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Cytoreductive Surgery for Primary Central Nervous System Lymphoma: Is it time to consider extent of resection? J Clin Neurosci 2022; 106:110-116. [DOI: 10.1016/j.jocn.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
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Bird CE, Traylor JI, Thomas J, Caruso JP, Kafka B, Rosado F, Blackburn KM, Hatanpaa KJ, Abdullah KG. Primary peripheral T-cell central nervous system lymphoma. Surg Neurol Int 2021; 12:465. [PMID: 34621580 PMCID: PMC8492444 DOI: 10.25259/sni_224_2021] [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: 03/06/2021] [Accepted: 08/07/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Primary peripheral T-cell central nervous system lymphoma (PCNSL) is a rare, aggressive tumor that arises in the craniospinal axis and has an increased risk in individuals who are immunocompromised. This lesion often mimics other benign and malignant processes on radiographic imaging, leading to misdiagnosis and delays in treatment. We present a case of a patient with a history of Sjögren's syndrome and progressive neurologic symptoms who underwent craniotomy for diagnosis. CASE DESCRIPTION A 61-year-old woman with a history of Sjögren's syndrome, progressive aphasia, left facial droop, and right-sided paresthesias for 4 months presented for evaluation and management. An enhancing, infiltrative lesion in the left frontal lobe with underlying vasogenic edema was appreciated and suggestive of a primary or metastatic neoplasm. The patient underwent an open biopsy for further evaluation of the lesion. Extensive histopathologic evaluation revealed a diagnosis of T-cell PCNSL. The patient was started on induction methotrexate and temozolomide followed by consolidative radiotherapy. CONCLUSION Autoimmune conditions are a risk factor for T-cell PCNSL development. T-cell PCNSL has radiographic and gross histologic features that are consistent with a broad differential, including gliomas and inflammatory processes. Prompt diagnosis and extensive histopathological evaluation is essential to ensure appropriate treatment.
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Affiliation(s)
- Cylaina E. Bird
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jeffrey I. Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Jenna Thomas
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - James P. Caruso
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Benjamin Kafka
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Flavia Rosado
- Department of Pathology The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kyle M. Blackburn
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kimmo J. Hatanpaa
- Department of Pathology The University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Kalil G. Abdullah
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
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Brown DA, Goyal A, Richter KR, Haglin JM, Himes BT, Lu VM, Snyder K, Hughes J, Decker PA, Opoku-Darko M, Link MJ, Burns TC, Parney IF. Clinical utility of brain biopsy for presumed CNS relapse of systemic lymphoma. J Neurosurg 2021; 136:30-39. [PMID: 34214988 DOI: 10.3171/2020.12.jns202517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/07/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to determine the frequency with which brain biopsy for presumed CNS relapse of systemic hematological malignancies yields new, actionable diagnostic information. Hematological malignancies represent a disparate group of genetic and histopathological disorders. Proclivity for brain involvement is dependent on the unique entity and may occur synchronously or metasynchronously with the systemic lesion. Diffuse large B-cell lymphomas (DLBCLs) have a high propensity for brain involvement. Patients in remission from systemic DLBCL may present with a lesion suspicious for brain relapse. These patients often undergo brain biopsy. The authors' a priori hypothesis was that brain biopsy in patients with a history of systemic DLBCL and a new brain MRI lesion would have lower diagnostic utility compared with patients with non-DLBCL systemic malignancies. METHODS The authors performed a retrospective review of patients who underwent brain biopsy between 2000 and 2019. Inclusion criteria were patients ≥ 18 years of age with a