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Skolka MP, Suanprasert N, Martinez-Thompson JM, King RL, Macon WR, Mauermann ML, Klein CJ, Habermann TM, Johnston PB, Micallef IN, Khurana A, Amrami K, Spinner RJ, Mandrekar J, Dyck PJ, Dyck PJB. Neurologic Clinical, Electrophysiologic, and Pathologic Characteristics of Primary vs Secondary Neurolymphomatosis. Neurology 2024; 103:e209777. [PMID: 39226481 DOI: 10.1212/wnl.0000000000209777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neurolymphomatosis (NL) is characterized by lymphomatous infiltration of the peripheral nervous system presenting as the initial manifestation of a lymphoma (primary NL [PNL]) or in relapse of a known lymphoma (secondary NL [SNL]). This report details and compares the neurologic clinicopathologic characteristics of these 2 groups. METHODS This retrospective study was performed on patients diagnosed with pathologically confirmed NL in nerve between January 1, 1992, and June 31, 2020. Patient clinical characteristics, neurologic examination, imaging studies, EMG, and nerve biopsy data were collected, analyzed, and compared between PNL and SNL. RESULTS A total of 58 patients were identified (34 PNL and 24 SNL). Time from neurologic symptom onset to diagnosis was longer in PNL at 18.5 months compared with 5.5 months in SNL (p = 0.01). Neurologic symptoms were similar in both patient groups and included primarily sensory loss (98%), severe pain (76%), and asymmetric weakness (76%). A wide spectrum of EMG-confirmed different neuropathy patterns were observed, but patients with SNL had increased numbers of mononeuropathies (n = 8) compared with PNL (n = 1, p = 0.01). MRI studies detected NL more frequently (86%) compared with fluorodeoxyglucose (FDG)-PET CT imaging studies (60%) (p = 0.007). Nerve biopsies revealed B-cell lymphoma (PNL n = 32, SNL n = 22), followed by T-cell lymphoma (PNL n = 2, SNL n = 2), with increased demyelination in both groups and increased axonal degeneration (p = 0.01) and multifocal myelinated fiber loss (p = 0.04) significant in SNL vs PNL. Identifying SNL resulted in patient treatment modifications but a worse prognosis compared with PNL (p = 0.025). DISCUSSION While PNL and SNL are both primarily painful and asymmetric neuropathies with axonal and demyelinating features on EMG and nerve biopsy, SNL presents somewhat differently than PNL with fulminant, asymmetric often mononeuropathies better detected on MRI than FDG-PET/CT. The focal pattern of SNL is likely a result of residual cancer cells that evaded initial chemotherapy, which does not cross the blood-nerve barrier, and these cells can later recur and result in fulminant disease. Although still resulting in a poorer prognosis, identifying SNL is important because this changed treatment and management in every SNL case.
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Affiliation(s)
- Michael P Skolka
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Narupat Suanprasert
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Jennifer M Martinez-Thompson
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Rebecca L King
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - William R Macon
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Michelle L Mauermann
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Christopher J Klein
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Thomas M Habermann
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Patrick B Johnston
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Ivana N Micallef
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Arushi Khurana
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Kimberly Amrami
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Robert J Spinner
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Jay Mandrekar
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - Peter J Dyck
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
| | - P James B Dyck
- From the Departments of Neurology (M.P.S., J.M.M.-T., M.L.M., C.J.K., P.J.D., P.J.B.D.), Laboratory Medicine and Pathology (R.L.K., W.R.M.), Hematology (T.M.H., P.B.J., I.N.M., A.K.), Radiology (K.A.), Neurosurgery (R.J.S.), and Quantitative Health Sciences (J.M.), Mayo Clinic, Rochester, MN; and Neurological Institute of Thailand (N.S.), Bangkok
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Zhang H, Chen S, Li J, Yang H, Luo YB. Primary neurolymphomatosis with MAG antibody: a case report. BMC Neurol 2024; 24:320. [PMID: 39237863 PMCID: PMC11375887 DOI: 10.1186/s12883-024-03798-7] [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: 11/04/2023] [Accepted: 01/28/2024] [Indexed: 09/07/2024] Open
Abstract
Neurolymphomatosis (NL) is a rare neurologic manifestation of non-Hodgkin lymphoma (NHL) with poor prognosis. Investigations including MRI, PET/CT, nerve biopsy and cerebrospinal fluid (CSF) analysis can aid the diagnosis of NL. In this study, we presented a case of NL with co-existing myelin-associated glycoprotein (MAG) antibody. The patient first presented with symptoms of peripheral neuropathy involving multiple cranial nerves and cauda equina, and later developed obstructive hydrocephalus and deep matter lesions. He also had persistently positive MAG antibody, but did not develop electrophysiologically proven neuropathy and monoclonal immunoglobulin. The final brain biopsy confirmed diffuse large B cell lymphoma.
