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Handzic A, Barbosa-Brossard N, Margolin E. Primary Central Nervous System Lymphoma Presenting With Cauda Equina Syndrome and Bilateral Third Nerve Palsies. J Neuroophthalmol 2024; 44:e445-e446. [PMID: 39164903 DOI: 10.1097/wno.0000000000001858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Affiliation(s)
- Armin Handzic
- Faculty of Medicine (AH, NB-B, EM), Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; and Faculty of Medicine (EM), Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
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Raymond MJ, Ottinger A, Rowley MA, Bobian M, Dornhoffer J, Brennan E, Rizk HG. A Scoping Review of Otologic Manifestations of Hematologic Malignancies. Otol Neurotol 2024; 45:362-375. [PMID: 38437804 DOI: 10.1097/mao.0000000000004141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To examine the otologic and neurotologic symptoms, physical examination findings, and imaging features secondary to hematologic malignancies. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases, including PubMed, Scopus, and CINAHL, were searched for articles including patients with otologic manifestations of leukemia, lymphoma and multiple myeloma. Data collected included patient and study demographics, specific hematologic malignancy, timing and classification of otologic symptoms, physical examination findings, imaging features and methods of diagnosis. Pooled descriptive analysis was performed. RESULTS Two hundred seventy-two articles, of which 255 (93.8%) were case reports and 17 (6.2%) were case series, reporting on 553 patients were identified. Otologic manifestations were reported on 307 patients with leukemia, 204 patients with lymphoma and 42 patients with multiple myeloma. Hearing loss and unilateral facial palsy were the most common presenting symptoms for 111 reported subjects with leukemia (n = 46, 41.4%; n = 43, 38.7%) and 90 with lymphoma (n = 38, 42.2%; n = 39, 43.3%). Hearing loss and otalgia were the most common presenting symptoms for 21 subjects with multiple myeloma (n = 10, 47.6%; n = 6, 28.6%). Hearing loss and unilateral facial palsy were the most common otologic symptoms indicative of relapse in subjects with leukemia (n = 14, 43.8%) and lymphoma (n = 5, 50%). CONCLUSION Hearing loss, facial palsy, and otalgia might be the first indication of a new diagnosis or relapse of leukemia, lymphoma, or multiple myeloma. Clinicians should have a heightened level of suspicion of malignant etiologies of otologic symptoms in patients with current or medical histories of these malignancies.
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Affiliation(s)
| | - Allie Ottinger
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - M Andrew Rowley
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Michael Bobian
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jim Dornhoffer
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
| | | | - Habib G Rizk
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC
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Xu J, Li J, Sun YJ, Quan W, Liu L, Zhang QH, Qin YD, Pei XC, Su H, Chen JJ. CD20-positive subcutaneous panniculitis-like T-cell lymphoma presenting as polycranial neuropathy: A CARE-compliant case report and literature review. Medicine (Baltimore) 2022; 101:e30233. [PMID: 36107521 PMCID: PMC9439810 DOI: 10.1097/md.0000000000030233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Subcutaneous panniculitis-like T-cell lymphoma(SPTCL) is a very rare cytotoxic T-cell skin lymphoma involving subcutaneous tissue, and mainly affects young females. T-cell phenotype is characterized by CD3+, CD8+, and CD4-. SPTCT with polycranial neuropathy has rarely been described. SPTCL is believed to show an indolent clinical course unless patients develop haemophagocytic syndrome or sudden respiratory failure. Its treatment has not been established yet. CASE PRESENTATION We report a case of intractable SPTCT in a 66-year-old woman with multiple cranial nerve palsies and diabetes. She showed involvement of the bilateral facial nerve, left trigeminal nerve, left auditory nerve, and right oculomotor nerve. The single inconspicuous skin lesion in the trunk presented with an erythematous nodule with a diameter of <5 cm and a slightly pink infiltrated plaque. Electromyography revealed bilateral damage to the facial nerve. Differential immunohistochemical characteristics were observed. Immunohistochemistry demonstrated diffuse CD20 positivity. Cerebral spinal fluid analysis revealed elevated protein levels of 0.92 (0.15-0.45) g/L. Her condition regressed severely over time. She was treated with chemotherapy but died 10 months later, the probable cause of death was lung involvement. CONCLUSION The patient's involvement with the central nervous system may be associated with positivity for CD20. Molecular biomarkers may act as therapeutic targets for SPTCL.
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Affiliation(s)
- Jing Xu
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Jia Li
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Ya-juan Sun
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Wei Quan
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Li Liu
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Qing-hui Zhang
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Yi-dan Qin
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Xiao-chen Pei
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Hang Su
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
| | - Jia-Jun Chen
- Department of Neurology, China–Japan Union Hospital of Jilin University, Jilin, China
- *Correspondence: Jia-Jun Chen, Department of Neurology, China–Japan Union Hospital of Jilin University, No. 126 Xiantai Road, Erdao District, Changchun, Jilin 130033, China (e-mail: )
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Mocikova H, Pytlík R, Benesova K, Janikova A, Duras J, Sykorova A, Steinerova K, Prochazka V, Campr V, Belada D, Trneny M. Peripheral T-Cell Lymphomas Involving the Central Nervous System: A Report From the Czech Lymphoma Study Group Registry. Front Oncol 2022; 12:874462. [PMID: 35646641 PMCID: PMC9133472 DOI: 10.3389/fonc.2022.874462] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction We analyzed the incidence, risk factors of central nervous system (CNS) relapse, and outcome of CNS involvement in patients with peripheral T-cell lymphomas (PTCL) from the Czech Lymphoma Study Group Registry NiHiL (Clinical Trial gov. NCT03199066). Materials and Methods Out of 1,040 patients with PTCL, we identified 29 patients (2.79%) with CNS involvement: 2 patients with primary CNS T cell lymphoma, 11 patients with CNS and systemic disease at diagnosis, and 16 patients (1.54%) at CNS relapse. The most common histology with CNS disease was PTCL, not otherwise specified. Progression-free survival (PFS) was defined as the time interval from diagnosis to progression or death. PFS-2 was defined as the interval from the date of a new relapse until the next relapse. Results Patients with testicular involvement received intrathecal prophylaxis with methotrexate. High-dose methotrexate-based treatment was administered in 44.8% of patients with CNS disease. Median follow-up was 71.3 months. The difference between the median PFS of 1,027 patients without initial CNS disease (32.6 months) and 11 patients with initial CNS and systemic disease (4.8 months) was significant (p = 0.04). The difference between the median PFS2 in CNS relapses (10.1 months) and 493 relapses outside of CNS (9.1 months) was not significant (p = 0.6). Risk factors for CNS relapses included the following: involvement of more than one extranodal site (p = 0.008), soft tissue involvement (p = 0.003), testicular involvement (p = 0.046), and the presence of B symptoms (p = 0.035). The difference between the median OS of 1,027 patients without initial CNS disease (46.0 months) and 11 patients with initial CNS and systemic disease (18.2 months) was significant (p = 0.02). The median OS2 in CNS relapses was 11.8 months and that in relapses outside of CNS was 21.3 months. CNS involvement was not associated with a significantly worse OS compared to relapsed/refractory patients without CNS involvement (p = 0.1). Conclusions The incidence of CNS disease at the time of diagnosis and at relapse in PTCL is low and usually associated with other systemic involvement. The prognosis of PTCL with initial CNS involvement is significantly worse when compared to patients without CNS disease at diagnosis. The outcome of CNS relapse is comparable with relapsed PTCL outside of CNS. The optimal treatment is not defined yet.
