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Chen J, Cen B, Hu F, Qiu Y, Xiao G, Zhou J, Ma X, Zhang F. Primary Brainstem Lymphoma: A Population-Based Study. Front Surg 2022; 9:829048. [PMID: 35874127 PMCID: PMC9299248 DOI: 10.3389/fsurg.2022.829048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPrimary brainstem lymphoma (PBSL) is rare and malignant. An understanding of this disease is lacking. We aimed to characterize clinical features, estimate survival, and explore survival-related factors of PBSL.MethodsPatients with a histological diagnosis of primary lymphoma in the brainstem (C71.7) from 1975 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) program. Log-rank tests and univariate and multivariate Cox proportional hazard analyses were used to identify survival-related factors.ResultsPBSL constituted 2.7% of brainstem malignancies. The median age of the PBSL patients was 59.5 years. Diffuse large B cell lymphoma (n = 49, 84.5%) was the most prevalent histology among the 58 cases with reported specific lymphoma subtype. The majority of PBSLs were localized (n = 46, 52.3%), at low Ann Arbor Stage (I/II, n = 63, 70.5%), and presented as a single primary (n = 71, 80.7%). Chemotherapy was applied in 50 (56.8%) cases. Three-year overall survival (OS) and disease-specific survival (DSS) rates were 42.7% and 53.5%, respectively. Multivariate analyses showed that independent predictive/prognostic factors for OS were age (P = 0.004), tumor number (P = 0.029), and chemotherapy (P = 0.001); DSS-related factors only included age (P = 0.014) and chemotherapy (P = 0.008).ConclusionsWe estimated survival rates for PBSL patients. Factors associated with OS and DSS were also identified. Our findings addressed the importance of chemotherapy in treating PBSL patients.
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Affiliation(s)
- Junyu Chen
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Bo Cen
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Fei Hu
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Yong Qiu
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Guomin Xiao
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Junge Zhou
- General Hospital of the Yangtze River Shipping, Wuhan Brain Hospital, Wuhan, China
| | - Xiujian Ma
- German Cancer Research Center (DKFZ), DKFZ-ZMBH Alliance, Heidelberg, Germany
- Correspondence: Fangcheng Zhang Xiujian Ma
| | - Fangcheng Zhang
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Fangcheng Zhang Xiujian Ma
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Ganz JC. Less common intraparenchymal tumors. PROGRESS IN BRAIN RESEARCH 2022; 268:303-314. [PMID: 35074087 DOI: 10.1016/bs.pbr.2021.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The chapter outlines the management of a great variety of rare intraparenchymal tumors. For some like medulloblastomas or ependymomas, GKNS has little to offer. For others like neurocytomas, primary central nervous system lymphomas, and papillary pineal tumors the current findings look most hopeful. For choroid plexus papillomas there is currently not enough information to define the role of GKNS in their treatment. Pineal region tumors are a complex and varied group of neoplasms. Their complexity, variety and ethnic variability means that defining the role of GKNS will require continuing research before a consensus about management can be reached.
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Affiliation(s)
- Jeremy C Ganz
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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Palmer JD, Bhamidipati D, Shukla G, Epperla N, Glass J, Kim L, Shi W. Outcomes after stereotactic radiosurgery for CNS lymphoma. J Neurooncol 2020; 147:465-476. [PMID: 32108296 DOI: 10.1007/s11060-020-03444-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The standard of care for CNS lymphoma typically includes high dose methotrexate followed by whole brain radiation therapy, but there is an increased risk of neurotoxicity with this regimen. In our institution, we offered stereotactic radiosurgery (SRS) for disease refractory to HD-MTX in a subset of patients. A search of the literature on this modality for CNS lymphoma was also conducted. METHODS Medical records of six patients who received partial brain radiation therapy for persistent CNS lymphoma were reviewed. SRS was given via 1-3 fractions to doses of 21 or 24 Gy. PubMed, SCOPUS, and Cochrane Library databases were systematically searched for articles reporting on outcomes for CNS lymphoma treated with SRS. RESULTS Six patients (eleven lesions) were treated with SRS for CNS lymphomas. Median follow up was 15.6 months (range 3.3-37.8). Median RT dose per lesion was 21 Gy and median time to progression was 12.7 months. Median overall survival was not reached. Four patients had distant intracranial failure with two developing local recurrence. The search strategy yielded 16 studies of which only one was prospective and included a control group. 183 out of 256 evaluated lesions (69%) responded completely to treatment and 13 of 204 patients (6%) recurred within the treatment area at last follow-up. Overall, the treatment was well tolerated. CONCLUSION SRS may provide favorable local control in patients with refractory CNS lymphomas. A prospective trial is warranted to validate the efficacy of such an approach.