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Affiliation(s)
- Honglian Zhang
- Department of neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Department of Neurology, Xiangya Hospital, Central South University, Jiangxi, National Regional Center for Neurological Diseases, Nanchang, 330000, Jiangxi, China
| | - Si Chen
- Department of Neurology, Xiangya Hospital Central South University, Changsha, 410000, Hunan, China
| | - Jing Li
- Department of Neurology, Xiangya Hospital Central South University, Changsha, 410000, Hunan, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital Central South University, Changsha, 410000, Hunan, China
| | - Yue-Bei Luo
- Department of Neurology, Xiangya Hospital Central South University, Changsha, 410000, Hunan, China.
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Assayag E, Semionov A, Rappoport D. Monocular Blurred Vision and Ipsilateral Facial Numbness as Presenting Symptoms in a Child With Disseminated Burkitt Lymphoma. J Neuroophthalmol 2024:00041327-990000000-00712. [PMID: 39231611 DOI: 10.1097/wno.0000000000002255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Affiliation(s)
- Elishai Assayag
- Department of Ophthalmology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Kaulen LD, Hielscher T, Doubrovinskaia S, Hoffmann DC, Kessler T, Traub BL, Baehring JM, Wick W. Clinical Presentation, Management, and Outcome in Neurolymphomatosis: A Systematic Review. Neurology 2024; 103:e209698. [PMID: 39102613 DOI: 10.1212/wnl.0000000000209698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neurolymphomatosis (NL) refers to lymphomatous infiltration of the peripheral nervous system (PNS). NL diagnosis and treatment are challenging given the broad differential diagnosis of peripheral neuropathy, the lack of larger cohorts, and the subsequent unavailability of prognostic factors or consensus therapy. This study aimed to define characteristics and prognostic factors of NL. METHODS A systematic review of the literature (2004-2023) was performed using PubMed and Scopus databases and reported following PRISMA guidelines. Studies reporting individual patient data on cases with definitive NL diagnosis were included. Clinical, radiologic, pathologic, and outcome information were extracted. Univariable and multivariable survival analyses were performed using log-rank tests and Cox proportional hazard models. RESULTS A total of 459 NL cases from 264 studies were accumulated. NL was the first manifestation of malignancy (primary NL) in 197 patients. PNS relapse of known non-Hodgkin lymphoma (secondary NL) occurred in 262 cases after a median 12 months. NL predominantly presented with rapidly deteriorating, asymmetric painful polyneuropathy. Infiltrated structures included peripheral nerves (56%), nerve roots (52%), plexus (33%), and cranial nerves (32%). Diagnosis was established at a median of 3 months after symptom onset with substantial delays in primary NL. It mainly relied on PNS biopsy or FDG-PET, which carried high diagnostic yields (>90%). Postmortem diagnoses were rare (3%). Most cases were classified as B-cell (90%) lymphomas. Tumor-directed therapy was administered in 96% of patients and typically consisted of methotrexate or rituximab-based polychemotherapy. The median overall survival was 18 months. Primary NL without concurrent systemic disease outside the nervous system (hazard ratio [HR]: 0.44; 95% CI 0.25-0.78; p = 0.005), performance status (ECOG <2, HR: 0.30; 95% CI 0.18-0.52; p < 0.0001), and rituximab-based treatment (HR: 0.46; 95% CI 0.28-0.73; p = 0.001) were identified as favorable prognostic markers on multivariable analysis when adjusting for clinical and sociodemographic parameters. DISCUSSION Advances in neuroimaging modalities, particularly FDG-PET, facilitate NL diagnosis and offer a high diagnostic yield. Yet, diagnostic delays in primary NL remain common. Rituximab-based therapy improves NL outcome. Findings may assist clinicians in early recognition, prognostic stratification, and treatment of NL.
