1
|
Ichikawa T, Shimojima Y, Kishida D, Kaneko T, Sekijima Y. Primary central nervous system lymphoma in neuropsychiatric systemic lupus erythematosus: case-based review. Rheumatol Int 2020; 41:1009-1017. [PMID: 32253501 DOI: 10.1007/s00296-020-04569-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/24/2020] [Indexed: 11/26/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) sometimes occurs in immune-compromised hosts or patients with autoimmune diseases. Some cohort studies have previously reported an increased risk of non-Hodgkin's lymphoma in systemic lupus erythematosus (SLE), while some cases of PCNSL in patients with SLE were reported. We present the case of PCNSL which developed in a patient with the active phase of neuropsychiatric SLE (NPSLE). Furthermore, we reviewed published English articles to confirm the characteristics of PCNSL related to SLE. To our knowledge, this is the first report of PCNSL occurring in NPSLE. Histology demonstrated B-cell lymphoma with a positive Epstein-Barr virus-encoded RNA. This patient recovered following surgical resection of the lymphoma, whole brain radiation therapy, intravenous infusion of rituximab (RTX), and administration of belimumab after RTX. Given the series of reviews, our report suggests that the persistence of damage in the central nervous system (CNS) and long-term exposure to immunosuppressants may impact oncogenic immune responses within the CNS, leading to PCNSL development.
Collapse
MESH Headings
- Adult
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antineoplastic Agents, Immunological/administration & dosage
- Brain/diagnostic imaging
- Brain/pathology
- Female
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunosuppression Therapy/adverse effects
- Immunosuppressive Agents/administration & dosage
- Lupus Vasculitis, Central Nervous System/complications
- Lupus Vasculitis, Central Nervous System/drug therapy
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/virology
- Rituximab/administration & dosage
Collapse
Affiliation(s)
- Takanori Ichikawa
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yasuhiro Shimojima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Dai Kishida
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tomoki Kaneko
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| |
Collapse
|
2
|
Tanki HN, Malik KN, Makhdoomi R, Feroz S, Ramzan AU. Primary Hypothalamic Lymphoma in an Adult Male: A Case Report and Literature Review. Oman Med J 2018; 33:346-351. [PMID: 30038736 DOI: 10.5001/omj.2018.63] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary central nervous system lymphoma is a well-known entity. However, the hypothalamus is a rare location, especially in adults. Few cases of secondary lymphomas have been reported. We report a case of primary hypothalamic lymphoma in an adult male with normal pituitary functions. Lymphoma should be considered as one of the differential diagnosis of lesions involving the hypothalamic/third ventricular area.
Collapse
Affiliation(s)
- Humam Nisar Tanki
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Kashmir, India
| | - Khursheed Nayil Malik
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Kashmir, India
| | - Rumana Makhdoomi
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Kashmir, India
| | - Shaheen Feroz
- Department of Radiology, Sheri-Kashmir-Institute of Medical Sciences, Kashmir, India
| | - Altaf Umaŕ Ramzan
- Department of Neurosurgery, Sheri-Kashmir-Institute of Medical Sciences, Kashmir, India
| |
Collapse
|
3
|
Roriz M, Lopes A, Jarrin I, Lechtman S, Polivka M, Bergmann JF, Sène D, Mouly S. [Central nervous system lymphoma revealed by lymphocytic meningitis in a patient with systemic lupus erythematosus: An unusual association]. Rev Med Interne 2016; 38:269-273. [PMID: 27363932 DOI: 10.1016/j.revmed.2016.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/16/2016] [Accepted: 05/28/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We report an unusual observation of central nervous system (CNS) lymphoma in a 60-year-old woman with systemic lupus erythematosus and fatal outcome. OBSERVATION The patient had systemic erythematosus lupus for 7 years, treated with mycophenolate mofetil and developed lymphocytic meningitis in 2015 associated to the presence of EBV in the cerebrospinal fluid and a necrotic vermis' lesion. Diagnosis of large B-cell lymphoma was histologically confirmed from stereotaxic biopsy, shortly before she died from neurological complications. CONCLUSION Even though the current association is unusual, lymphocytic meningitis with hypoglycorrachia in patients with systemic lupus erythematosus may reveal CNS lymphoma and diagnosis confirmation requires stereotaxic biopsy in order not to delay specific therapeutic management.
