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Tosefsky K, Rebchuk AD, Martin KC, Chen DW, Yip S, Makarenko S. Preoperative Corticosteroids Reduce Diagnostic Accuracy of Stereotactic Biopsies in Primary Central Nervous System Lymphoma: A Systematic Review and Meta-Analysis. Neurosurgery 2024:00006123-990000000-01141. [PMID: 38865324 DOI: 10.1227/neu.0000000000002944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/12/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite general acceptance that corticosteroid therapy (CST) should be withheld before biopsy for suspected primary central nervous system lymphoma (PCNSL), there remains conflicting evidence surrounding the precise impact of preoperative CST on the histopathological diagnosis. The objective of this systematic review and meta-analysis was to describe and quantify the effects of preoperative CST on the diagnostic accuracy of biopsies for PCNSL. METHODS Primary articles were screened from Ovid MEDLINE, Embase, Web of Science, and Scopus databases. Meta-analysis was performed for immunocompetent patients with histologically confirmed PCNSL. Subgroup and regression analyses were performed to assess the effects of biopsy type, CST duration, dose, and preoperative taper on the diagnostic accuracy. In addition, the sensitivity of cerebrospinal fluid (CSF) analyses for PCNSL was assessed. RESULTS Nineteen studies, comprising 1226 patients (45% female; mean age: 60.3 years), were included. Preoperative CST increased the risk of nondiagnostic biopsy with a relative risk (RR) of 2.1 (95% CI: 1.1-4.1). In the stereotactic biopsy subgroup, the RR for nondiagnostic biopsy was 3.0 (95% CI: 1.2-7.5). CST taper, duration, and dose did not significantly influence diagnostic biopsy rates. The sensitivity of CSF cytology, including flow cytometry, for PCNSL was 8.0% (95% CI: 6.0%-10.7%). CONCLUSION Our results suggest that preoperative CST reduces the diagnostic yield of stereotactic biopsies for PCNSL. We found no evidence that tapering CST before biopsy improves diagnostic rates. CSF analysis currently has a poor sensitivity for the diagnosis of PCNSL.
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Affiliation(s)
- Kira Tosefsky
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander D Rebchuk
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karina Chornenka Martin
- Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David W Chen
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Serge Makarenko
- Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Saad T, Tuck A, Golestani F, Smith P, McCulloch R. Primary central nervous system lymphoma: a practical guide for neurologists. Pract Neurol 2023:pn-2022-003656. [PMID: 36823116 DOI: 10.1136/pn-2022-003656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
Primary central nervous system lymphoma is rare, comprising 4% of intracranial neoplasms. Although haematologists or oncologists subsequently manage the condition, it is often neurologists who first make, or at least suspect, the diagnosis. This article reviews the disease, its clinical and radiological features and details the work-up needed to achieve a diagnosis (namely histological or cytological confirmation) and to prepare the patient for treatment. We note the importance of brain biopsy, the role of corticosteroids and the varied treatment options.
