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Lee S, Choi SY, Choi J, Oh EH, Yoo D, Lee S, Kim HJ, Choi J, Kim J, Choi K. Ocular motor and vestibular dysfunction in central nervous system lymphoma. Eur J Neurol 2024; 31:e16242. [PMID: 38344918 PMCID: PMC11235991 DOI: 10.1111/ene.16242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND PURPOSE Diagnosis of lymphoma involving the central nervous system (CNS) is challenging. This study aimed to explore the abnormal vestibular and ocular motor findings in CNS lymphoma. METHODS A retrospective search of the medical records identified 30 patients with CNS lymphoma presenting ocular motor and vestibular abnormalities from four neurology clinics of university hospitals in South Korea (22 men, age range 14-81 years, mean 60.6 ± 15.2). The demographic and clinical features and the results of laboratory, radiological and pathological evaluation were analyzed. RESULTS Patients presented with diplopia (13/30, 43%), vestibular symptoms (15/30, 50%) or both (2/30, 7%). In 15 patients with diplopia, abnormal ocular motor findings included ocular motor nerve palsy (n = 10, 67%), internuclear ophthalmoplegia (n = 2, 13%), external ophthalmoplegia (n = 2, 13%) and exophoria (n = 1, 7%). The vestibular abnormalities were isolated in 14 (82%) of 17 patients with vestibular symptoms and included combined unilateral peripheral and central vestibulopathy in three from lesions involving the vestibular nuclei. CNS lymphoma involved the brainstem (53%), cerebellum (33%), leptomeninges (30%), deep gray nuclei (23%) or cranial nerves (17%). Two patients showed the "double-panda" sign by involving the midbrain. CONCLUSIONS This study expands the clinical and radiological spectra of CNS lymphoma. Neuro-ophthalmological and neuro-otological evaluation may guide the early diagnosis of CNS lymphoma.
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Affiliation(s)
- Suk‐Min Lee
- Department of Neurology, Pusan National University HospitalPusan National University School of Medicine and Biomedical Research InstituteBusanSouth Korea
| | - Seo Young Choi
- Department of Neurology, Pusan National University HospitalPusan National University School of Medicine and Biomedical Research InstituteBusanSouth Korea
| | - Jae‐Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsanSouth Korea
| | - Eun Hye Oh
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsanSouth Korea
| | - Dallah Yoo
- Department of Neurology, Kyung Hee University HospitalKyung Hee UniversitySeoulSouth Korea
| | - Sun‐Uk Lee
- Department of NeurologyKorea University Medical CenterSeoulSouth Korea
| | - Hyo Jung Kim
- Research Administration TeamSeoul National University Bundang HospitalSeongnamSouth Korea
- Dizziness Center, Clinical Neuroscience Center, and Department of NeurologySeoul National University Bundang HospitalSeongnamSouth Korea
| | - Jeong‐Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, and Department of NeurologySeoul National University Bundang HospitalSeongnamSouth Korea
- Department of Neurology, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Ji‐Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of NeurologySeoul National University Bundang HospitalSeongnamSouth Korea
- Department of Neurology, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Kwang‐Dong Choi
- Department of Neurology, Pusan National University HospitalPusan National University School of Medicine and Biomedical Research InstituteBusanSouth Korea
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Yue J, Lin P, Lian C, Yao H, Jiang L, Liao S, Xu L, Zhang J, Tan J, Chen Z, Yang J, Gao C, Huang L, Yang X, Long Y. Brain radial enhancement pattern in patients with negative glial fibrillary acidic protein-IgG: A cases series study. J Neurol Sci 2023; 453:120782. [PMID: 37683309 DOI: 10.1016/j.jns.2023.120782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Brain radial enhancement pattern on magnetic resonance imaging (MRI) has been identified as typical lesions in autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A). However, the authors encountered several patients without GFAP-IgG showing that such specific imaging. In the present study, we reported the clinical pictures of 5 GFAP-IgG-negative patients with GFAP-A specific imaging pattern. METHODS Data was retrospectively obtained from June 2013 through April 2023, and five GFAP-IgG-negative patients with valid data were recruited. Clinical information was either obtained by the investigators or retrieved from the referring clinicians and included prodromal symptoms, neurologic manifestations, comorbidities, results of ancillary studies. RESULTS Altogether five GFAP-IgG-negative patients with "meningoencephalitis/encephalitis" manifestations and brain radial perivascular enhancement were confirmed. One patient had peripheral lymphoma. Four patients had other autoimmune antibody in serum and/or cerebrospinal fluid, of which one patient had positive aquaporin IgG. Clinical features of the five patients included headache, fever, epilepsy and abnormal behavioral symptoms. MRI of patients revealed radial perivascular gadolinium enhancement extending from the lateral ventricles to the white matter suggestive of autoimmune GFAP-A. CONCLUSION GFAP-A-like disorders with radial perivascular enhancement could be found in GFAP-IgG-negative patients with or without neoplasm, which could provide new insight into the differential diagnosis of GFAP-A.