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Affiliation(s)
- Leon D Kaulen
- From the Department of Neurology (L.D.K., S.D., D.C.H., T.K., B.-L.T., W.W.), University Hospital Heidelberg, Heidelberg University; Clinical Cooperation Unit (CCU) Neuro-Oncology (L.D.K., D.C.H., T.K., W.W.), German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research, Heidelberg; Department of Biostatistics (T.H.), German Cancer Research Center (DKFZ), Heidelberg, Germany; and Departments of Neurology and Neurosurgery (J.M.B.), Yale School of Medicine, New Haven, CT
| | - Thomas Hielscher
- From the Department of Neurology (L.D.K., S.D., D.C.H., T.K., B.-L.T., W.W.), University Hospital Heidelberg, Heidelberg University; Clinical Cooperation Unit (CCU) Neuro-Oncology (L.D.K., D.C.H., T.K., W.W.), German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research, Heidelberg; Department of Biostatistics (T.H.), German Cancer Research Center (DKFZ), Heidelberg, Germany; and Departments of Neurology and Neurosurgery (J.M.B.), Yale School of Medicine, New Haven, CT
| | - Sofia Doubrovinskaia
- From the Department of Neurology (L.D.K., S.D., D.C.H., T.K., B.-L.T., W.W.), University Hospital Heidelberg, Heidelberg University; Clinical Cooperation Unit (CCU) Neuro-Oncology (L.D.K., D.C.H., T.K., W.W.), German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research, Heidelberg; Department of Biostatistics (T.H.), German Cancer Research Center (DKFZ), Heidelberg, Germany; and Departments of Neurology and Neurosurgery (J.M.B.), Yale School of Medicine, New Haven, CT
| | - Dirk C Hoffmann
- From the Department of Neurology (L.D.K., S.D., D.C.H., T.K., B.-L.T., W.W.), University Hospital Heidelberg, Heidelberg University; Clinical Cooperation Unit (CCU) Neuro-Oncology (L.D.K., D.C.H., T.K., W.W.), German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research, Heidelberg; Department of Biostatistics (T.H.), German Cancer Research Center (DKFZ), Heidelberg, Germany; and Departments of Neurology and Neurosurgery (J.M.B.), Yale School of Medicine, New Haven, CT
| | - Tobias Kessler
- From the Department of Neurology (L.D.K., S.D., D.C.H., T.K., B.-L.T., W.W.), University Hospital Heidelberg, Heidelberg University; Clinical Cooperation Unit (CCU) Neuro-Oncology (L.D.K., D.C.H., T.K., W.W.), German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research, Heidelberg; Department of Biostatistics (T.H.), German Cancer Research Center (DKFZ), Heidelberg, Germany; and Departments of Neurology and Neurosurgery (J.M.B.), Yale School of Medicine, New Haven, CT
| | - Benjamin-Leon Traub
- From the Department of Neurology (L.D.K., S.D., D.C.H., T.K., B.-L.T., W.W.), University Hospital Heidelberg, Heidelberg University; Clinical Cooperation Unit (CCU) Neuro-Oncology (L.D.K., D.C.H., T.K., W.W.), German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research, Heidelberg; Department of Biostatistics (T.H.), German Cancer Research Center (DKFZ), Heidelberg, Germany; and Departments of Neurology and Neurosurgery (J.M.B.), Yale School of Medicine, New Haven, CT
| | - Joachim M Baehring
- From the Department of Neurology (L.D.K., S.D., D.C.H., T.K., B.-L.T., W.W.), University Hospital Heidelberg, Heidelberg University; Clinical Cooperation Unit (CCU) Neuro-Oncology (L.D.K., D.C.H., T.K., W.W.), German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research, Heidelberg; Department of Biostatistics (T.H.), German Cancer Research Center (DKFZ), Heidelberg, Germany; and Departments of Neurology and Neurosurgery (J.M.B.), Yale School of Medicine, New Haven, CT
| | - Wolfgang Wick
- From the Department of Neurology (L.D.K., S.D., D.C.H., T.K., B.-L.T., W.W.), University Hospital Heidelberg, Heidelberg University; Clinical Cooperation Unit (CCU) Neuro-Oncology (L.D.K., D.C.H., T.K., W.W.), German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research, Heidelberg; Department of Biostatistics (T.H.), German Cancer Research Center (DKFZ), Heidelberg, Germany; and Departments of Neurology and Neurosurgery (J.M.B.), Yale School of Medicine, New Haven, CT