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Affiliation(s)
- Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, 460 W 10th Avenue, Columbus, OH, 43210, USA.
| | - Deepak Bhamidipati
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Gaurav Shukla
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Narendranath Epperla
- Department of Internal Medicine, Division of Hematology, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, USA
| | - Jon Glass
- Department of Neurosurgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Lyndon Kim
- Department of Neurosurgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
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Akay A, Rüksen M, Islekel S. Magnetic Resonance Imaging-guided Stereotactic Biopsy: A Review of 83 Cases with Outcomes. Asian J Neurosurg 2019; 14:90-95. [PMID: 30937016 PMCID: PMC6417362 DOI: 10.4103/ajns.ajns_81_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the relationship between the radiological and histopathological distribution of the cerebral lesions diagnosed with stereotactic biopsy (STB) procedure and its outcomes. MATERIALS AND METHODS In the current study, a retrospective analysis of 83 patients that underwent the STB in our clinic from January 2011 to December 2015 was made. T1-weighted contrast-enhanced cranial magnetic resonance imaging examinations were performed on patients on whom Leksell stereotactic frame system was installed. The histopathological and the radiological data derived from the STB procedure were classified. RESULTS In terms of localization, glial tumor (56.6%) was the most common lesion in all regions, except for the multifocal lesions. Contrary to the common knowledge, lymphoma (14.4%) was found to be the most common lesion among multifocal lesions. The success of obtaining positive STB samples in the current series was 95.2% and the complication rate was 3.6%. CONCLUSION Had a routine computed tomography scan been performed on each patient in this series, the number of clinically insignificant small intracerebral hematomas would have probably been higher. Nevertheless, the rate of the STB sampling accuracy and the complication rate were similar to those reported in the relevant literature.
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Affiliation(s)
- Ali Akay
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
| | - Mete Rüksen
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
| | - Sertaç Islekel
- Department of Neurosurgery, Kent Hospital, Izmir, Turkey
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Primary central nervous system lymphoma mimicking cerebellopontine angle tumour. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kim J, Kim YZ. A Case of Primary Central Nervous System Lymphoma Located at Brain Stem in a Child. Brain Tumor Res Treat 2016; 4:155-159. [PMID: 27867930 PMCID: PMC5114190 DOI: 10.14791/btrt.2016.4.2.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 11/20/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is an extranodal Non-Hodgkin's lymphoma that is confined to the brain, eyes, and/or leptomeninges without evidence of a systemic primary tumor. Although the tumor can affect all age groups, it is rare in childhood; thus, its incidence and prognosis in children have not been well defined and the best treatment strategy remains unclear. A nine-year old presented at our department with complaints of diplopia, dizziness, dysarthria, and right side hemiparesis. Magnetic resonance image suggested a diffuse brain stem glioma with infiltration into the right cerebellar peduncle. The patient was surgically treated by craniotomy and frameless stereotactic-guided biopsy, and unexpectedly, the histopathology of the mass was consistent with diffuse large B cell lymphoma, and immunohistochemical staining revealed positivity for CD20 and CD79a. Accordingly, we performed a staging work-up for systemic lymphoma, but no evidence of lymphoma elsewhere in the body was obtained. In addition, she had a negative serologic finding for human immunodeficient virus, which confirmed the histopathological diagnosis of PCNSL. She was treated by radiosurgery at 12 Gy and subsequent adjuvant combination chemotherapy based on high dose methotrexate. Unfortunately, 10 months after the tissue-based diagnosis, she succumbed due to an acute hydrocephalic crisis.