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Affiliation(s)
- Heidi Mocikova
- Department of Internal Medicine - Hematology, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Robert Pytlík
- Institute of Haematology and Blood Transfusion, Prague, Czechia
| | - Katerina Benesova
- 1st Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czechia
| | - Andrea Janikova
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czechia
| | - Juraj Duras
- Department of Hemato-Oncology, University Hospital and Faculty of Medicine, Ostrava, Czechia
| | - Alice Sykorova
- 4th Department of Internal Medicine - Hematology, University Hospital and Faculty of Medicine, Hradec Kralove, Czechia
| | | | - Vit Prochazka
- Department of Haemato-Oncology, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czechia
| | - Vit Campr
- Institute of Pathology and Molecular Medicine, University Hospital Motol, Prague, Czechia
| | - David Belada
- 4th Department of Internal Medicine - Hematology, University Hospital and Faculty of Medicine, Hradec Kralove, Czechia
| | - Marek Trneny
- 1st Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czechia
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Zing N, Fischer T, Federico M, Chiattone C, Ferreri AJM. Diagnosis, prevention and treatment of central nervous system involvement in peripheral t-cell lymphomas. Crit Rev Oncol Hematol 2021; 167:103496. [PMID: 34653598 DOI: 10.1016/j.critrevonc.2021.103496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022] Open
Abstract
Non-Hodgkin lymphomas with T-cell immunophenotype encompass a heterogeneous group of infrequent neoplasms that follow variable clinical courses but prevalently include aggressive behavior and high mortality rates. The involvement of the central nervous system (CNS) is an uncommon event in T-cell lymphomas, with wide variability among the different disease entities. CNS can be affected either at initial diagnosis or at recurrence, and both forms are considered "secondary CNS T-cell lymphoma". Given the low incidence of secondary CNS T-cell lymphoma, related literature is sparse, contradictory, and primarily constituted by small case series and single case reports. However, reported studies uniformly suggest high mortality rates related to this event. Therefore, to improve our ability to identify high-risk patients and offer them successful CNS prophylaxis or timely and effective treatment once the event has occurred may prevent CNS-related T-cell lymphomas deaths. For example, some entities like aggressive adult T-cell leukemia/lymphoma, extranodal natural killer/T-cell lymphoma, and other peripheral T-cell lymphomas with involvement of two or more extranodal organs are prone to CNS dissemination and should be considered for personalized CNS prophylaxis. The level of evidence suggesting an increased risk of CNS recurrence for other T-cell lymphomas and for other risk factors is lower. Published case series show that, following the example of aggressive B-cell lymphomas, patients with T-cell lymphomas and putative increased CNS risk receive different forms of prophylaxis, mostly methotrexate and cytarabine delivered by intrathecal and/or intravenous routes, with varied success. To date, achievements in the treatment of CNS involvement in patients with aggressive B-cell lymphoma were not replicated in secondary CNS T-cell lymphomas, and identification of effective therapies remains an urgent research target. This review is focused on clinical findings, diagnosis, treatment, and prognosis of patients with T-cell lymphoma experiencing CNS dissemination either at presentation or relapse. It aims to provide logical and, oftentimes, evidence-based answers to the most common questions on the most probable risk factors to CNS involvement in patients with T-cell lymphoma, the indications and strategies to prevent this life-threating event, and the management of patients with CNS disease.
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Affiliation(s)
- Natalia Zing
- Departament of Onco-Hematology, Hospital Beneficência Portuguesa de São Paulo, Brazil; T-cell Brazil Project, Brazil
| | - Thais Fischer
- Hospital AC Camargo Cancer Center, Brazil; T-cell Brazil Project, Brazil
| | - Massimo Federico
- Medical Oncology, CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy; T-cell Brazil Project, Brazil
| | - Carlos Chiattone
- Hospital Samaritano de São Paulo, Brazil; T-cell Brazil Project, Brazil; Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil
| | - Andrés J M Ferreri
- Lymphoma Unit, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Seegobin K, Alhaj Moustafa M, Fischer D, Keller K, Hastings J, Kharfan‐Dabaja MA, Ayala E, Gupta V, Tun HW, Jiang L. Systemic ALK-positive anaplastic large cell lymphoma with bilateral optic neurolymphomatosis resulting in permanent blindness. Clin Case Rep 2020; 8:2629-2633. [PMID: 33363793 PMCID: PMC7752471 DOI: 10.1002/ccr3.3231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/20/2020] [Indexed: 11/11/2022] Open
Abstract
ALK-positive ALCL can lead to rapid irreversible destruction of the optic pathway. Early treatment should be instituted in patients with CNS involvement or those at increased CNS risk.