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Affiliation(s)
- Jiajia Yue
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Peihao Lin
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Chun Lian
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Haiyan Yao
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Lihong Jiang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Sha Liao
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Lufen Xu
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Jiayuan Zhang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Jie Tan
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Zixuan Chen
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Jie Yang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Cong Gao
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Li Huang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China
| | - Xinguang Yang
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Sun Yat-sen Memorial Hospital, the Second Affiliated Hospital of Sun Yat-sen University, 107#Yan Jiang West Road, Guangzhou, China
| | - Youming Long
- Department of Neurology, the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China, Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang east Road, Guangzhou, 510260, Guangdong Province, China.
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Iriyama C, Murate K, Iba S, Okamoto A, Goto N, Yamamoto H, Kato T, Mihara K, Miyama T, Hattori K, Kajiya R, Okamoto M, Mizutani Y, Yamada S, Tsukamoto T, Hirose Y, Mutoh T, Watanabe H, Tomita A. Utility of cerebrospinal fluid liquid biopsy in distinguishing CNS lymphoma from cerebrospinal infectious/demyelinating diseases. Cancer Med 2023; 12:16972-16984. [PMID: 37501501 PMCID: PMC10501233 DOI: 10.1002/cam4.6329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/12/2023] [Accepted: 07/01/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Distinguishing between central nervous system lymphoma (CNSL) and CNS infectious and/or demyelinating diseases, although clinically important, is sometimes difficult even using imaging strategies and conventional cerebrospinal fluid (CSF) analyses. To determine whether detection of genetic mutations enables differentiation between these diseases and the early detection of CNSL, we performed mutational analysis using CSF liquid biopsy technique. METHODS In this study, we extracted cell-free DNA from the CSF (CSF-cfDNA) of CNSL (N = 10), CNS infectious disease (N = 10), and demyelinating disease (N = 10) patients, and performed quantitative mutational analysis by droplet-digital PCR. Conventional analyses were also performed using peripheral blood and CSF to confirm the characteristics of each disease. RESULTS Blood hemoglobin and albumin levels were significantly lower in CNSL than CNS infectious and demyelinating diseases, CSF cell counts were significantly higher in infectious diseases than CNSL and demyelinating diseases, and CSF-cfDNA concentrations were significantly higher in infectious diseases than CNSL and demyelinating diseases. Mutation analysis using CSF-cfDNA detected MYD88L265P and CD79Y196 mutations in 60% of CNSLs each, with either mutation detected in 80% of cases. Mutual existence of both mutations was identified in 40% of cases. These mutations were not detected in either infectious or demyelinating diseases, and the sensitivity and specificity of detecting either MYD88/CD79B mutations in CNSL were 80% and 100%, respectively. In the four cases biopsied, the median time from collecting CSF with the detected mutations to definitive diagnosis by conventional methods was 22.5 days (range, 18-93 days). CONCLUSIONS These results suggest that mutation analysis using CSF-cfDNA might be useful for differentiating CNSL from CNS infectious/demyelinating diseases and for early detection of CNSL, even in cases where brain biopsy is difficult to perform.