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Affiliation(s)
- Toni Saad
- Department of Neurology, Gloucestershire Royal Hospital, Gloucester, UK
| | | | - Farhad Golestani
- Department of Neurology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Paul Smith
- Department of Neurology, Gloucestershire Royal Hospital, Gloucester, UK.,Neuroradiology, North Bristol NHS Trust, Bristol, UK
| | - Rory McCulloch
- Haematology, Gloucestershire Royal Hospital, Gloucester, UK
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DeRon N, Ahmed M, Lopez D, Alobaidi A. A Rare Presentation of Primary Central Nervous System Lymphoma in an Immunocompetent Patient. Cureus 2022; 14:e23858. [PMID: 35530884 PMCID: PMC9072256 DOI: 10.7759/cureus.23858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/05/2022] Open
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Callovini GM, Sherkat S, Sperduti I, Crispo F, Raus L, Gazzeri R, Telera S. Hemorrhagic Attitude in Frameless and Frame-Based Stereotactic Biopsy for Deep-Seated Primary Central Nervous System Lymphomas in Immunocompetent Patients: A Multicentric Analysis of the Last Twenty Years. World Neurosurg 2021; 149:e1017-e1025. [PMID: 33476784 DOI: 10.1016/j.wneu.2021.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare manifestation of aggressive extranodal non-Hodgkin lymphoma. In patients with deep-seated lesions, stereotactic brain biopsy (SBB) is an accepted diagnostic procedure to obtain histopathologic confirmation. OBJECTIVE The aim of this study was to assess the feasibility, diagnostic yield, safety, and complications of stereotactic procedures in midline and deep-seated PCNSLs. METHODS Patients selected had received a histopathologic diagnosis of PCNSL localized in deep-seated midline structures, obtained by SBB. The intraoperative frozen section was executed as an integral part of the procedure. Computed tomography scan was performed after surgery. RESULTS A total of 476 SBBs were performed between January 2000 and December 2019 . Of these SBBs, 91 deep-seated lesions had a histologic diagnosis of PCNSL. A significant increase of the incidence of PCNSL compared with all other diseases was observed (P < 0.0001). Eight patients (8.7%) showed a symptomatic hemorrhage, 4 of whom required craniotomy. There were 4 deaths and 2 cases of permanent morbidity. The hemorrhage risk in the PCNSL group was statistically significant (P = 0.0003) compared with other histotypes. CONCLUSIONS In suspected cases of PCNSL, a histopathologic diagnosis is necessary to distinguish it from glioblastoma or other, nonmalignant conditions. Deep-seated PCNSLs present a higher risk of biopsy-related morbidity and mortality. Intraoperative frozen section increases the diagnostic yield and reduces the number of sampling procedures. Postoperative computed tomography seems to be warranted in patients with suspected PCNSL.
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Affiliation(s)
| | - Shahram Sherkat
- Department of Neurosurgery, San Filippo Neri Hospital, Rome, Italy
| | - Isabella Sperduti
- Departments of Biostatistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Crispo
- Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Raus
- Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Roberto Gazzeri
- Department of Neurosurgery, San Giovanni-Addolorata Hospital, Rome, Italy; Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Telera
- Departments of Neurosurgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Patel PA, Anand AS, Parikh SK, Patel AD, Kulkarni RS. Primary Central Nervous System Burkitt Lymphoma in HIV Positive Pediatric Patient: A Rare Case Report. J Pediatr Neurosci 2019; 14:86-89. [PMID: 31516626 PMCID: PMC6712912 DOI: 10.4103/jpn.jpn_81_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Burkitt lymphoma is a high-grade B-cell lymphoma with aggressive course of disease and primarily systemic nodal involvement. Primary Burkitt lymphoma with isolated central nervous system (CNS) involvement and that too in pediatric population has been rarely reported. Here, we present a case of a primary Burkitt lymphoma involving brain in an human immunodeficiency virus–positive pediatric patient who was on antiretroviral therapy. Currently, there are no established protocols or guidelines for management of primary CNS Burkitt lymphoma thus posing challenges in the management of such cases. Our patient was successfully treated by surgical resection followed by chemotherapy and radiotherapy.