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Affiliation(s)
- Karan Seegobin
- Division of Haematology and Medical OncologyMayo ClinicJacksonvilleFlorida
| | | | - Deborah Fischer
- Division of Haematology and Medical OncologyMayo ClinicJacksonvilleFlorida
| | - Katelyn Keller
- Division of Haematology and Medical OncologyMayo ClinicJacksonvilleFlorida
| | - Jacquelyn Hastings
- Division of Haematology and Medical OncologyMayo ClinicJacksonvilleFlorida
| | | | - Ernesto Ayala
- Division of Haematology and Medical OncologyMayo ClinicJacksonvilleFlorida
| | - Vivek Gupta
- Department of RadiologyMayo ClinicJacksonvilleFlorida
| | - Han W. Tun
- Division of Haematology and Medical OncologyMayo ClinicJacksonvilleFlorida
| | - Liuyan Jiang
- Department of PathologyMayo ClinicJacksonvilleFlorida
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Pan Q, Luo Y. Recurrence of nasal type NK/T cell lymphoma presenting as neurolymphomatosis on 18F-FDG PET/CT: A case report and literature review. Medicine (Baltimore) 2020; 99:e18640. [PMID: 31895825 PMCID: PMC6946263 DOI: 10.1097/md.0000000000018640] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION NK/T cell lymphomas seldom involve the peripheral nervous system. We report a case of recurrent nasal type NK/T cell lymphoma presenting as neurolymphomatosis and its manifestation on F-FDG PET/CT. PATIENT CONCERNS A 55-year old man presented with a mass in the right nasal cavity was diagnosed with extranodal NK/T cell lymphoma, nasal type. F-FDG PET/CT showed intense FDG uptake within the mass. After radiotherapy the nasal tumor was completely relieved, but the patient experienced numbness and amyosthenia in the right upper extremity one week after completion of radiotherapy. DIAGNOSIS PET/CT showed intense FDG uptake in the brachial plexus, axillary, suprascapular and median nerves, suggestive of recurrence of lymphoma presenting as neurolymphomatosis. INTERVENTIONS After 1 cycle of chemotherapy, the follow-up PET/CT showed markedly reduced FDG uptake in the previous involved nerves, demonstrating a very good response of neurolymphomatosis to chemotherapy. OUTCOMES The patient finally had a progression free survival of 8 months after completion of 4 cycles of chemotherapy and autologous stem cell transplantation. LESSONS As neurolymphomatosis is a rare neurologic manifestation in recurrence of NK/T cell lymphoma, recognition of its presentation is important for prompt diagnosis and initiating treatment approach.
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Affiliation(s)
- Qingqing Pan
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine; Beijing, PR China
| | - Yaping Luo
- Department of Nuclear Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine; Beijing, PR China
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Li V, Jaunmuktane Z, Cwynarski K, Carr A. Diagnostic delay in a case of T-cell neurolymphomatosis. BMJ Case Rep 2019; 12:12/12/e232538. [PMID: 31888900 DOI: 10.1136/bcr-2019-232538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 69-year-old woman presented with severe subacute painful meningoradiculoneuritis. Neurophysiology showed a patchy, proximal axonal process with widespread denervation. Cerebrospinal fluid (CSF) was lymphocytic (normal T-cell predominant) with negative cytology. MRI revealed multiple sites of enhancement, but fluorodeoxyglucose positron emission tomography was negative. Bone marrow aspirate and trephine (BMAT) showed no evidence of a lymphoproliferative condition. Right brachial plexus biopsy demonstrated mixed T-cell/B-cell endoneurial inflammation not fulfilling criteria for vasculitis. She was stabilised with high-dose steroids and cyclophosphamide, followed by mycophenolate for inflammatory myeloradiculoneuritis. However, symptoms recurred when prednisolone was weaned. Although T-cell receptor gene analysis from the initial CSF demonstrated clonal rearrangements, it was only when the same clones were identified on two repeat BMATs and CSF that T-cell neurolymphomatosis, an exceedingly rare condition, was diagnosed. This case highlights the diagnostic challenge in peripheral neurolymphomatosis related to patchy disease, variable sensitivity and specificity of investigative tools, and the influence of therapies on traditional cytological definitions of lymphoma. The clinical picture, exhaustive exclusion of alternative causes and the persistence of an abnormal T-cell clone ultimately lead to a diagnostic consensus between specialist neurology and haematology clinicians.
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Affiliation(s)
- Vivien Li
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Zane Jaunmuktane
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aisling Carr
- Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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B-cell peripheral neurolymphomatosis: MRI and 18F-FDG PET/CT imaging characteristics. Skeletal Radiol 2019; 48:1043-1050. [PMID: 30666391 DOI: 10.1007/s00256-019-3145-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/27/2018] [Accepted: 01/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the MRI and 18F-FDG PET/CT imaging characteristics of peripheral neurolymphomatosis. MATERIALS AND METHODS All institutional cases of neurolymphomatosis with an MRI or 18F-FDG PET/CT from 2000 to 2017 were retrospectively reviewed. Included cases were biopsy-proven neurolymphomatosis or lymphoma patients with clinical and imaging evidence of neurolymphomatosis that resolved after chemotherapy. Multiple imaging parameters and clinical characteristics were recorded. RESULTS There were 27 cases of B-cell neurolymphomatosis in 25 patients (18 M, 7 F; mean age 64.6 ± 10.0 years). Of the total cases, 85% (23/27) were biopsy-proven. Most were diagnosed after disease progression or recurrence (20/27, 74%), and presented with isolated nerve involvement (18/27, 67%). Bone marrow biopsy (17/19, 89%) and CSF cytology (16/23, 70%) were usually negative. On 18F-FDG PET/CT, neurolymphomatosis presented as a linear or fusiform (23/26, 88%), FDG-avid (average SUVmax: 7.1 ± 4.5, range, 1.5-17.0) mass, and on MRI as a T2-weighted hyperintense (21/22, 95%), enhancing (21/22, 95%), linear or fusiform mass (19/22, 86%), with associated muscle denervation (14/22, 64%). FDG avidity was significantly higher in patients with muscular denervation on MRI (mean SUVmax 8.2 ± 4.6 vs. 4.3 ± 2.3, p = 0.04). CONCLUSIONS B-cell neurolymphomatosis most commonly manifests as T2-weighted hyperintense, enhancing linear or fusiform neural enlargement associated with muscular denervation on MRI, with intense FDG activity on PET/CT. It is most often an isolated site of disease, presenting after progression or recurrence. A familiarity with the imaging appearance of neurolymphomatosis can help refine the differential diagnosis, direct biopsy, and aid in accurate diagnosis.
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Abstract
We report a case of a primary malignant lymphoma of the trigeminal nerve that was associated with facial pain. A 65-year-old man was examined at another hospital for unilateral facial pain. Carbamazepine was prescribed, but his symptoms did not improve. Magnetic resonance imaging (MRI) revealed swelling of the trigeminal nerve and a mass lesion in Meckel's cave. The patient was referred to our hospital at this point. Gadolinium-enhanced MRI and F18-Fluorodeoxyglucose-position emission tomography suggested a likely malignant tumour and a biopsy was performed. Histopathological examination showed diffuse a large B cell lymphoma. The patient was treated with high-dose methotrexate (HD-MTX) and radiotherapy. Despite responding well to initial treatment, the patient relapsed, with lymphoma observed throughout the body. He died of pneumonia 18 months after the initial diagnosis. Facial pain is a symptom that is commonly managed in general practice. If symptoms do not improve, repeated imaging studies, including contrast MRI, is warranted. This is the first reported case of primary neurolymphomatosis (NL) of the trigeminal nerve associated with facial pain alone. Furthermore, HD-MTX and radiotherapy may be considered for the management of primary NL of a cranial nerve.