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Affiliation(s)
- Chisako Iriyama
- Department of HematologyFujita Health University School of MedicineToyoakeJapan
| | - Kenichiro Murate
- Department of NeurologyFujita Health University School of MedicineToyoakeJapan
| | - Sachiko Iba
- Department of HematologyFujita Health University School of MedicineToyoakeJapan
| | - Akinao Okamoto
- Department of HematologyFujita Health University School of MedicineToyoakeJapan
| | - Naoe Goto
- Department of HematologyFujita Health University School of MedicineToyoakeJapan
| | - Hideyuki Yamamoto
- Department of HematologyFujita Health University School of MedicineToyoakeJapan
| | - Toshiharu Kato
- Department of HematologyFujita Health University School of MedicineToyoakeJapan
| | - Keichiro Mihara
- International Center for Cell and Gene TherapyFujita Health UniversityToyoakeJapan
| | - Takahiko Miyama
- International Center for Cell and Gene TherapyFujita Health UniversityToyoakeJapan
| | - Keiko Hattori
- Department of HematologyFujita Health University School of MedicineToyoakeJapan
| | - Ryoko Kajiya
- Department of HematologyFujita Health University School of MedicineToyoakeJapan
| | - Masataka Okamoto
- Department of HematologyFujita Health University School of MedicineToyoakeJapan
- Department of Hematology and OncologyFujita Health University Okazaki Medical CenterOkazakiJapan
| | - Yasuaki Mizutani
- Department of NeurologyFujita Health University School of MedicineToyoakeJapan
| | - Seiji Yamada
- Department of PathologyFujita Health University School of MedicineToyoakeJapan
| | - Tetsuya Tsukamoto
- Department of PathologyFujita Health University School of MedicineToyoakeJapan
| | - Yuichi Hirose
- Department of NeurosurgeryFujita Health University School of MedicineToyoakeJapan
| | - Tatsuro Mutoh
- Department of HematologyFujita Health University School of MedicineToyoakeJapan
| | - Hirohisa Watanabe
- Department of NeurologyFujita Health University School of MedicineToyoakeJapan
| | - Akihiro Tomita
- Department of HematologyFujita Health University School of MedicineToyoakeJapan
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Iglseder S, Nowosielski M, Bsteh G, Muigg A, Heugenhauser J, Mayer E, Grams A, Stockhammer G, Nevinny-Stickel M. Whole brain radiotherapy combined with intrathecal liposomal cytarabine for leptomeningeal metastasis-a safety analysis and validation of the EANO-ESMO classification. Strahlenther Onkol 2022; 198:475-483. [PMID: 35267049 PMCID: PMC9038800 DOI: 10.1007/s00066-022-01910-9] [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: 07/31/2021] [Accepted: 02/08/2022] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although there is no proven standard therapy for leptomeningeal metastases (LM), treatment often includes intrathecal chemotherapy combined with whole brain radiation therapy (WBRT). Little is known about the toxicity of such combination therapies. We performed a retrospective safety analysis for the combination of intrathecal liposomal cytarabine with WBRT in patients with LM and validated the EANO-ESMO (European Association of Neuro-oncology-European Society for Medical Oncology) classification in this unique cohort. METHODS Treatment toxicities in patients diagnosed with LM between 2004 and 2014 were retrospectively analyzed according to RTOG (Radiation Therapy Oncology Group) toxicity criteria and NCI CTCAE V5.0 (National Cancer Institute Common Terminology Criteria for Adverse Events, Version 5.0). Diagnostic criteria and treatment response as assessed by EANO-ESMO classification were correlated with survival by Kaplan-Meier analysis and Breslow test. RESULTS In all, 40 patients with LM who were treated with combined WBRT and intrathecal cytarabine, were identified. Ten patients (25%) experienced adverse events ≥grade 3 according to RTOG toxicity criteria; in 22 patients (55%) NCI CTCAE ≥grade 3 were detected. Median overall survival was 124 days. Median time to neurological progression was 52 days. Patients with positive cerebrospinal fluid (CSF) cytology (n = 26) showed worse prognosis compared to patients with negative CSF cytology (n = 14; mOS (median overall survival) 84 days versus 198 days, p = 0.006, respectively). The EANO-ESMO response assessment was significantly associated with survival: "stable" (n = 7) mOS 233 days, "response" (n = 10) mOS 206 days, "progression" (n = 17) mOS 45 days, "suspicion of progression" (n = 6) mOS 133 days; overall, p < 0.001. CONCLUSIONS In this retrospective analysis, combined treatment of WBRT and intrathecal liposomal cytarabine shows an acceptable safety profile and may indicate a trend towards improved efficacy. The EANO-ESMO classification for diagnosis and treatment response predicts survival.