Collapse
Affiliation(s)
- M Roriz
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France.
| | - A Lopes
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - I Jarrin
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France
| | - S Lechtman
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - M Polivka
- Service d'anatomopathologie, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J-F Bergmann
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - D Sène
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - S Mouly
- Département de médecine interne, hôpital Fernand-Widal, groupe hospitalier Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France; UMR-S1144, UFR de médecine Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| |
Collapse
|
4
|
Cellina M, Fetoni V, Baron P, Orsi M, Oliva G. Unusual primary central nervous system lymphoma location involving the fourth ventricle and hypothalamus. Neuroradiol J 2015; 28:120-5. [PMID: 25923685 DOI: 10.1177/1971400915576671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A previously healthy 65-year-old man presented with a two-week history of weight loss, headaches, blurred vision, asthenia and quickly worsening walking impairment. He denied photophobia, neck stiffness, fever, nausea or vomiting.Neurological examination showed global motor slowing, tendency to fall asleep during the clinical examination, generalized weakness against resistance to head and limbs, and osteotendon reflexes present in the upper limbs, but not evoked in the lower limbs. No sensitive deficit or focal neurologic sign was recognizable.Non-contrast multislice computed tomography (MSCT) of the head was performed in the emergency department, showing diffuse periventricular white matter and thalamic mild hyperdensity.Lumbar puncture, blood tests, including serology for HIV and other infections, were negative.On the third day the patient, showing decreased consciousness, underwent magnetic resonance imaging (MRI) with contrast medium injection. MRI revealed the presence of multiple pseudonodular avidly enhancing lesions, supra and infratentorial, crossing the midline, involving the ventricular system, including the fourth ventricle, with extension into the surrounding white matter, the corpus callosum, the thalamus and the hypothamalus.A stereotactic biopsy led to a diagnosis of diffuse large B-cell lymphoma, primarily located in the central nervous system (PCNSL).After the completion of the first phase of treatment (immunotherapy with intravenous Rituximab and corticosteroid), the MRI showed a marked regression of tumor masses.
Collapse
Affiliation(s)
| | - Vincenza Fetoni
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
| | - Pierluigi Baron
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
| | - Marcello Orsi
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
| | - Giancarlo Oliva
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
| |
Collapse
|
5
|
Antic D, Smiljanic M, Bila J, Jankovic S, Todorovic M, Andjelic B, Mihaljevic B. Hypothalamic dysfunction in a patient with primary lymphoma of the central nervous system. Neurol Sci 2011; 33:387-90. [PMID: 21822693 DOI: 10.1007/s10072-011-0726-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/19/2011] [Indexed: 10/17/2022]
Abstract
A 60-year-old woman with no previous history of chronic disease or malignancy presented with intense back and left leg pain and sleep disturbances. The patient had been treated unsuccessfully for the past 6 months with analgetics. Magnetic resonance imaging showed a soft tissue tumor in the L5-S1 region that involved the spinal canal, and a pathohistological analysis of the tumor specimen confirmed the presence of non-Hodgkin, diffuse large B cell lymphoma. After the diagnosis was confirmed, malaise, nausea, and vomiting developed. Multislice computed tomography of the endocranium showed focal infiltration of the hypothalamus and lateral ventricle; dissemination of a systemic lymphoma was excluded. Therapy was initiated as per the De Angelis protocol. After intravenous and intrathecal administration of metotrexate, the patient developed signs of central diabetes insipidus, which responded to therapy with an antidiuretic hormone analog. Despite the obvious infiltration of the hypothalamus, we cannot exclude an idiosyncratic effect of methotrexate on the central diabetes insipidus.
Collapse
Affiliation(s)
- Darko Antic
- Clinic for Hematology, Clinical Center Serbia, Koste Todorovica 2, 11000 Belgrade, Serbia.
| | | | | | | | | | | | | |
Collapse
|