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Affiliation(s)
- Hirotaka Sato
- Department of Neurosurgery, Asahikawa Medical University, Hokkaido, Japan
| | - Satoru Hiroshima
- Department of Neurosurgery, Asahikawa Medical University, Hokkaido, Japan
| | - Ryogo Anei
- Department of Neurosurgery, Asahikawa Medical University, Hokkaido, Japan
| | - Kyousuke Kamada
- Department of Neurosurgery, Asahikawa Medical University, Hokkaido, Japan
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Spinal primary central nervous system lymphoma: Case report and literature review. J Clin Neurosci 2018; 50:16-19. [DOI: 10.1016/j.jocn.2018.01.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/08/2018] [Indexed: 12/30/2022]
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Haydaroglu Sahin H, Mete A, Pehlivan M. Neurolymphomatosis in non-Hodgkin lymphoma with cranial multineuritis: A case report. Medicine (Baltimore) 2018; 97:e0303. [PMID: 29642156 PMCID: PMC5908615 DOI: 10.1097/md.0000000000010303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Neurolymphomatosis (NL) is a rare syndrome of lymphoma and leukemic infiltration of cranial or peripheral nerves. PATIENT CONCERNS We report a case of non-Hodgkin Lymphoma (NHL) in a 24-year-old man presented with difficulty in swallowing, hypersalivation, hoarseness, ptosis, facial paralysis, and facial hypoesthesia associated with NL. DIAGNOSIS NL was diagnosed based upon cranial magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination. INTERVENTIONS The patient was treated with intrathecal methotreaxate (12.5 mg) and cytosine arabinoside (70 mg), systemic high-dose methotrexate therapy, and cranial radiotherapy. OUTCOME Due to the deterioration of general condition of the patient, he was admitted to intensive care unit, but died 22 days after the onset of symptoms in spite of aggressive treatment. LESSONS In this case, we present a patient with T cell lymphoma and multineuritis of NL diagnosed by MRI and as far as we know, this is the first reported case in which so many cranial nerves (3, 5, 7, 8, 9, and 10 th) were involved. Briefly, in a patient with hematologic malignancy and neurological complaints, NL should be considered. Early and effective use of imaging modalities such as positron emission tomography (PET-CT), MRI, and aggressive therapies are important for prolonged survival.
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Affiliation(s)
| | - Ahmet Mete
- Department of Radiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Splavski B, Muzevic D, Ladenhauser-Palijan T, Splavski B. Primary Central Nervous System Anaplastic Large T-cell Lymphoma. Med Arch 2018; 70:311-313. [PMID: 27703297 PMCID: PMC5034991 DOI: 10.5455/medarh.2016.70.311-313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 07/15/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Primary central nervous system lymphoma (PCNSL) of T-cell origin is an exceptionally rare, highly malignant intracranial neoplasm. Although such a tumor typically presents with a focal mass lesion. CASE REPORT Past medical history of a 26-year-old male patient with a PCNS lymphoma of T-cell origin was not suggestive of intracranial pathology or any disorder of other organs and organic systems. To achieve a gross total tumor resection, surgery was performed via osteoplastic craniotomy using the left frontal transcortical transventricular approach. Histological and immunohistochemical analyses of the tissue removed described tumor as anaplastic large cell lymphoma of T-cells (T-ALCL). Postoperative and neurological recovery was complete, while control imaging of the brain showed no signs of residual tumor at a six-month follow-up. The patient, who did not appear immunocompromized, was referred to a hematologist and an oncologist where corticosteroids, the particular chemotherapeutic protocol and irradiation therapy were applied. CONCLUSION Since PCNS lymphoma is a potentially curable brain tumor, we believe that proper selection of the management options, including early radical tumor resection for solitary PCNS lymphoma, may be proposed as a major treatment of such a tumor in selected patients, resulting in a satisfactory outcome.
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Affiliation(s)
- Bruno Splavski
- Department of Neurosurgery, "J. J. Strossmayer" University of Osijek School of Medicine, Osijek, Croatia
| | - Dario Muzevic
- Department of Neurosurgery, "J. J. Strossmayer" University of Osijek School of Medicine, Osijek, Croatia
| | - Tatjana Ladenhauser-Palijan
- Division of Hematology, Department of Internal Medicine, "J. J. Strossmayer" University of Osijek School of Medicine, Osijek, Croatia
| | - Brano Splavski
- Division of Ophthalmology, Osijek Clinical Hospital Center, Osijek, Croatia
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Asanome A, Kano K, Takahashi K, Saito T, Sawada J, Katayama T. [A case of neurolymphomatosis that was diagnosed by acoustic nerve biopsy]. Rinsho Shinkeigaku 2018; 58:93-99. [PMID: 29386492 DOI: 10.5692/clinicalneurol.cn-001080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 58-year-old female was admitted to our hospital because of recurrent multiple cranial neuropathy (right facial palsy followed by involvement of the left trigeminal, facial, acoustic, pharyngeal, and vagal nerves and the right abducens nerve). Brain MRI showed gadolinium enhancement of the right abducens, bilateral facial/acoustic, and left pharyngeal/vagal nerves, and 18F-Fluorodeoxyglucose (FDG)-positron emission tomography revealed abnormal FDG uptake in the right facial, acoustic, pharyngeal, and vagal nerves and the left cervical lymph nodes. Blood and biochemical analyses did not show any abnormalities, including in the patient's lactate dehydrogenase and soluble interleukin-2 receptor (sIL2R) levels. A cerebrospinal fluid (CSF) examination showed gradual increases in the patient's cell counts and protein, β2-microglobulin, and sIL2R levels, but no malignant cells were detected. A thorough investigation involving repeated CSF examinations, whole-body computed tomography, bone marrow aspiration, random skin biopsies, and cervical lymph node aspiration biopsy examinations did not result in any definitive conclusions. Steroid therapy was ineffective, and the patient developed deafness in her left ear. Therefore, we performed a biopsy examination of the left acoustic nerve, which resulted in the patient being diagnosed with diffuse large B-cell lymphoma. High-dose MTX following the intrathecal administration of MTX, cytarabine, and prednisolone partially improved her symptoms, but she died after several episodes of clinical recurrence. Acoustic nerve biopsy may help diagnose neurolymphomatosis in carefully selected cases.