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Affiliation(s)
- Sarah Iglseder
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Martha Nowosielski
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Armin Muigg
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Johanna Heugenhauser
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Elke Mayer
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Günther Stockhammer
- Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Meinhard Nevinny-Stickel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
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Ungureanu A, Le Garff-Tavernier M, Costopoulos M, Parratte T, Brinet A, Durand H, Gaultier C, Hurstel R, Alamome I, Sellal F, Ahle G. CSF interleukin 6 is a useful marker to distinguish pseudotumoral CNS inflammatory diseases from primary CNS lymphoma. J Neurol 2021; 268:2890-2894. [PMID: 33609156 DOI: 10.1007/s00415-021-10453-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Interleukin 6 (IL-6) is a pleomorphic cytokine that can be found in the cerebrospinal fluid (CSF) in a wide spectrum of inflammatory pathologies of the central nervous system (CNS). OBJECTIVE Our aim was to characterize the diagnostic significance of CSF IL-6 among various CNS inflammatory diseases with pseudotumoral lesions (CNSID) and primary CNS lymphoma (PCNSL). METHODS We retrospectively analyzed the CSF IL-6 concentrations in 43 consecutive patients with suspected PCNSL. A total of 28 patients were positively diagnosed with PCNSL and 15 with CNSID. We verified the results with CSF IL-10, an established biomarker for PCNSL. RESULTS In the PCNSL group, the median CSF IL-6 concentration was 8 pg/ml, interquartile range (IQR) 5-18.5. For the patients with CNSID, the median concentration was 70 pg/ml, IQR 5-1368. A group comparison showed significantly higher CSF IL-6 levels in patients with CNSID than in those with PCNSL (p = 0.032). Moreover, IL-6 was correlated with CSF cell count in the CNSID group (r = 0.56, p = 0.028), but not in the PCNSL group (r = 0.3, p = 0.13). We found significantly higher CSF IL-10 levels in patients with PCNSL than in patients with CNS inflammatory lesions (p < 0.001). DISCUSSION AND CONCLUSIONS Our study suggests that CSF IL-6 levels could represent, in addition to CSF IL-10, a useful biomarker in the differential diagnosis of CNSID and suspected PCNSL.
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Affiliation(s)
- Aurelian Ungureanu
- Service de Neurologie, Hôpitaux Civils de Colmar, Colmar, France. .,Service de Neurologie, Hôpital Saint Antoine et Hôpital Pitié Salpêtrière, AP-HP, 184 Faubourg de Saint Antoine, 75012, Paris, France.
