To the Editor.–The June Archives contains an article concerning extramedullary nervous system spread of lymphoma.1 The advent of newer methods of multidisciplined therapy has meant that patients are living longer and that recognition of complications secondary to their primary disease is common.
A patient at Children's Hospital in Minneapolis, with known undifferentiated lymphoblastic lymphoma of nine months duration, developed a bilateral seventh nerve paralysis over a 36-hour period. Otolaryngologic and radiographic examination results were normal. Spinal fluid examination denoted 2,600 blast cells, normal protein, and normal pressure. The child had been treated with intensive systemic chemotherapy and intrathecal methotrexate prior to the episode. He was then treated with intrathecal cytarabine and linear accelerator radiation to the entire brain stem and seventh nerve peripheral pathways. Complete resolution of the process occurred within 17 days.
Palva's article fails to mention either spinal fluid results or attempts at therapy. A major
SINGHER LJ. Malignant Lymphoma. Arch Otolaryngol. 1975;101(4):269. doi:10.1001/archotol.1975.00780330065022
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