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Affiliation(s)
- Asuka Asanome
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University.,Asahikawa Rehabilitation Hospital
| | - Kohei Kano
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University
| | - Kae Takahashi
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University
| | - Tsukasa Saito
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University
| | - Jun Sawada
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University
| | - Takayuki Katayama
- Division of Neurology, First Department of Internal Medicine, Asahikawa Medical University
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Jiménez de la Peña MDM, Vicente LG, Alonso RC, Cabero SF, Suárez AM, de Vega VM. The Multiple Faces of Nervous System Lymphoma. Atypical Magnetic Resonance Imaging Features and Contribution of the Advanced Imaging. Curr Probl Diagn Radiol 2017; 46:136-145. [DOI: 10.1067/j.cpradiol.2016.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/25/2016] [Indexed: 11/22/2022]
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17
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Primary CNS T-cell Lymphomas: A Clinical, Morphologic, Immunophenotypic, and Molecular Analysis. Am J Surg Pathol 2016; 39:1719-1729. [PMID: 26379152 DOI: 10.1097/pas.0000000000000503] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary central nervous system (CNS) lymphomas are relatively rare with the most common subtype being diffuse large B-cell lymphoma. Primary CNS T-cell lymphomas (PCNSTL) account for <5% of CNS lymphomas. We report the clinical, morphologic, immunophenotypic, and molecular characteristics of 18 PCNSTLs. Fifteen cases were classified as peripheral T-cell lymphoma, not otherwise specified, 2 of which were of γδ T-cell derivation and 1 was TCR silent; there was 1 anaplastic large cell lymphoma, ALK-positive and 2 anaplastic large cell lymphoma, ALK-negative. Median age was 58.5 years (range, 21 to 81 y), with an M:F ratio of 11:7. Imaging results showed that 15 patients had supratentorial lesions. Regardless of subtype, necrosis and perivascular cuffing of tumor cells were frequently observed (11/18 cases). CD3 was positive in all cases but 1; 10/17 were CD8-positive, and 5/17 were CD4-positive. Most cases studied had a cytotoxic phenotype with expression of TIA1 (13/15) and granzyme-B (9/13). Polymerase chain reaction analysis of T-cell receptor γ rearrangement confirmed a T-cell clone in 14 cases with adequate DNA quality. Next-generation sequencing showed somatic mutations in 36% of cases studied; 2 had >1 mutation, and none showed overlapping mutations. These included mutations in DNMT3A, KRAS, JAK3, STAT3, STAT5B, GNB1, and TET2 genes, genes implicated previously in other T-cell neoplasms. The outcome was heterogenous; 2 patients are alive without disease, 4 are alive with disease, and 6 died of disease. In conclusion, PCNSTLs are histologically and genomically heterogenous with frequent phenotypic aberrancy and a cytotoxic phenotype in most cases.
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Grisold W, Grisold A, Marosi C, Meng S, Briani C. Neuropathies associated with lymphoma †. Neurooncol Pract 2015; 2:167-178. [PMID: 31386037 DOI: 10.1093/nop/npv025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Indexed: 12/12/2022] Open
Abstract
Neuropathy occurs with various manifestations as a consequence of lymphoma, and an understanding of the etiology is necessary for proper treatment. Advances in medical imaging have improved the detection of peripheral nerve involvement in lymphoma, yet tissue diagnosis is often equally important. The neoplastic involvement of the peripheral nervous system (PNS) in lymphoma can occur within the cerebrospinal fluid (CSF), inside the dura, or outside of the CSF space, affecting nerve root plexuses and peripheral nerves. The infiltration of either cranial or peripheral nerves in lymphoma is termed neurolymphomatosis (NL). These infiltrations can occur as mononeuropathy, multifocal neuropathy, symmetric neuropathies, or plexopathies. In rare cases, intravascular lymphoma (IL) can affect the PNS and an even rarer condition is the combination of NL and IL. Immune-mediated and paraneoplastic neuropathies are important considerations when treating patients with lymphoma. Demyelinating neuropathies, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy, occur more frequently in non-Hodgkin's lymphoma than in Hodgkin's disease. Paraproteinemic neuropathies can be associated with lymphoma and paraneoplastic neuropathies are rare. While the treatment of lymphomas has improved, a knowledge of neurotoxic, radiotherapy, neoplastic, immune-mediated and paraneoplastic effects are important for patient care.
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Affiliation(s)
- Wolfgang Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Anna Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Christine Marosi
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Stefan Meng
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
| | - Chiara Briani
- Department of Neurology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (W.G.); Department of Neurology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (A.G.); Department of Oncology, Medical University of Vienna, Waehringer Gürtel 18-20, Vienna 1090, Austria (C.M.); Department of Radiology, Kaiser Franz Josef Hospital, Kundratstraße 3, Vienna 1100, Austria (S.M.); Department of Neurosciences, University of Padova, Via Giustiniani, 5, Padova 35128, Italy (C.B.)
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Mazur MD, Ravindra VM, Alashari M, Raetz E, Poppe MM, Bollo RJ. Primary T cell central nervous system lymphoblastic lymphoma in a child: case report and literature review. Childs Nerv Syst 2015; 31:977-84. [PMID: 25681952 DOI: 10.1007/s00381-015-2633-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/03/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) of T cell origin is rare in pediatric patients. We report a case of T cell PCNSL in a 12-year-old boy and review the literature to highlight the importance of brain biopsy to definitively establish the diagnosis when PCNSL is suspected. CASE REPORT A 12-year-old boy presented with worsening left-sided weakness, nausea, vomiting, headache, blurred vision, and diplopia. Magnetic resonance imaging revealed right parietal gyral thickening with faint meningeal contrast enhancement. No clear diagnosis was identified after serum testing, cerebrospinal fluid analysis, and cerebral angiography. To establish the diagnosis definitively, a right craniotomy and open, frameless stereotactic biopsy were performed, which yielded the diagnosis of lymphoblastic T cell lymphoma. CONCLUSIONS PCNSL of T cell origin in children remains poorly studied, with only 18 detailed cases reported over the last three decades, including this case. Establishing a definitive diagnosis of PCNSL is challenging, and a brain biopsy is often required to obtain enough tissue for pathological analysis. Increasing awareness and identification of children diagnosed with T cell PCNSL is needed to better understand the molecular biology of this disease and develop more standardized treatment regimens.