| | | | - Myrto Costopoulos
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | | | | | - Hélène Durand
- Service de Neurologie, Hôpitaux Civils de Colmar, Colmar, France
| | - Claude Gaultier
- Service de Neurologie, Hôpitaux Civils de Colmar, Colmar, France
| | - Remy Hurstel
- Laboratoire d'Hématologie, Hôpitaux Civils de Colmar, Colmar, France
| | - Isabelle Alamome
- Laboratoire d'Hématologie, Hôpitaux Civils de Colmar, Colmar, France
| | - François Sellal
- Service de Neurologie, Hôpitaux Civils de Colmar, Colmar, France
| | - Guido Ahle
- Service de Neurologie, Hôpitaux Civils de Colmar, Colmar, France
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Voultsinou D, Mantatzis M, Gerukis T, Heva A, Birbilis T, Prassopoulos P. Magnetic Resonance Imaging patterns in central nervous system lymphomas: A pictorial review. Clin Imaging 2021; 78:1-7. [PMID: 33706068 DOI: 10.1016/j.clinimag.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/09/2020] [Accepted: 02/08/2021] [Indexed: 11/16/2022]
Abstract
Five distinctive Magnetic Resonance Imaging (MRI) patterns of Central Nervous System Lymphomas (CNSL) are introduced in this pictorial essay - in an attempt to differentiate lymphoma from other abnormalities with similar MRI appearance, - namely a. solitary supratentorial, b. multiple supratentorial, c. infratentorial, d. intravascular, and e. extraparencymal. Recognition of a specific imaging pattern on brain MR imaging, may facilitate the early diagnosis and prompt treatment initiation, thus improving prognosis of brain lymphoma.
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Affiliation(s)
| | - Michalis Mantatzis
- Department of Radiology, University Hospital of Alexandroupolis, Democritus University of Thrace, Greece.
| | | | - Angeliki Heva
- Department of Pathology, AHEPA University Hospital of Thessaloniki, Aristotle University, Thessaloniki, Greece
| | - Theodosios Birbilis
- Department of Neurosurgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Greece
| | - Panos Prassopoulos
- Department of Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University, Thessaloniki, Greece
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7
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Makranz C, Arkadir D, Nachmias B, Gatt ME, Eliahou R, Atlan K, Mordechai A, Goldshmit N, Lossos A. Neurological misdiagnoses of lymphoma. Neurol Sci 2020; 42:1933-1940. [PMID: 32974798 DOI: 10.1007/s10072-020-04724-8] [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: 05/25/2020] [Accepted: 09/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lymphoma of the nervous system is rare and usually involves the brain, spinal cord, or peripheral nerves. Hence, it has varied clinical presentations, and correct diagnosis is often challenging. Incorrect diagnosis delays the appropriate treatment and affects prognosis. We report 5 patients with delayed diagnosis of lymphoma involving the central and/or peripheral nervous system, initially evaluated for other neurological diagnoses. We also discuss the challenge of diagnosis and appropriate testing. METHODS Retrospective review of 2011-2019 records of patients with confirmed nervous system lymphoma diagnosed in a tertiary care medical center. RESULTS We present 5 adult patients initially evaluated for inflammatory myelopathy, inflammatory lumbosacral plexopathy, atypical parkinsonism, and demyelinating disease of the CNS. Final diagnosis of the nervous system lymphoma was delayed by 4 to 18 months and was based on tissue biopsy in 4, and on CSF and bone marrow examination in 1 patient. CONCLUSIONS Lymphoma may imitate various central and peripheral nervous system disorders. We suggest several red flags that indicate the need to consider lymphoma, including subacute but progressive symptomatic evolution, painful neurological deficit, unclear clinical diagnosis, and transient steroid responsiveness. Correct diagnosis often requires a combination of diagnostic tests, while pathology testing is crucial for early diagnosis and is strongly recommended in the appropriate clinical setting.