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Affiliation(s)
- Priyanka A Patel
- Department of Medical and Pediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Asha S Anand
- Department of Medical and Pediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Sonia K Parikh
- Department of Medical and Pediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Akash D Patel
- Department of Medical and Pediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
| | - Rahul S Kulkarni
- Department of Medical and Pediatric Oncology, Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India
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Labak CM, Holdhoff M, Bettegowda C, Gallia GL, Lim M, Weingart JD, Mukherjee D. Surgical Resection for Primary Central Nervous System Lymphoma: A Systematic Review. World Neurosurg 2019; 126:e1436-e1448. [DOI: 10.1016/j.wneu.2019.02.252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 12/14/2022]
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Liu D, Liu X, Ba Z, Xie L, Han J, Yu D, Ma X. Delayed Contrast Enhancement in Magnetic Resonance Imaging and Vascular Morphology of Primary Diffuse Large B-Cell Lymphoma (DLBCL) of the Central Nervous System (CNS): A Retrospective Study. Med Sci Monit 2019; 25:3321-3328. [PMID: 31055591 PMCID: PMC6515976 DOI: 10.12659/msm.913439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background This study aimed to compare the magnetic resonance imaging (MRI) findings of primary diffuse large B-cell lymphoma (DLBCL) of the central nervous system (CNS) with delayed contrast enhancement and histological microvessel density (MVD). T1-weighted and T2-weighted contrast-enhanced and non-enhanced brain imaging were used. CNS lymphoma tissue was evaluated using primary antibodies to endothelial cells and smooth muscle cells, and histochemical staining for reticulin fibers and basement membrane, which allowed quantification of the MVD. Material/Methods Twenty-one patients with histologically confirmed primary DLBCL of the CNS underwent pre-contrast-enhanced and postcontrast-enhanced MRI. Histology of the CNS lymphoma tissue included immunohistochemical staining with antibodies to CD34 for vascular endothelial cells and alpha smooth muscle actin (ASMA) for vascular smooth muscle cells, and histochemical staining included periodic acid-Schiff (PAS) and silver staining for reticulin fibers to evaluate microvessel density (MVD). Results In primary DLBCL of the CNS, a positive correlation was found between the degree of necrosis and the size of the lymphoma (r=0.546, P=0.01). Delayed imaging enhancement was significantly correlated with the number of mature vessels, MVD, basement membrane, and reticulin fibers (r=0.593, 0.466, 0.446 and 0.497, respectively). Standardized β regression coefficient analysis showed that the MVD, PAS-positive structures, the number of mature vessels, and reticulin fibers, were significantly associated with delayed enhancement on MRI (β values, 0.425, 0.409, 0.295, and 0.188, respectively). Conclusions In primary DLBCL of the CNS, delayed imaging enhancement on MRI may be due to reduced neovascularization and vascular infiltration by lymphoma cells.
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Affiliation(s)
- Dandan Liu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland).,Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, China (mainland)
| | - Xiaojun Liu
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, China (mainland)
| | - Zhaogui Ba
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, China (mainland)
| | - Limei Xie
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, China (mainland)
| | - Jiwu Han
- Department of Radiology, Laigang Hospital Affiliated to Taishan Medical University, Laiwu, Shandong, China (mainland)
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Xiangxing Ma
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
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Li X, Huang Y, Bi C, Yuan J, He H, Zhang H, Yu Q, Fu K, Li D. Primary central nervous system diffuse large B-cell lymphoma shows an activated B-cell-like phenotype with co-expression of C-MYC, BCL-2, and BCL-6. Pathol Res Pract 2017; 213:659-665. [PMID: 28552541 DOI: 10.1016/j.prp.2017.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/13/2017] [Accepted: 02/17/2017] [Indexed: 11/28/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma, whose main prognostic factor is closely related to germinal center B-cell-like subtype (GCB- DLBCL) or activated B-cell-like type (non-GCB-DLBCL). The most common type of primary central nervous system lymphoma is diffuse large B-cell type with poor prognosis and the reason is unclear. This study aims to stratify primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL) according to the cell-of-origin (COO) and to investigate the multiple proteins expression of C-MYC, BCL-6, BCL-2, TP53, further to elucidate the reason why primary central nervous system diffuse large B-cell lymphoma possesses a poor clinical outcome as well. Nineteen cases of primary central nervous system DLBCL were stratified according to immunostaining algorithms of Hans, Choi and Meyer (Tally) and we investigated the multiple proteins expression of C-MYC, BCL-6, BCL-2, TP53. The Epstein-Barr virus and Borna disease virus infection were also detected. Among nineteen cases, most (15-17 cases) were assigned to the activated B-cell-like subtype, highly expression of C-MYC (15 cases, 78.9%), BCL-2 (10 cases, 52.6%), BCL-6 (15 cases, 78.9%). Unfortunately, two cases were positive for PD-L1 while PD-L2 was not expressed in any case. Two cases infected with BDV but no one infected with EBV. In conclusion, most primary central nervous system DLBCLs show an activated B-cell-like subtype characteristic and have multiple expressions of C-MYC, BCL-2, BCL-6 protein, these features might be significant factor to predict the outcome and guide treatment of PCNS-DLBCLs.