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Affiliation(s)
- Marcus D Mazur
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Primary Children's Hospital, University of Utah, 100 North Mario Capecchi Drive, Suite 1475, Salt Lake City, UT, 84113-1100, USA
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20
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Guzzetta M, Drexler S, Buonocore B, Donovan V. Primary CNS T-Cell Lymphoma of the Spinal Cord: Case Report and Literature Review. Lab Med 2015; 46:159-63. [DOI: 10.1309/lm85gpxdt8njsdab] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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21
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Sakai N, Ito-Yamashita T, Takahashi G, Baba S, Koizumi S, Yamasaki T, Tokuyama T, Namba H. Primary neurolymphomatosis of the lower cranial nerves presenting as Dysphagia and hoarseness: a case report. J Neurol Surg Rep 2014; 75:e62-6. [PMID: 25083392 PMCID: PMC4110151 DOI: 10.1055/s-0033-1363505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 11/03/2013] [Indexed: 11/13/2022] Open
Abstract
Primary neurolymphomatosis is an extremely rare tumor. We report the case of a 74-year-old patient presenting with dysphagia and hoarseness. Initial contrast-enhanced computed tomography of the head, neck, and chest did not reveal any lesions. His symptoms improved with short-term administration of prednisone but recurred and deteriorated. Magnetic resonance (MR) imaging revealed a tumor along the ninth and tenth cranial nerves across the jugular foramen. Fluorine-18 fluorodeoxyglucose positron emission tomography indicated this was a primary tumor. Repeated MR imaging after 2 months revealed considerable tumor enlargement. A left suboccipital craniotomy was performed to remove the tumor that infiltrated the ninth and tenth cranial nerves. The histopathologic diagnosis was diffuse large B-cell lymphoma. Although focal radiation therapy was administered to ensure complete eradication of the tumor, the patient died of aspiration pneumonia with systemic metastasis. To our knowledge, this is the first reported case of primary neurolymphomatosis in the lower cranial nerves.
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Affiliation(s)
- Naoto Sakai
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Tae Ito-Yamashita
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Goro Takahashi
- Department of Otolaryngology, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Satoshi Baba
- Department of Diagnostic Pathology, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Shinichiro Koizumi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Tomohiro Yamasaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Tsutomu Tokuyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
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22
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Deivaraju C, Inzunza JF, Hammel N, Conway SA. Isolated Recurrence of Diffuse Large B-Cell Lymphoma in Sciatic Nerve. World J Oncol 2014; 5:126-128. [PMID: 29147390 PMCID: PMC5649815 DOI: 10.14740/wjon736w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2014] [Indexed: 11/11/2022] Open
Abstract
Sciatica is a common clinical presentation with a number of etiological factors. Many of them are innocuous like prolapsed intervertebral disc or peripheral compression in the sciatic nerve. Occasionally the cause could be of a more serious nature like a nerve sheath tumor or more infrequently, lymphomatosis. We describe recurrent lymphoma in a patient who had been in remission presented with sciatica as result of the involvement of the nerve with metastatic tumor.
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23
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Matias-Guiu JA, Rodríguez-Gómez O, Plaza JC, Marcos-Dolado A, Porta-Etessam J. Cerebral venocclusive disease due to CNS T cell lymphoma. Neurol Sci 2014; 35:947-9. [PMID: 24554418 DOI: 10.1007/s10072-014-1684-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 02/11/2014] [Indexed: 11/25/2022]
Affiliation(s)
- J A Matias-Guiu
- Service of Neurology, Hospital Clinico San Carlos, 28040, Madrid, Spain,
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24
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AlQahtani A, Touitou V, Cassoux N, Aknin C, Merle-Beral H, Bodaghi B, LeHoang P. More than a masquerade syndrome: atypical presentations of vitreoretinal lymphomas. Ocul Immunol Inflamm 2014; 22:189-96. [PMID: 24475870 DOI: 10.3109/09273948.2013.835427] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To present a population of patients sharing atypical manifestations of vitreoretinal lymphoma (VRL). METHODS Institutional case series in a single tertiary center. Patients with cytologically proven VRL, referred between November 2009 and May 2010, were retrospectively reviewed. Diagnosis of VRL was based on cytology of vitreous samples, immunohistochemistry, and molecular biology. Patients with confirmed VRL and clinical features different from the typical manifestations were included. Demographical and clinical characteristics of these patients were studied. RESULTS Twelve cases of VRL were diagnosed. Four cases (2M/2F) were considered atypical (A-VRL) in their presentations. Mean age for typical lymphoma (T-VRL) was 71.9 years (range: 62-87 years); mean age for A-VRL was 54 years (range: 50-59 years). CONCLUSIONS Diagnosis of VRL is challenging and diagnostic delay is frequent. The authors describe a series of patients sharing common characteristics, such as a younger age (p = 0.05), severe anterior chamber reaction, mild or no vitritis, and possible fulminant evolution.
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25
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Rupp A, Ives E, Rudorf H, Constantino‐Casas F. Sciatic T‐cell neurolymphomatosis in a dog. VETERINARY RECORD CASE REPORTS 2014. [DOI: 10.1136/vetreccr-2014-000050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Angie Rupp
- Department of Veterinary MedicineUniversity of CambridgeCambridgeUK
| | - Edward Ives
- Department of Veterinary MedicineUniversity of CambridgeCambridgeUK
| | - Heike Rudorf
- Department of Veterinary MedicineUniversity of CambridgeCambridgeUK
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26
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Taylor JW, Flanagan EP, O'Neill BP, Siegal T, Omuro A, Deangelis L, Baehring J, Nishikawa R, Pinto F, Chamberlain M, Hoang-Xuan K, Gonzalez-Aguilar A, Batchelor T, Blay JY, Korfel A, Betensky RA, Lopes MBS, Schiff D. Primary leptomeningeal lymphoma: International Primary CNS Lymphoma Collaborative Group report. Neurology 2013; 81:1690-6. [PMID: 24107866 DOI: 10.1212/01.wnl.0000435302.02895.f3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate clinical presentation, optimal diagnostic evaluation and treatment, and outcome in primary leptomeningeal lymphoma, a rare form of primary CNS lymphoma without parenchymal or systemic involvement. METHODS The International Primary CNS Lymphoma Collaborative Group, a multidisciplinary group of physicians with a particular interest in primary CNS lymphoma, retrospectively identified cases of lymphoma isolated to the leptomeninges as diagnosed by CSF cytology, flow cytometry, or biopsy, without systemic or parenchymal brain/spinal cord lymphoma or immunodeficiency. RESULTS Forty-eight patients were identified, with median age at diagnosis of 51 years and median Eastern Cooperative Oncology Group performance status of 2. Presenting symptoms were multifocal in 68%. Leptomeningeal enhancement was seen in 74% and CSF profile was abnormal in all cases. CSF cytology detected malignant lymphocytes in 67%. Flow cytometry identified monoclonal population in 80%, as did receptor gene rearrangement studies in 71%. Sixty-two percent had B-cell lymphoma, 19% T-cell, and 19% unclassified. Treatment varied and included fractionated radiotherapy (36%), systemic chemotherapy (78%), and intra-CSF chemotherapy (66%), with 66% receiving ≥ 2 modalities. Seventy-one percent had a favorable clinical response; ultimately, 44% received salvage treatment. Median overall survival was 24 months, with 11 patients still alive at 50 months follow-up. CONCLUSION Primary leptomeningeal lymphoma is a rare form of primary CNS lymphoma. Patients usually present with multifocal symptoms, with evidence of leptomeningeal enhancement and diagnostic CSF analysis. Although treatment is highly variable, patients have a better prognosis than previously reported and a subset may be cured.