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Shomal Zadeh F, Khan AK, Pooyan A, Alipour E, Azhideh A, Chalian M. Sciatic diffuse large B-cell lymphoma with treatment response to CHOP and radiotherapy. Radiol Case Rep 2024; 19:207-212. [PMID: 38028295 PMCID: PMC10651427 DOI: 10.1016/j.radcr.2023.10.027] [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: 09/14/2023] [Revised: 10/02/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Neurolymphomatosis is an uncommon presentation of lymphoma caused by the infiltration of the peripheral nervous system by lymphoid cells. Here, we describe a case of neurolymphomatosis of the sciatic nerve in 41-year-old woman, which presented by acute onset pain and progress to paresthesia and weakness. Magnetic resonance imaging (MRI) revealed lobulated mass involving the right sciatic nerve with central necrosis and mild surrounding edema, which was isointense on T1-weighted images, hyperintense on short tau inversion recovery (STIR). Positron emission tomography and computed tomography (PET-CT) showed centrally necrotic mass with avid fluorodeoxyglucose (FDG) uptake in the right sciatic nerve. Partial resection of the tumor was done, and the diagnosis of the diffuse large B-cell lymphoma was made and confirmed by bone marrow biopsy. Patient was treated with R-CHOP chemotherapy (regimen consisting of cyclophosphamide, doxorubicin, prednisone, rituximab, and vincristine) and radiotherapy.
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Affiliation(s)
- Firoozeh Shomal Zadeh
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Ayimen Khalid Khan
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Atefe Pooyan
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Ehsan Alipour
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Arash Azhideh
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
| | - Majid Chalian
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105, USA
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Ponzo G, Umana GE, Valastro M, Giuffrida M, Tranchina MG, Nicoletti GF, Scalia G. Cervical radiculopathy as first presentation of CD3-positive diffuse large B-cell lymphoma of the cervico-thoracic junction. Br J Neurosurg 2023; 37:1190-1193. [PMID: 33012208 DOI: 10.1080/02688697.2020.1828278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 09/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) in rare cases can presents an unusual expression of CD3 T-cell specific antigen. We report the first case of a CD3-positive DLBCL of the cervico-thoracic junction presenting with persistent cervical radiculopathy. CASE PRESENTATION A 74-years-old male patient presented a severe and persistent right C8 radiculopathy associated with right-sided neck pain, progressive numbness and weakness of the right arm. The symptoms prominent during the night interfering with sleep and were resistant to anti-inflammatory drugs and cervical orthosis. Spine MRI showed a solid hypointense lesion on T2-weighted images and hyperintense on STIR sequences involving the epidural space at C7, T1 and T2. The patient underwent a C7-T1 decompressive laminectomy and left T2 hemilaminectomy with resection of the epidural tissue resulting in subtotal removal. Histology showed a DLBCL germinal center B-cell lymphoma with expression of CD3 T-cell specific antigen. Then the patient underwent adjuvant radiotherapy and chemotherapy consisting of R-CHOP protocol. At last follow-up (2 years) the patient is still in good clinical status (KPS = 80) with almost complete recovery of the cervical radiculopathy. CONCLUSIONS To our knowledge this is the first case of DLBLC GCB-like CD3 positive to present with radiculopathy.