prior systemic hematological malignancy in remission presenting with a new brain MRI lesion concerning for CNS relapse. Patients with a history of any CNS neoplasms, demyelinating disorders, or active systemic disease were excluded. The main outcome was the proportion of patients with a distinct histopathological brain diagnosis compared with the systemic malignancy. The authors secondarily assessed overall survival, procedure-related morbidity, and 30-day mortality. RESULTS Sixty patients met inclusion criteria (40 males and 20 females); the median age at brain biopsy was 67 years (range 23-88 years). The median follow-up was 8.5 months (range 0.1-231 months). Thirty-nine (65.0%) patients had DLBCL and 21 (35%) had non-DLBCL malignancies. Thirty-five of 36 (97.2%) patients with prior systemic DLBCL and a diagnostic biopsy had histopathological confirmation of the original systemic disease versus 0 of 21 patients with non-DLBCL systemic malignancies (p < 0.001). Morbidity and 30-day mortality were 8.3% and 10.0%, respectively; 2 of 6 30-day mortalities were directly attributable to the biopsy. The median overall survival following brain biopsy was 10.8 months. CONCLUSIONS Patients with a history of systemic DLBCL and presumed CNS relapse gained minimal clinical benefit from brain biopsy but were at high risk of morbidity and mortality. In patients with a history of non-DLBCL systemic malignancies, brain biopsy remained critical given the high likelihood for discovery of distinct diagnostic entities. It was determined that patients with a prior systemic DLBCL and presumed brain relapse should likely receive empirical therapy obviating treatment delay and the risks of brain biopsy.
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Affiliation(s)
| | | | - Kent R Richter
- 2Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona; and
| | - Jack M Haglin
- 2Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine, Scottsdale, Arizona; and
| | | | | | | | - Joshua Hughes
- 3Department of Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee
| | - Paul A Decker
- 4Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
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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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Sopittapan T, Tunthanathip T, Kaewborisutsakul A. Outcome and Prognostic Factors of Primary Central Nervous System Lymphoma in Southern Thailand. Asian J Neurosurg 2020; 15:560-565. [PMID: 33145207 PMCID: PMC7591185 DOI: 10.4103/ajns.ajns_208_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/27/2020] [Accepted: 07/09/2020] [Indexed: 11/04/2022] Open
Abstract
Context: Primary central nervous system lymphoma (PCNSL) is an uncommon type of brain tumor that has an aggressive disease course. Its outcomes, including factor-related outcomes, are therefore not well established in our country. Aims: This study aims to investigate the outcome and prognostic factors in PCNSL patients at our institute. Settings and Design: Retrospective study in a single university hospital. Subjects and Methods: We reviewed consecutive cases of newly diagnosed PCNSL at Prince of Songkla University from 2005 to 2018. The data were collected to evaluate the treatment outcomes and prognostic factors. Statistical Analysis Used: The Kaplan–Meier method for survival analysis, and Cox regression for variable analysis. Results: Eighty-seven patients met the inclusion criteria. Patients were predominantly male, and their mean age was 58.8 ± 11.2 years. Only four patients were infected with HIV. Motor weakness was the most common presentation, and neuroimaging revealed multiple lesions in 56.3% of patients. The patients were divided into four groups according to treatment modality: palliative treatment, whole-brain radiotherapy (WBRT) alone, chemotherapy (CMT) alone, and combined WBRT and CMT groups. The median overall survival was 7 months. The 1-, 2-, and 5-year survival rates were 29%, 21.5%, and 4.6%, respectively. The age of >60 years was a significant poor prognostic factor. In addition, patients who received combined treatment exhibited the highest survival rate. Conclusions: PCNSL has a low survival rate, even in the present era. Older age is the most substantial factor associated with unfavorable outcomes. The most effective treatment is combined with WBRT and CMT.