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Affiliation(s)
- Xiaomei Li
- Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China; Institute of Neuroscience, Faculty of Basic Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Ying Huang
- Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China; Institute of Neuroscience, Faculty of Basic Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Chengfeng Bi
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha 68198, USA
| | - Ji Yuan
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha 68198, USA
| | - Hong He
- Department of Internal Medicine, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Hong Zhang
- Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China; Institute of Neuroscience, Faculty of Basic Medicine, Chongqing Medical University, Chongqing 400016, China
| | - QiuBo Yu
- Molecular Medical Laboratory, Chongqing Medical University, Chongqing 400016, China
| | - Kai Fu
- Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha 68198, USA
| | - Dan Li
- Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China; Institute of Neuroscience, Faculty of Basic Medicine, Chongqing Medical University, Chongqing 400016, China.
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Yamamoto J, Shimajiri S, Nakano Y, Nishizawa S. Primary central nervous system lymphoma with preceding spontaneous pseudotumoral demyelination in an immunocompetent adult patient: A case report and literature review. Oncol Lett 2014; 7:1835-1838. [PMID: 24932243 PMCID: PMC4049747 DOI: 10.3892/ol.2014.2033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/06/2014] [Indexed: 11/05/2022] Open
Abstract
The rapid disappearance of primary central nervous system lymphomas (PCNSL) following steroid therapy is common; however, the spontaneous regression of PCNSL without any treatment is extremely rare. This study presented a rare case of PCNSL with preceding pseudotumoral demyelination and no previous steroid treatment, and the pitfalls of PCNSL diagnosis were discussed. A 70-year-old healthy male experienced memory and gait disturbances and showed multiple enhanced lesions with perifocal brain edema in the left cerebrum. The patient had no previous symptoms, no chronic lesions and negative oligoclonal immunoglobulin G bands in the cerebrospinal fluid. Histological examination of a brain biopsy specimen revealed predominantly destructive, demyelinating characteristics with infiltration of several T lymphocytes and foamy macrophages resulting in the diagnosis of multiple sclerosis. The patient received steroid therapy and demonstrated gradual improvement, multiple brain lesions had disappeared from the magnetic resonance imaging (MRI)scan two months after the biopsy. However, three months after the biopsy, the condition of the patient deteriorated. MRI indicated a homogeneous enhanced lesion in the right frontal lobe and a second biopsy was performed. Histological examination during the second biopsy revealed a diffuse large B-cell lymphoma. The patient received whole-brain radiation and steroid therapy, however, succumbed eight months following the initial diagnosis. In the current report a comparison between the our case and six previously reported cases is presented.
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Affiliation(s)
- Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Shohei Shimajiri
- Department of Surgical Pathology, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Yoshiteru Nakano
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Shigeru Nishizawa
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
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He M, Zuo C, Wang J, Liu J, Jiao B, Zheng J, Cai Z. Prognostic significance of the aggregative perivascular growth pattern of tumor cells in primary central nervous system diffuse large B-cell lymphoma. Neuro Oncol 2013; 15:727-34. [PMID: 23482670 PMCID: PMC3661096 DOI: 10.1093/neuonc/not012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/14/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Primary central nervous system lymphomas, predominantly diffuse large B-cell lymphomas (PCNS-DLBCL), are aggressive malignancies, and no histopathological variables with independent prognostic value are currently available. The aim of this study is to determine the prognostic value of histopathological variables of PCNS-DLBCL. METHODS Aggregative perivascular tumor cells (APVTs) and reactive perivascular T cell infiltrates (RPVIs) in tumor samples from 62 immunocompetent patients with PCNS-DLBCL were histopathologically and immunohistochemically studied. A mouse brain DLBCL model was established to confirm the special morphological features of PCNS-DLBCL. The therapy, overall response rate (ORR), and overall survival (OS) among patients were followed up. RESULTS APVT was present in 54 (87%) of the 62 cases, whereas RPVI was present in 20 (32%). Patients with APVT-positive lesions exhibited significantly worse OS, with intermediate to high International Extranodal Lymphoma Study Group (IELSG) scores, compared with patients with RPVI-positive lesions. Among cases of APVT-positive lymphoma, the semiquantitative score of immunostaining of X-box-binding protein (XBP1) and CD44 demonstrated prognostic significance. Multivariate analysis confirmed independent associations between APVT and XBP1 and between CD44 staining and survival. CONCLUSIONS The presence of APVT and staining of XBP1 and CD44 are independently associated with survival among patients with PCNS-DLBCL. These features could be routinely assessed in histopathological and immunohistochemical specimens.