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Affiliation(s)
- Giancarlo Ponzo
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Cannizzaro Hospital, Trauma Center, Gamma Knife Center, Catania, Italy
| | - Maurizio Valastro
- Radiodiagnostic Unit, Highly Specialized Hospital of National Importance "Garibaldi", Catania, Italy
| | - Massimiliano Giuffrida
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | | | | | - Gianluca Scalia
- Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
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Tu W, Gottumukkala RV, Schieda N, Lavallée L, Adam BA, Silverman SG. Perineural Invasion and Spread in Common Abdominopelvic Diseases: Imaging Diagnosis and Clinical Significance. Radiographics 2023; 43:e220148. [PMID: 37319024 DOI: 10.1148/rg.220148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Malignancies and other diseases may spread by multiple pathways, including direct extension, hematogenous spread, or via lymphatic vessels. A less-well-understood route is the peripheral nervous system, which is known as perineural spread (PNS). In addition to accounting for pain and other neurologic symptoms, PNS affects both disease prognosis and management. Although PNS is commonly discussed in relation to head and neck tumors, there is emerging data regarding PNS in abdominopelvic malignancies and other conditions such as endometriosis. Due to improved contrast and spatial resolution, perineural invasion, a finding heretofore diagnosed only at pathologic examination, can be detected at CT, MRI, and PET/CT. PNS most commonly manifests as abnormal soft-tissue attenuation extending along neural structures, and diagnosis of it is aided by optimizing imaging parameters, understanding pertinent anatomy, and becoming familiar with the typical neural pathways of spread that largely depend on the disease type and location. In the abdomen, the celiac plexus is a central structure that innervates the major abdominal organs and is the principal route of PNS in patients with pancreatic and biliary carcinomas. In the pelvis, the lumbosacral plexus and inferior hypogastric plexus are the central structures and principal routes of PNS in patients with pelvic malignancies. Although the imaging findings of PNS may be subtle, a radiologic diagnosis can have a substantial effect on patient care. Knowledge of anatomy and known routes of PNS and optimizing imaging parameters is of utmost importance in providing key information for prognosis and treatment planning. © RSNA, 2023 Supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Wendy Tu
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Ravi V Gottumukkala
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Luke Lavallée
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin A Adam
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Stuart G Silverman
- From the Department of Radiology and Diagnostic Imaging (W.T.) and Department of Laboratory Medicine and Pathology (B.A.A.), University of Alberta, 116 St & 85 Ave, Edmonton, AB, Canada T6G 2R3; Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Mass (R.V.G., S.G.S.); and Departments of Radiology (N.S.) and Urology (L.L.), University of Ottawa, Ottawa, Ontario, Canada
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8
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Ducatel P, Michaud M, Viala K, Leblond V, Charlotte F, Roos-Weil D, Benoit C, Debs R, Maisonobe T. Neurolymphomatosis: involvement of peripheral nervous system revealing hematologic malignancy, a report of nine cases. J Peripher Nerv Syst 2023. [PMID: 36861226 DOI: 10.1111/jns.12541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/19/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND AND AIM Neurolymphomatosis is defined as an infiltration of the peripheral nervous system (PNS) by malignant lymphoma cells. It is a rare entity and diagnosis is complicated especially when PNS involvement is the initial and leading symptom. To improve knowledge of the disorder and shorten the time to diagnosis, we report a series of nine patients without a history of hematologic malignancy, who were diagnosed with neurolymphomatosis after evaluation and workup of peripheral neuropathy. METHODS The patients were included from the Department of Clinical Neurophysiology at Pitié Salpêtrière and Nancy Hospitals over a period of 15 years. Diagnosis of neurolymphomatosis was confirmed by histopathologic examination for each patient. We characterized their clinical, electrophysiological, biological, imaging, and histopathologic features. RESULTS The neuropathy was characterized by pain (78%), proximal involvement (44%) or of all four limbs (67%), asymmetrical or with multifocal distribution (78%), abundant fibrillation (78%), a tendency to worsen rapidly, and significant associated weight loss (67%). Neurolymphomatosis was diagnosed principally on nerve biopsy (89%) identifying infiltration of lymphoid cells, atypical cells (78%), a monoclonal population (78%), and supported by fluorodeoxyglucose-positron emission tomography, spine or plexus MRI, cerebrospinal fluid analysis, and blood lymphocyte immunophenotyping. Six patients had systemic disease and three impairment limited to the PNS. In the latter case, progression could be unpredictable and may be diffuse and explosive, sometimes occurring years after a seemingly indolent course. INTERPRETATION This study provides better knowledge and understanding of neurolymphomatosis when neuropathy is the initial presentation.
