Spinal cord compression: to biopsy, or not to biopsy?

A patient presenting with acute spinal cord compression initially thought to be secondary to metastatic cancer based on magnetic resonance imaging alone is described. No primary tumour was identified on further imaging, and although deemed to be technically very difficult, surgical decompression was postponed in favour of obtaining a histological diagnosis. Histology confirmed a low grade non-Hodgkin's lymphoma, a diagnosis which would not have been considered had a biopsy not been undertaken. The correct curative treatment was subsequently initiated, and the patient responded well to localised radiotherapy and intrathecal methotrexate.