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Affiliation(s)
- Miaoxia He
- Department of Pathology, Changhai Hospital, Shanghai, 200433, China
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Sasani M, Bayhan M, Sasani H, Kaner T, Oktenoglu T, Cakiroglu G, Ozer AF. Primary central nervous system lymphoma presenting as a pure third ventricular lesion: a case report. J Med Case Rep 2011; 5:213. [PMID: 21619666 PMCID: PMC3121681 DOI: 10.1186/1752-1947-5-213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 05/28/2011] [Indexed: 11/14/2022] Open
Abstract
Introduction Primary central nervous system lymphomas are infrequently occurring lymphomas that account for only 0.3-1.5% of all intra-cranial neoplasms in patients without acquired immune deficiency syndrome. However, a pure third ventricle lymphoma is extremely rare. Here, we discuss the similar radiological appearances of lesions localized in the third ventricle and the importance of accurately diagnosing primary central nervous system lymphomas for favorable treatment outcomes. Case presentation A 38-year-old Caucasian man from Turkey presented with a severe headache lasting for three months that failed to respond to any medication. Both severity and duration of the symptoms increased gradually, resulting in vomiting, nausea and gait disturbance that accompanied the headache for three weeks. Neuro-imaging studies showed a lesion located solely in the third ventricle, resulting in partial obstruction of the foramen of Monro. The pre-operative diagnosis was a colloid cyst. Following the surgical procedure, the results of pathological and immunochemical assays revealed that the pre-operative diagnosis was incorrect and that the lesion was a primary central system lymphoma. Conclusion Pure third ventricle lymphomas are extremely rare and are exceptionally localized. It is important to be aware of, and to differentiate between, other possible third ventricular lesions that may mimic the same radiological appearance. Accurate diagnosis is necessary for selecting appropriate treatment modalities.
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Affiliation(s)
- Mehdi Sasani
- American Hospital Neurosurgery Department, Nisantasi, Istanbul, Turkey.
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Zhang D, Hu LB, Henning TD, Ravarani EM, Zou LG, Feng XY, Wang WX, Wen L. MRI findings of primary CNS lymphoma in 26 immunocompetent patients. Korean J Radiol 2010; 11:269-77. [PMID: 20461180 PMCID: PMC2864853 DOI: 10.3348/kjr.2010.11.3.269] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 12/08/2009] [Indexed: 11/25/2022] Open
Abstract
Objective To record the MR imaging features of primary central nervous system lymphoma (PCNSL) and compare these features in monofocal and multifocal disease. Materials and Methods Twenty-one cases of monofocal disease were compared to five cases of multifocal disease. All patients were examined by non-enhanced and contrast-enhanced MRI. Tumor location, tumor size, signal intensity, enhancement characteristics, age distribution, peritumoral edema, cystic changes, and the presence of calcifications were assessed. The MRI features were compared between the monofocal and multifocal disease cases. Results The 26 cases, including both the monofocal and multifocal cases, exhibited 37 lesions. Contrast-enhanced images showed variable enhancement patterns: homogeneous enhancement (33 lesions), ring-like enhancement (2), and 'open-ring-like' enhancement (2). The 'notch sign' was noted in four of 33 homogeneously enhancing lesions. One case of hemorrhage and three cases of cystic formation were observed. Intra-tumoral calcification was not found. The frontal lobe, the corpus callosum and the basal ganglia were commonly affected in both the monofocal and multifocal groups. Tumor size differed significantly between the two groups (t = 3.129, p < 0.01) and mildly or moderately enhanced lesions were more frequently found in the monofocal group (p < 0.05). There was no statistical difference between perifocal edema (p > 0.05) and the signal characteristics (p > 0.05) between the two groups. Conclusion Our data show that PCNSL has a variable enhancement pattern on MR images. We first reported two lesions with an 'open-ring' enhancement as well as four cases with a 'notch sign'. Monofocal PCNSL cases typically have larger sized tumors with mild or moderate enhancement.