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Affiliation(s)
- Pauline Ducatel
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Maud Michaud
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Karine Viala
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Véronique Leblond
- Département d'Hématologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Frédéric Charlotte
- Département d'Anatomopathologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Damien Roos-Weil
- Département d'Hématologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Charline Benoit
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Rabab Debs
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Thierry Maisonobe
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Département de Neuropathologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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9
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Gupta M, Pasricha S, Ahmed R, Choudhury PS. A Case Series of Neurolymphomatosis: Role of Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Scan Reiterated. Indian J Nucl Med 2023; 38:44-49. [PMID: 37180178 PMCID: PMC10171769 DOI: 10.4103/ijnm.ijnm_165_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 02/25/2023] Open
Abstract
Neurolymphomatosis is rarely encountered in high-grade lymphomas. In this case series, we retrospectively analyzed six neurolymphomatosis cases to look for possible risk factors, common and uncommon presentations, and the lessons learned. Neuropathic pain was the most common symptom with mono or polyradiculopathy in this series. However, all lymphomatous infiltrated nerves diagnosed on fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) were not symptomatic. The lumbar, brachial plexus, and trigeminal nerve were the most common sites and were depicted well on FDG PET/CT. Magnetic resonance imaging (MRI) of the brain better delineates cranial nerves and meningeal involvement. Cerebrospinal fluid flow cytometry was normal until meninges were involved. FDG PET/CT incrementally evaluated extra-neural disease sites, thus helping in deciding biopsy sites and further management. We concluded that a whole-body FDG PET/CT including limbs with MRI brain was the appropriate investigation for evaluating suspected neurolymphomatosis in advanced-stage diffuse large B-cell lymphoma.
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Affiliation(s)
- Manoj Gupta
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sunil Pasricha
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Rayaz Ahmed
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Partha Sarathi Choudhury
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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10
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Isolated Primary Neurolymphomatosis in the Right Brachial Plexus Proven by Partial Nerve Biopsy. Neurologist 2022:00127893-990000000-00043. [DOI: 10.1097/nrl.0000000000000471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Okamura‐Shiki I, Asakura K, Ikeda T. Neurolymphomatosis as a manifestation of relapsed diffuse large B-cell lymphoma. EJHAEM 2022; 3:1396-1397. [PMID: 36467846 PMCID: PMC9713069 DOI: 10.1002/jha2.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Ikue Okamura‐Shiki
- Division of Haematology and Stem Cell TransplantationShizuoka Cancer CenterShizuokaJapan
| | - Koiku Asakura
- Division of Diagnostic RadiologyShizuoka Cancer CentreShizuokaJapan
| | - Takashi Ikeda
- Division of Haematology and Stem Cell TransplantationShizuoka Cancer CenterShizuokaJapan
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12
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Arçay A, Bural GG, Şenol U. Neurolymphomatosis with Spinal Nerve Root Involvement Demonstrated on 18F-FDG PET/CT. Mol Imaging Radionucl Ther 2022; 31:242-243. [PMID: 36268937 PMCID: PMC9585998 DOI: 10.4274/mirt.galenos.2021.05902] [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] [Indexed: 12/01/2022] Open
Abstract
A 56 years old woman with a diagnosis of diffuse large B-cell lymphoma had dyspnea, weakness in the left upper extremity and vocal cord paralysis after chemotherapy. She underwent cervical, thoracal and lumbosacral magnetic resonance imaging (MRI) however findings on MRI could not entirely explain the symptoms of the patient. Therefore, the patient underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography and the scan revealed focal symmetrical 18F-FDG uptake on the cervical, thoracal and lumbal spinal nerve roots. Considering the symptoms of the patient and cerebrospinal fluid cytology findings, hypermetabolic spinal nerve roots were interpreted as lymphoma involvement.