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Affiliation(s)
- Thanya Sopittapan
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Thara Tunthanathip
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Anukoon Kaewborisutsakul
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
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Liu Z, Zhang Y, Zhu Y, Zhang W. Prognosis of Intravascular Large B Cell Lymphoma (IVLBCL): Analysis of 182 Patients from Global Case Series. Cancer Manag Res 2020; 12:10531-10540. [PMID: 33122951 PMCID: PMC7591067 DOI: 10.2147/cmar.s267825] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose This study provides an overview of the prognosis of intravascular large B cell lymphoma (IVLBCL) over the past 10 years and analyzes the possible relevant factors. Patients and Methods We conducted a literature search of case reports, case series, and retrospective studies of IVLBCL published from January 2008 to July 2018. After excluding inappropriate data, 103 publications were selected for the analysis. Statistical analyses of different treatment modalities, the effect of blood–brain barrier (BBB)-penetrating drugs, and prognostic factors for outcomes were performed. Results In total, 182 pathologically confirmed cases of IVLBCL were included in our study. The results revealed that the 1- and 3-year overall survival rates were 42.3 and 11.5%, respectively, whereas the median overall survival was 340 days. Overall survival (450 days vs 180 days) and progression-free survival (420 days vs 150 days) were significantly longer in patients who received rituximab-containing regimens than in those treated with other regimens. For IVLBCL involving the CNS, regimens containing BBB-penetrating drugs failed to provide an additional survival benefit. In addition, lactic dehydrogenase levels ≥700 U/L, CNS involvement, and hemophagocytic syndrome were identified as unfavorable risk factors in patients with IVLBCL, whereas skin involvement appeared to be a protective factor. Conclusion Rituximab-containing chemotherapy can improve the outcomes of patients with IVLBCL, but the prognosis remains unsatisfactory. Treatment regimens containing BBB-penetrating drugs failed to improve outcomes in patients with CNS-involved IVLBCL. Several factors affect the prognosis of patients with IVLBCL, and further research on the underlying mechanisms is needed.
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Affiliation(s)
- Ziyue Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuelun Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Franca RA, Travaglino A, Varricchio S, Russo D, Picardi M, Pane F, Pace M, Del Basso De Caro M, Mascolo M. HIV prevalence in primary central nervous system lymphoma: A systematic review and meta-analysis. Pathol Res Pract 2020; 216:153192. [PMID: 32956921 DOI: 10.1016/j.prp.2020.153192] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022]
Abstract
HIV infection is considered a major risk factor for primary central nervous system lymphoma (PCNSL). However, the percentage of PCNSL that occurs in HIV + patients is not well defined. We aimed to assess the prevalence of HIV infection in patients with PCNSL through a systematic review and meta-analysis. Electronic databases were searched for studies assessing the presence of HIV infection in series of patients with PCNSL. Pooled prevalence of HIV infection in PCNSL was calculated, with a subgroup analysis based on the geographic area. Twenty-seven studies with 6422 patients were included. Overall, pooled prevalence of HIV infection among PCNSL patients was 6.1 % with high heterogeneity. In the subgroup analysis, pooled prevalence was 3.6 % in India with low heterogeneity, 30.2 % (overall) and 16.5 % (after 2000) in the USA with high heterogeneity, 5.7 % in Europe with high heterogeneity, 2.2 % in East Asia with null heterogeneity, 7.3 % in South America with moderate heterogeneity. In conclusion, only a minor part of PCNSL occurs in patients with HIV. The results stratified by geographic area reflect the different prevalence of HIV infection in the general population, except for India, probably due to the shorter life expectancy of HIV + patients.
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Affiliation(s)
- Raduan Ahmed Franca
- Department of Advanced Biomedical Sciences, Pathology Section, Federico II University of Naples, Naples, Italy
| | - Antonio Travaglino
- Department of Advanced Biomedical Sciences, Pathology Section, Federico II University of Naples, Naples, Italy
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, Pathology Section, Federico II University of Naples, Naples, Italy
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, Pathology Section, Federico II University of Naples, Naples, Italy
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Section, Federico II University of Naples, Naples, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Section, Federico II University of Naples, Naples, Italy
| | - Mirella Pace
- Department of Advanced Biomedical Sciences, Pathology Section, Federico II University of Naples, Naples, Italy
| | | | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Section, Federico II University of Naples, Naples, Italy.
