-02","article-title":"Posterior percutaneous endoscopic cervical foraminotomy and diskectomy with unilateral biportal endoscopy","volume":"40","author":"Park","year":"2017","journal-title":"Orthopedics"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1007\/s00701-021-04921-0","article-title":"Biportal endoscopic unilateral laminotomy with bilateral decompression for the treatment of cervical spondylotic myelopathy","volume":"163","author":"Kim","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Jing, X., Gong, Z., Qiu, X., Zhong, Z., Ping, Z., and Hu, Q. (2022). \u201cCave-in\u201d decompression under unilateral biportal endoscopy in a patient with upper thoracic ossification of posterior longitudinal ligament: Case report. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.1030999"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"129","DOI":"10.14245\/ns.2346060.030","article-title":"Biportal endoscopic posterior thoracic laminectomy for thoracic spondylotic myelopathy caused by ossification of the ligamentum flavum: Technical developments and outcomes","volume":"20","author":"Kim","year":"2023","journal-title":"Neurospine"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Kim, S.K., Bendardaf, R., Ali, M., Kim, H.A., Heo, E.J., and Lee, S.C. (2022). Unilateral biportal endoscopic tumor removal and percutaneous stabilization for extradural tumors: Technical case report and literature review. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.863931"},{"key":"ref_43","first-page":"301","article-title":"Unilateral biportal endoscopy for the resection of thoracic intradural extramedullary tumors: Technique case report and literature review","volume":"17","author":"Peng","year":"2024","journal-title":"Int. Med. Case Rep. J."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/1\/61\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T11:36:59Z","timestamp":1770982619000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/1\/61"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["reports9010061"],"URL":"https:\/\/doi.org\/10.3390\/reports9010061","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]}}}