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Affiliation(s)
- Dong Zhang
- Department of Radiology, XinQiao Hospital, Third Military Medical University, ChongQing, P.R.China
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Cihan YB, Uzun G, Yildiz Ş, Dönmez H. Hyperbaric oxygen therapy for radiation-induced brain necrosis in a patient with primary central nervous system lymphoma. J Surg Oncol 2009; 100:732-5. [DOI: 10.1002/jso.21387] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Primary central nervous system lymphoma in rheumatoid arthritis. J Clin Rheumatol 2008; 14:54-5. [PMID: 18431104 DOI: 10.1097/rhu.0b013e318163cd02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gobbato PL, Pereira Filho ADA, de David G, Faria MDB, de David F, Aleixo PB, Barra MB, Ferreira NP. Primary meningeal Burkitt-type lymphoma presenting as the first clinical manifestation of acquired immunodeficiency syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:511-5. [PMID: 16917629 DOI: 10.1590/s0004-282x2006000300030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 02/23/2006] [Indexed: 11/22/2022]
Abstract
The purpose of this study is to report a rare case of primary meningeal high grade Burkitt-type lymphoma presenting as the first clinical manifestation of acquired immunodeficiency syndrome. A 38-year-old Caucasian man, with a negative past medical history, sought treatment after experiencing global headache for five days. CT-Scan revealed a right front-temporo-parietal hyperdense subdural expansive mass. A craniotomy was performed and a hard white subdural was microsurgically dissected. Some hours after the surgery, the patient developed hemispheric cerebral edema and intracranial hypertension syndrome. Decompressive craniotomy was performed and the patient had an excellent recovery. Screening blood tests diagnosed human immunodeficiency virus infection. Further investigation ruled out systemic diseases. Eleven days after the initial surgery, the patient developed an acute respiratory failure and sepsis, dying on that day. Pathological studies diagnosed Burkitt-type lymphoma.
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Affiliation(s)
- Pedro Luís Gobbato
- Hospital São José, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre RS, Brazil
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Hanselman B, Kruth S, Poma R, Nykamp S. Hypernatremia and Hyperlipidemia in a Dog with Central Nervous System Lymphosarcoma. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb01824.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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de Beukelaar JW, van Arkel C, van den Bent MJ, van't Veer MB, van Doornum GJ, Cornelissen JJ, Sillevis Smitt PA, Gratama JW. Resolution of EBV(+) CNS lymphoma with appearance of CSF EBV-specific T cells. Ann Neurol 2006; 58:788-92. [PMID: 16240354 DOI: 10.1002/ana.20640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Current knowledge of Epstein-Barr virus (EBV)-specific T-cell responses in the cerebrospinal fluid (CSF) of patients with EBV-related lymphoproliferative disease (EBV-LPD) in the central nervous system (CNS) is very limited. Here, we present two recipients of hematopoietic stem cell transplants with EBV-LPD in the CNS. EBV-specific CD8(+) T lymphocytes were detected in CSF and peripheral blood using major histocompatibility complex (MHC) class I multimers loaded with EBV-derived peptides. The appearance of EBV-specific CD8(+) T cells in CSF and blood correlated with neurological improvement and disappearance of EBV-LPD. These observations suggest a role for EBV-specific CD8(+) T cells in the control of EBV-LPD in the CNS.
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