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Affiliation(s)
- Jennie W Taylor
- From the Massachusetts General Hospital (J.W.T., T.B., R.A.B.), Boston; Mayo Clinic (E.P.F., B.P.O.), Rochester, MN; Hadassah Hebrew University Medical Center (T.S.), Jerusalem, Israel; Memorial Sloan-Kettering (A.O., L.D.), New York, NY; Yale University (J.B.), New Haven, CT; Saitama Medical University (R.N.), Japan; Kings College Hospital (F.P.), London, UK; University of Washington (M.C.), Seattle; LOC National Expert Center (K.H.-X., A.G.-A.), APHP, UPMC, Pitie-Salpetriere, Paris; Centre Leon Berard (J.-Y.B.), Lyon, France; Campus Benjamin Franklin (A.K.), Charite Universitätsmedizin Berlin, Germany; Department of Biostatistics (R.A.B.), Harvard School of Public Health, Boston, MA; and University of Virginia (M.-B.S.L., D.S.), Charlottesville
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27
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Ahmed RM, Halmagyi GM. Malignant meningitis presenting as pseudotumor cerebri. J Neurol Sci 2013; 329:62-5. [PMID: 23578793 DOI: 10.1016/j.jns.2013.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/06/2013] [Accepted: 03/14/2013] [Indexed: 11/30/2022]
Abstract
Malignant leptomeningitis can present as the clinical syndrome of pseudotumor cerebri due to infiltration of arachnoid villi in the superior sagittal sinus. We show that malignant pachymeningitis can also present with pseudotumor cerebri, likely due to cerebral venous hypertension from transverse sinus compression. We present 3 cases of pseudotumor cerebri due to pachymeningeal or leptomeningeal metastases and discuss the mechanism of intracranial hypertension in such cases, its diagnosis and treatment.
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Affiliation(s)
- R M Ahmed
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.
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28
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Gheorghe G, Radu O, Milanovich S, Hamilton RL, Jaffe R, Southern JF, Ozolek JA. Pathology of central nervous system posttransplant lymphoproliferative disorders: lessons from pediatric autopsies. Pediatr Dev Pathol 2013; 16:67-73. [PMID: 23286282 DOI: 10.2350/12-01-1148-oa.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Posttransplant lymphoproliferative disorders (PTLD) involving the central nervous system (CNS) in children are uncommon and can prove diagnostically challenging. The clinical and imaging characteristics of CNS PTLD can overlap with those of infection, hemorrhage, and primary CNS tumors. Some cases of CNS PTLD remain clinically unsuspected and are diagnosed postmortem. We report 6 instances of CNS PTLD in children, 2 of which were limited to the CNS and were unsuspected before autopsy. In our autopsy series, PTLD was found outside the CNS in 4 out of 6 cases. Since CNS PTLD has a poor prognosis and the presentation can be subtle, unsuspected, and high grade, it is important to maintain a high index of suspicion and to perform imaging and brain biopsy whenever clinically appropriate. In the presence of leptomeningeal involvement, the diagnosis could be made by cerebral spinal fluid examination.
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Affiliation(s)
- Gabriela Gheorghe
- Department of Pathology, Children's Hospital of Wisconsin, Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Shah AK, Smith SM, Lukas RV. Rapid neurologic decline in a patient with peripheral T-cell lymphoma: a case of leptomeningeal lymphomatosis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2012; 13:70-2. [PMID: 22995951 DOI: 10.1016/j.clml.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 06/15/2012] [Accepted: 07/26/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Anishee K Shah
- Department of Neurology, Cedars-Sinai Medical Center, West Hollywood, CA, USA
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30
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Mandrioli L, Morini M, Biserni R, Gentilini F, Turba ME. A case of feline neurolymphomatosis: pathological and molecular investigations. J Vet Diagn Invest 2012; 24:1083-6. [PMID: 22964430 DOI: 10.1177/1040638712460674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Neurolymphomatosis is a very rare form of nervous system infiltration by lymphoma that can affect cranial and peripheral nerves and spinal nerve roots. The clinical appearance can mimic autoimmune or paraneoplastic neuropathies. To date, only 2 cases of neurolymphomatosis have been reported in the veterinary literature (1 dog and 1 cat). A case of neurolymphomatosis in a 5-year-old female Domestic Shorthair cat is reported. Two, whitish, bosselated, non-symmetric masses (1 cm × 1.2 cm × 0.5 cm) that incorporated almost all cranial nerves and semilunar ganglia occupying the basisphenoid depression were histologically composed of a proliferation of monomorphic lymphocytes. These lymphoid cells were positive for CD3 (T-cell lymphoma). Nested polymerase chain reaction detected feline leukemia provirus. Fragment analysis of feline T-cell receptor (TCR) gene rearrangements evidenced an oligoclonal pattern with few peaks of similar height. The integration of pathologic with biomolecular findings adds to the information concerning the role of Feline leukemia virus on TCRγ rearrangements in cases of feline lymphoma.
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Affiliation(s)
- Luciana Mandrioli
- Department of Veterinary Medical Science, Alma Mater Studiorum University of Bologna, Bologna, Italy.