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Affiliation(s)
- Ayça Arçay
- Akdeniz University Faculty of Medicine, Department of Nuclear Medicine, Antalya, Turkey
| | - Gonca Gül Bural
- Akdeniz University Faculty of Medicine, Department of Nuclear Medicine, Antalya, Turkey
| | - Utku Şenol
- Akdeniz University Faculty of Medicine, Department of Radiology, Antalya, Turkey
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13
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Cerri F, Gentile F, Clarelli F, Santoro S, Falzone YM, Dina G, Romano A, Domi T, Pozzi L, Fazio R, Podini P, Sorosina M, Carrera P, Esposito F, Riva N, Briani C, Cavallaro T, Filippi M, Quattrini A. Clinical and pathological findings in neurolymphomatosis: Preliminary association with gene expression profiles in sural nerves. Front Oncol 2022; 12:974751. [PMID: 36226068 PMCID: PMC9549065 DOI: 10.3389/fonc.2022.974751] [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: 06/21/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Although inflammation appears to play a role in neurolymphomatosis (NL), the mechanisms leading to degeneration in the peripheral nervous system are poorly understood. The purpose of this exploratory study was to identify molecular pathways underlying NL pathogenesis, combining clinical and neuropathological investigation with gene expression (GE) studies. We characterized the clinical and pathological features of eight patients with NL. We further analysed GE changes in sural nerve biopsies obtained from a subgroup of NL patients (n=3) and thirteen patients with inflammatory neuropathies as neuropathic controls. Based on the neuropathic symptoms and signs, NL patients were classified into three forms of neuropathy: chronic symmetrical sensorimotor polyneuropathy (SMPN, n=3), multiple mononeuropathy (MN, n=4) and acute motor-sensory axonal neuropathy (AMSAN, n=1). Predominantly diffuse malignant cells infiltration of epineurium was present in chronic SMPN, whereas endoneurial perivascular cells invasion was observed in MN. In contrast, diffuse endoneurium malignant cells localization occurred in AMSAN. We identified alterations in the expression of 1266 genes, with 115 up-regulated and 1151 down-regulated genes, which were mainly associated with ribosomal proteins (RP) and olfactory receptors (OR) signaling pathways, respectively. Among the top up-regulated genes were actin alpha 1 skeletal muscle (ACTA1) and desmin (DES). Similarly, in NL nerves ACTA1, DES and several RPs were highly expressed, associated with endothelial cells and pericytes abnormalities. Peripheral nerve involvement may be due to conversion towards a more aggressive phenotype, potentially explaining the poor prognosis. The candidate genes reported in this study may be a source of clinical biomarkers for NL.
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Affiliation(s)
- Federica Cerri
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Gentile
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Ferdinando Clarelli
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Santoro
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Yuri Matteo Falzone
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giorgia Dina
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Romano
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Teuta Domi
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Laura Pozzi
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Fazio
- Department of Neurology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Paola Podini
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Melissa Sorosina
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Paola Carrera
- Division of Genetics and Cell Biology and Laboratory of Clinical Molecular Biology and Cytogenetics, Unit of Genomics for Human Disease Diagnosis, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Federica Esposito
- Department of Neurology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Laboratory of Human Genetics of Neurological Disorders, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Nilo Riva
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- *Correspondence: Nilo Riva, ; Angelo Quattrini,
| | - Chiara Briani
- Department of Neuroscience , University of Padova, Padova, Italy
| | - Tiziana Cavallaro
- Department of Neurology, Azienda Ospedaliera Universitaria Integrata, University Hospital G.B. Rossi, Verona, Italy
| | - Massimo Filippi
- Department of Neurology, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS Ospedale San Raffaele Scientific Institute, Milan, Italy
- *Correspondence: Nilo Riva, ; Angelo Quattrini,
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14
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van Koulil Q, Santifort KM, Beukers M, Ioannidis M, Van Soens I. Neurolymphomatosis in a cat with diffuse neuromuscular signs including cranial nerve involvement. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Quinten van Koulil
- Evidensia Small Animal Hospital ‘Hart van Brabant’ Waalwijk The Netherlands