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Affiliation(s)
- Jinho Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Zoon Kim
- Division of Neurooncology and Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Berrocal-Izquierdo N, Muñoz F, Bosch J, Molet J. Primary central nervous system lymphoma mimicking cerebellopontine angle tumour. Neurologia 2016; 33:614-616. [PMID: 27452624 DOI: 10.1016/j.nrl.2016.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/03/2016] [Accepted: 06/09/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- N Berrocal-Izquierdo
- Servicio de Neurología, SCIAS, Hospital de Barcelona, Barcelona, España; Servicio de Neurología, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España.
| | - F Muñoz
- Servicio de Neurocirugía, SCIAS, Hospital de Barcelona, Barcelona, España; Servicio de Neurocirugía, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J Bosch
- Servicio de Neurología, SCIAS, Hospital de Barcelona, Barcelona, España
| | - J Molet
- Servicio de Neurocirugía, SCIAS, Hospital de Barcelona, Barcelona, España; Servicio de Neurocirugía, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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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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Kenai H, Yamashita M, Nakamura T, Asano T, Momii Y, Nagatomi H. Gamma Knife surgery for primary central nervous system lymphoma: usefulness as palliative local tumor control. J Neurosurg 2009; 105 Suppl:133-8. [PMID: 18503346 DOI: 10.3171/sup.2006.105.7.133] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Although there is no established treatment for primary central nervous system lymphoma (PCNSL), therapeutic protocols involving high-dose methotrexate therapy followed, in some cases, by whole-brain radiotherapy (WBRT) have generally been adopted, and they have yielded relatively favorable results. Gamma Knife surgery (GKS) is a stopgap measure to treat patients with PCNSL. The authors summarize the results of their cases and evaluate the efficacy and usefulness of GKS. METHODS Between June 1999, and June 2005, 22 patients suffering from PCNSL were treated with GKS at the authors' institution and were followed up for more than 6 months. Some combination of chemotherapy and/or WBRT and/or microsurgery had been performed in 18 of the 22 patients before GKS. The remaining four patients had not undergone any previous treatment. In these patients, the mean tumor volume was 4.14 cm3, and the tumors were treated with a mean margin dose of 16.5 Gy to the 52.8% isodose line. Magnetic resonance imaging demonstrated the disappearance of the GKS-treated lesions; however, new lesions were observed in other regions of the brain in 10 patients and repeated GKS was performed in some cases. No local recurrences were observed an average of 19.4 months after GKS, and good level of quality of life (QOL) was maintained during this period. CONCLUSIONS Gamma Knife surgery should be performed only for local tumor control as a stopgap measure in the treatment of PCNSL. It is noninvasive and safe, and its effects occur rapidly. Its use improves prognosis and enhances the patient's quality of life. Gamma Knife surgery should be considered one of the treatment strategies for patients with PCNSLs.
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Affiliation(s)
- Hiroyuki Kenai
- Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita, Japan.
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Matsumoto Y, Horiike S, Fujimoto Y, Shimizu D, Kudo-Nakata Y, Kimura S, Sato M, Nomura K, Kaneko H, Kobayashi Y, Shimazaki C, Taniwaki M. Effectiveness and limitation of gamma knife radiosurgery for relapsed central nervous system lymphoma: a retrospective analysis in one institution. Int J Hematol 2007; 85:333-7. [PMID: 17483078 DOI: 10.1532/ijh97.06205] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe 6 patients with relapsed central nervous system lymphoma (CNSL) treated with Gamma Knife radiosurgery (GKR). The histologic diagnosis in all 6 patients was diffuse large B-cell lymphoma without human immunodeficiency virus infection. Two patients had intracranial relapse of primary CNSL, and the remaining 4 had CNS relapse of systemic lymphoma. All patients were treated with GKR without severe adverse effects, and all but 1 patient received subsequent chemotherapy shortly after GKR. Four patients showed a complete response, and the remaining 2 patients had a partial response or stable disease. Although the neurologic symptoms disappeared or improved markedly in all patients, all of the diseases recurred or progressed 3 to 13 months after the first GKR. A second GKR was eventually performed in 4 patients. The median overall survival and progression-free survival times after the first GKR were 17 and 11 months, respectively. In our experience, GKR seems to be a useful procedure for the treatment of relapsed CNSL, because it facilitates excellent local control in a short-term treatment period without severe complications, although the efficacy period is not long enough.
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Affiliation(s)
- Yosuke Matsumoto
- Department of Hematology and Oncology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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