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Vecchio D, Mittino D, Terazzi E, Nassi L, Luca N, Conconi A, Monaco F. A case of cranial multinevritis: from the onset to the diagnosis of primary neurolymphomatosis. BMJ Case Rep 2012; 2012:bcr.06.2011.4299. [PMID: 22707692 DOI: 10.1136/bcr.06.2011.4299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Neurolymphomatosis (NL) is a rare peripheral or cranial neuropathy caused by non-Hodgkin's lymphoma (NHL). Diagnosis is often delayed and prognosis is poor. The authors described a woman in her 70s with a facial left peripheral palsy, complete right abducent palsy, left hypoacusia and balance deficit. Then she presented with low progressive hyposthenia at four limbs and cognitive impairment, sudden facial right peripheral palsy and complete left abducent palsy. The authors performed brain and spinal MRI, cerebrospinal fluid (CSF) analysis and extensive haematological examinations for infections, autoimmune and neoplastic diseases. All the results were not diagnostic. Only repeating for the third time a spinal tap, CSF presented neoplastic B cells suggestive for large B-NHL. The authors diagnosed primary NL. The patient was treated with R-CHOP but she died 2 months later. In front of rapidly progressive neuropathy, a NL has to be considered performing different examinations, especially and repeating them after a short period.
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Affiliation(s)
- Domizia Vecchio
- Neurological Clinic, University of Eastern Piedmont and ‘Maggiore della Carità’ Hospital, Novara, Italy
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33
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Primary brain T-cell lymphoma in an HTLV-1 serologically positive male. J Neurol Sci 2011; 314:163-5. [PMID: 22118868 DOI: 10.1016/j.jns.2011.10.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 09/16/2011] [Accepted: 10/21/2011] [Indexed: 11/24/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is a subgroup of extranodal non-Hodgkin lymphoma usually due to B-cells. The incidence of T-cell PCNSL is 1-4% in Western countries. Human T-lymphotropic virus (HTLV-1) causes tropical spastic paraparesis/myelopathy and adult T-cell leukemia/lymphoma. We describe the extremely rare occurrence of T-cell PCNSL in a 29 year old HTLV-1 carrier. Additional unusual features of the case included the patient's young age and normal cerebrospinal fluid cytological findings, without leptomeningeal spread. Given the long latency between HTLV-1 infection and disease manifestation, more such cases may be diagnosed in the future. We recommend that every patient with T-cell PCNSL be screened for HTLV-1.
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Ahluwalia MS, Wallace PK, Peereboom DM. Flow cytometry as a diagnostic tool in lymphomatous or leukemic meningitis. Cancer 2011; 118:1747-53. [DOI: 10.1002/cncr.26335] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 05/19/2011] [Accepted: 05/19/2011] [Indexed: 11/08/2022]
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Tang Y, Booth T, Bhogal P, Malhotra A, Wilhelm T. Imaging of primary central nervous system lymphoma. Clin Radiol 2011; 66:768-77. [DOI: 10.1016/j.crad.2011.03.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/01/2011] [Accepted: 03/08/2011] [Indexed: 11/26/2022]
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Multiple radiculopathy as the presenting manifestation of primary spinal leptomeningeal B cell lymphoma detected by flow cytometry of cerebrospinal fluid. Neurol Sci 2011; 32:1171-4. [PMID: 21567181 DOI: 10.1007/s10072-011-0613-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 04/28/2011] [Indexed: 10/18/2022]
Abstract
Primary leptomeningeal lymphoma is a rare syndrome characterized by lymphomatous meningeal infiltration without identification of systemic lymphoma or parenchymal central nervous system lymphoma. We report a case of a 62-year-old immunocompetent woman with primary spinal leptomeningeal lymphoma presenting as cervical and lumbar radiculopathy who is rare because of particularly unusual onset site of B cell lymphoma. Interestingly, the diagnosis was possible only by cerebrospinal fluid flow cytometry.
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F-18 FDG PET/CT for detection of malignant involvement of peripheral nerves: case series and literature review. Clin Nucl Med 2011; 36:96-100. [PMID: 21220969 DOI: 10.1097/rlu.0b013e318203bb0e] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the role of positron emission tomography plus computed tomography (PET/CT) scans in detecting malignant involvement of the peripheral nerves (PNs). MATERIAL AND METHODS We retrospectively reviewed medical records of all PET/CT studies performed at The University of Texas MD Anderson Cancer Center between 2003 and 2009, and selected patients in whom F-18 fluorodeoxyglucose (FDG) PET/CT findings were suspicious for malignant involvement of the PNs. We identified 26 cases of suspected tumorous involvement of the PNs that was subsequently confirmed by either biopsy or clinical follow-up. We evaluated the value of PET/CT in diagnosing malignant involvement of the PNs. RESULTS Of the 26 patients, 12 had lymphoma, 10 had breast cancer, 2 had lung cancer, 1 had colon cancer, and 1 had melanoma. In 21 patients, magnetic resonance imaging (MRI) was performed, either for follow-up of the PET/CT finding or to find an explanation for symptoms. MRI confirmed the presence of disease in only 9 patients, was interpreted as normal in 7 patients, and was inconclusive in 5 patients. FDG PET/CT was able to differentiate an active tumor from post-treatment fibrosis and could assess response to therapy with a high degree of confidence. CONCLUSIONS Our results indicate that FDG PET/CT is helpful in diagnosing malignant involvement of the PNs, especially when findings from anatomic imaging (MRI or CT) are negative. In cases of known treated malignancy involving the PNs, follow-up by PET/CT has the advantage of high sensitivity for local recurrence.
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Abstract
Neurolymphomatosis (NL) is a rare clinical entity. The International Primary CNS Lymphoma Collaborative Group retrospectively analyzed 50 patients assembled from 12 centers in 5 countries over a 16-year period. NL was related to non-Hodgkin lymphoma in 90% and to acute leukemia in 10%. It occurred as the initial manifestation of malignancy in 26% of cases. The affected neural structures included peripheral nerves (60%), spinal nerve roots (48%), cranial nerves (46%), and plexus (40%) with multiple site involvement in 58%. Imaging studies often suggested the diagnosis with 77% positive magnetic resonance imaging, and 84% (16 of 19) positive computed tomography-positron emission tomography studies. Cerebrospinal fluid cytology was positive in 40%, and nerve biopsy confirmed the diagnosis in 23 of 26 (88%). Treatment in 47 patients included systemic chemotherapy (70%), intra-cerebrospinal fluid chemotherapy (49%), and radiotherapy (34%). Response to treatment was observed in 46%. The median overall survival was 10 months, with 12- and 36-month survival proportions of 46% and 24%, respectively. NL is a challenging diagnosis, but contemporary imaging techniques frequently detect the relevant neural invasion. An aggressive multimodality therapy can prevent neurologic deterioration and is associated with a prolonged survival in a subset of patients.
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Galloway M, Thom M. Brain and cerebrospinal fluid. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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