Intracranial malignant lymphoma. Report of 30 cases and review of the literature

Although primary malignant lymphoma is a rare entity in the gamut of intracranial tumors, it is more frequently seen than the secondary intracranial spread of a primary extracranial lymphoma. In general, the occurrence of lymphomas seems to be provoked by immunosuppression, as with medication (predominantly after transplantation) or with immunodepressive disease such as acquired immunodeficiency syndrome (AIDS). The usual age of onset of this disease is 55 to 65 years; and the male:female patient distribution is roughly 2:1. Characteristically, computerized tomography (CT) scans of lymphomas show a mass which is often large with regular contours, moderate mass effect, and hyper- or isodensity with marked and often homogeneous enhancement. In the series of 30 patients reported, the locations of lesions, in order of decreasing frequency, were the frontocallosal and temporal regions, the basal ganglia, and the cerebellum. Multiple lesions were present in 15% of these cases (20% to 40% in the literature). The following features should raise the suspicion of intracranial lymphoma: mirror lesions of the basal ganglia, bilateral subependymal infiltration, and leptomeningeal involvement contiguous with an intracerebral mass. According to the literature, the angiographic finding typical of lymphoma is an avascular tumor. A blush or vascular encasement of the mass seems to be rare, and the present series was in accordance with other reports in this respect. Differential diagnostic consideration should include meningioma, glioblastoma, metastatic disease, and focal infectious lesions such as toxoplasmosis or multifocal progressive leukoencephalitis, particularly in immunodepressed subjects. Diagnosing lymphoma from CT scans offers the alternative of substituting stereotaxic biopsy and neuropathological diagnosis for the more aggressive open surgical approach, since radiation therapy and possibly chemotherapy usually prove to be the treatment of choice.

[Lateral lumbar disk hernia]

Eleven cases are reported of lateral lumbar herniated disc, an anatomical form presenting fairly atypical features and of relatively recent discovery. The patients presented with a highly painful single root lesion usually affecting L4 and L5 roots. Saccoradiculography was negative in almost all cases whereas computed tomography imaging allowed easy diagnosis of a lateral herniated disc, and demonstrated its foraminal or extraforaminal site. An appropriate surgical approach was thus possible, extremely lateral forms requiring an extraisthmian approach.

[Multi-institution, multidisciplinary radiology and endoscopy trial of the diagnostic accuracy of the double contrast examination of the stomach surface]

In 12 X-ray and gastroenterology departments 1570 patients, clinically suspected to have a gastric pathology, have been examined by double contrast (surface) examination of the stomach followed by gastroscopy. Diagnostic accuracy was 93% in respect of endoscopic data, assumed correct by hypothesis. On the basis of a cost and benefit evaluation, made according to the well known criteria, a wider routine use of the double contrast technique is proposed.

Dynamic lymphadenoscintigraphy of the lower limbs (notes on technique and normal findings)

The use of dynamic lymphadenoscintigraphy is proposed for the study of the lymphatic flow in the lower limbs. The method is based on the determination of the flow curves of radiocolloid (antimony-sulphide labelled with 99mTc) in the lower limbs, on the time of its appearance in the inguinal lymphatic vessels and in the liver, and also on the recording by periodically repeated photoscans of the progress of the radiocolloid in the pre-lymph node ducts. Thus, the method is suggested for use in the observation of flow variations as an expression of metastatic or systemic lymph node diseases and in the differential diagnosis of lymphatic and venous oedema.