Resident Loma Linda University Medical Center, United States
Introduction: DLBCL is an aggressive non-Hodgkin lymphoma with a predilection for extranodal involvement. Sciatic nerve infiltration is rare but may result in significant neurological deficits, including pain, weakness, and sensory disturbances. No consensus exists regarding the optimal management of DLBCL with peripheral nerve involvement. However, treatment generally includes chemotherapy, surgical resection and radiotherapy especially for localized or residual disease. The aim is to systematically review the clinical presentation, management, and outcomes of diffuse large B-cell lymphoma (DLBCL) involving the sciatic nerve.
Methods: A systematic review adhering to PRISMA guidelines was performed. PubMed, Web of Science, and Cochrane databases were searched, yielding 16 articles comprising 17 cases of sciatic nerve involvement.
Results: The average patient age was 62.8 years, with 6 males (35%) and 11 females (65%). Presenting symptoms included pain (28%), weakness (15%), and paresthesia (10%), with a mean symptom duration of 9.9 months. MRI was performed in all patients and FDG-PET in 9, revealing masses along the sciatic nerve, with an average tumor diameter of 8.2 cm. Histological diagnosis was confirmed in 65%, all CD20-positive, while the remainder were diagnosed radiologically. Treatment included chemotherapy in 94%, surgical resection in 24%, and adjuvant radiotherapy in 53%. At last follow-up, 44% of patients showed neurological improvement, while 31% worsened, the rest remains unchanged. Recurrence occurred in 6 patients (35%): 5 were initially managed with chemotherapy alone, with 4 also had chemotherapy alone to manage their recurrence and one had salvage radiotherapy. After recurrence, 4 (out of 6) patients died with an overall mortality rate of 76% at las follow-up in the present study.
Conclusion : Sciatic nerve DLBCL primarily affects older adults with varied neurological presentations. A multidisciplinary approach of radiotherapy and surgery in addition to chemotherapy may enhance outcomes and reduce recurrence.