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Yu W, Si M, Li L, He P, Fan Z, Zhang Q, Jiao X. Biomarkers Reflecting The Destruction Of The Blood-Brain Barrier Are Valuable In Predicting The Risk Of Lymphomas With Central Nervous System Involvement. Onco Targets Ther 2019; 12:9505-9512. [PMID: 31807026 PMCID: PMC6857655 DOI: 10.2147/ott.s222432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/25/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We aimed to identify the biomarkers in cerebrospinal fluid (CSF) that facilitate the diagnosis of lymphomas with central nervous system (CNS) involvement. METHODS Four cases of non-Hodgkin's lymphoma (NHL) patients with/without CNS involvement were enrolled respectively, and non-CNS tumor patients (n=3) were selected to be the controls. Lab biomarkers, cytokines, and tight junction proteins (TJs) in CSF and serum were measured. RESULTS When comparing the CNS to non-CNS group, cytokine including MMP-9 (15.24 vs 0.36 ng/mL), CCL-2 (1922.04 vs 490.68 pg/mL), and sVCAM-1 (61.36 vs 9.00 pg/mL), TJs including OCLN (6.68 vs 2.59 pg/mL), and ZO-1 (710.04 vs 182.98 pg/mL) in CSF were significantly higher in lymphomas patients with CNS involvement than those without CNS involvement. However, serum biomarkers were not significantly elevated. Contrary to the major findings, all conventional biomarkers and MRI results showed no significant change. CONCLUSION CSF biomarkers affecting BBB disruption are valuable in mirroring the risk of lymphoma CNS metastasis. Further study with a larger sample size is needed to verify these biomarkers in predicting lymphoma CNS involvement.
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Affiliation(s)
- Wenjun Yu
- Department of Hematology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong515041, People’s Republic of China
| | - Mengya Si
- Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong515041, People’s Republic of China
| | - Li Li
- Obstetrics Department, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong515041, People’s Republic of China
| | - Ping He
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - Zhiqiang Fan
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - Qiaoxin Zhang
- Clinical Laboratory, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong515041, People’s Republic of China
| | - Xiaoyang Jiao
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
- Correspondence: Xiaoyang Jiao Department of Cell Biology and Genetics, Shantou University Medical College, 22 Xinling Road, Guangdong515041, People’s Republic of China Email
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Royer-Perron L, Hoang-Xuan K. Management of primary central nervous system lymphoma. Presse Med 2018; 47:e213-e244. [PMID: 30416008 DOI: 10.1016/j.lpm.2018.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/21/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022] Open
Abstract
A rare tumor, primary central nervous system lymphoma can affect immunocompetent and immunocompromised patients. While sensitive to radiotherapy or chemotherapy crossing the blood-brain barrier, it often recurs. Modern treatment consists of high-dose methotrexate-based induction chemotherapy, often followed by consolidation with either radiotherapy or further chemotherapy. Neurotoxicity is however a concern with radiotherapy, especially for patients older than 60 years. The benefit of the addition of rituximab to chemotherapy is unclear. Targeted therapies and immunotherapy have been effective in some patients and are tested on a larger scale. Survival has improved in the last decade, but remains poor in older patients.
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Affiliation(s)
- Louis Royer-Perron
- Hôpital Pierre-Boucher, Longueuil, Canada; AP-HP, Sorbonne universités, UPMC université Paris 06, hôpitaux Universitaires La Pitié Salpêtrière, Charles Foix, service de neurologie, 2, Mazarin, 75013, Paris, France; LOC network, 75561 Paris cedex 13, France.
| | - Khê Hoang-Xuan
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Paris, France; AP-HP, Sorbonne universités, UPMC université Paris 06, hôpitaux Universitaires La Pitié Salpêtrière, Charles Foix, service de neurologie, 2, Mazarin, 75013, Paris, France; LOC network, 75561 Paris cedex 13, France
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