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Affiliation(s)
- Chen Makranz
- Departments of Oncology and Neurology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - David Arkadir
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Boaz Nachmias
- Department of Hematology, Sharett Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Moshe E Gatt
- Department of Hematology, Sharett Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ruth Eliahou
- Departments of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Karine Atlan
- Departments of Pathology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Anat Mordechai
- Departments of Oncology and Neurology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Netta Goldshmit
- Department of Hematology, Sharett Institute for Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alexander Lossos
- Departments of Oncology and Neurology, Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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8
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Costopoulos M, Kim R, Choquet S, Maloum K, Houillier C, Algrin C, Settegrana C, Villemonteix J, Brissard M, Quiney C, Bernard S, Davi F, Thieblemont C, Hoang-Xuan K, Leblond V, Merle-Beral H, Le Garff-Tavernier M. Cerebrospinal fluid interleukin (IL)-10 and IL-10:IL-6 ratio as biomarkers for small B-cell lymphoproliferations with leptomeningeal dissemination. Semin Hematol 2017; 55:179-181. [PMID: 30502843 DOI: 10.1053/j.seminhematol.2017.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 11/11/2022]
Abstract
We here report for the first time that low levels of interleukin (IL)-10 do not exclude lymphomatous meningitis (LM) in B-cell lymphoproliferative disorders (CLPD). Unexpectedly, IL-10 levels and IL-10:IL-6 ratio in CLPD differed from the levels observed in diffuse large B-cell lymphoma (DLBCL). We report the usefulness of adding the IL-10:IL-6 ratio in order to potentially reveal more aggressive lymphomas: either a transformation or an association with another "hidden" lymphoma such as primary CNS lymphoma (PCNSL).
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Affiliation(s)
- Myrto Costopoulos
- Department of Biological Hematology, Pitie-Salpetriere Hospital, Paris, France; Sorbonne Universités, UPMC, Paris, France; Centre de Recherche des Cordeliers, Cell Death and Drug Resistance in Lymphoproliferative Disorders, Paris, France.
| | - Rathana Kim
- Department of Biological Hematology, Pitie-Salpetriere Hospital, Paris, France
| | - Sylvain Choquet
- Department of Clinical Hematology, Pitie-Salpetriere Hospital, Paris, France
| | - Karim Maloum
- Department of Biological Hematology, Pitie-Salpetriere Hospital, Paris, France
| | | | - Caroline Algrin
- Department of Clinical Hematology, Pitie-Salpetriere Hospital, Paris, France
| | | | | | - Martine Brissard
- Department of Biological Hematology, Pitie-Salpetriere Hospital, Paris, France
| | - Claire Quiney
- Department of Biological Hematology, Pitie-Salpetriere Hospital, Paris, France
| | - Sophie Bernard
- APHP, Saint-Louis Hospital, Hemato-oncology Department and Paris Cité Sorbonne Diderot 7 University, Paris, France
| | - Frederic Davi
- Department of Biological Hematology, Pitie-Salpetriere Hospital, Paris, France; Sorbonne Universités, UPMC, Paris, France; Centre de Recherche des Cordeliers, Cell Death and Drug Resistance in Lymphoproliferative Disorders, Paris, France
| | - Catherine Thieblemont
- APHP, Saint-Louis Hospital, Hemato-oncology Department and Paris Cité Sorbonne Diderot 7 University, Paris, France
| | - Khe Hoang-Xuan
- Sorbonne Universités, UPMC, Paris, France; Department of Neuro-Oncology, Pitie-Salpetriere Hospital, Paris, France
| | - Veronique Leblond
- Sorbonne Universités, UPMC, Paris, France; Department of Clinical Hematology, Pitie-Salpetriere Hospital, Paris, France
| | - Helene Merle-Beral
- Department of Biological Hematology, Pitie-Salpetriere Hospital, Paris, France; Sorbonne Universités, UPMC, Paris, France; Centre de Recherche des Cordeliers, Cell Death and Drug Resistance in Lymphoproliferative Disorders, Paris, France
| | - Magali Le Garff-Tavernier
- Department of Biological Hematology, Pitie-Salpetriere Hospital, Paris, France; Centre de Recherche des Cordeliers, Cell Death and Drug Resistance in Lymphoproliferative Disorders, Paris, France
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Galicia N, Dégano R, Díez P, González-González M, Góngora R, Ibarrola N, Fuentes M. CSF analysis for protein biomarker identification in patients with leptomeningeal metastases from CNS lymphoma. Expert Rev Proteomics 2017; 14:363-372. [DOI: 10.1080/14789450.2017.1307106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- N. Galicia
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - R. Dégano
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - P. Díez
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - M. González-González
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - R. Góngora
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - N. Ibarrola
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - M. Fuentes
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
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