| | - Koen M. Santifort
- Evidensia Small Animal Hospital ‘Hart van Brabant’ Waalwijk The Netherlands
- Evidensia Small Animal Hospital Arnhem Arnhem The Netherlands
| | - Martijn Beukers
- Evidensia Small Animal Hospital ‘Hart van Brabant’ Waalwijk The Netherlands
| | - Marianthi Ioannidis
- Veterinary Pathology Diagnostic Centre, Faculty of Veterinary Medicine University of Utrecht Utrecht The Netherlands
| | - Iris Van Soens
- Evidensia Small Animal Hospital ‘Hart van Brabant’ Waalwijk The Netherlands
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15
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Bordeau K, Eberlé MC, Fabbro M, Fersing C, Deshayes E. Lumbosacral Plexus Neurolymphomatosis: A Typical 18FDG PET/CT Pattern to Recognize. Clin Nucl Med 2022; 47:352-353. [PMID: 34739401 DOI: 10.1097/rlu.0000000000003949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 79-year-old man anteriorly treated for primary central nervous system diffuse large B-cell lymphoma with MRI complete response after immunochemotherapy was referred 1 year later for 18FDG PET/CT because of right persistent lombosciatic radicular pain for 6 months with negative medullary and spine MRI and negative cerebrospinal fluid cytology. Linearly intense uptake was observed in several roots of lumbosacral plexus, highly suggestive of peripheral neurolymphomatosis relapse. No specific treatment was engaged because of rapid decrease of performance status leading to death.
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Affiliation(s)
| | | | - Michel Fabbro
- Medical Oncology, Institut Régional du Cancer de Montpellier, Université de Montpellier
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16
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Gelezhe P, Medvedeva A. A case of neurolymphomatosis. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:150-153. [DOI: 10.17116/jnevro2022122081150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Valaiyapathy NC, Mohan VS, Priya RR, Sarala S, Bhargavi D, Chandra VVR, Kalawat TC. F-18 Fluorodeoxyglucose Positron Emission Tomography Computed Tomography Findings in an Interesting Case of Primary Cauda Equina Lymphoma with Literature Review. Indian J Nucl Med 2021; 36:425-428. [PMID: 35125761 PMCID: PMC8771067 DOI: 10.4103/ijnm.ijnm_75_21] [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: 06/01/2021] [Revised: 07/12/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022] Open
Abstract
Primary lymphomatous involvement of spinal cord, nerve roots, and cauda equina is a rare entity and comprises only 0.1% of extra-nodal lymphoma spectrum. Here, we present a case of non-Hodgkin lymphoma involving cauda equina, initially suspected as ependymoma on magnetic resonance imaging that was later confirmed on nerve root biopsy as high B cell non-Hodgkin's lymphoma of L1-S1 nerve roots. F-18 fluorodeoxyglucose positron emission tomography-computed tomography was performed for staging workup which showed abnormal metabolic activity within the spinal canal from D10-S2 with no evidence of distant organ involvement.
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Affiliation(s)
- N C Valaiyapathy
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V Saikrishna Mohan
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - R Ramya Priya
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - S Sarala
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - D Bhargavi
- Department of Medical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V V Ramesh Chandra
- Department of Neurosurgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Tek Chand Kalawat
- Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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18
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Lee YC, Huang GS, Chang WC, Hsu YC. Fried egg sign: A typical ultrasonography feature of neurolymphomatosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:878-880. [PMID: 34145594 DOI: 10.1002/jcu.23029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 06/12/2023]
Abstract
Neurolymphomatosis (NL) is a rare condition caused by non-Hodgkin's lymphoma or leukemia. We present a case of NL and describe ultrasound features, including the "fried egg sign" in which there is a clear demarcation between an avascular echogenic core and a hypoechoic vascularized peripheral zone that may help to distinguish NL from primary nerve sheath tumors.
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Affiliation(s)
- Ying-Chieh Lee
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Department of Radiology, SongShan Armed Forces General Hospital, Taipei, Taiwan, ROC
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yi-Chih Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
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19
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Murthy NK, Amrami KK, Broski SM, Johnston PB, Spinner RJ. Perineural spread of peripheral neurolymphomatosis to the cauda equina. J Neurosurg Spine 2021:1-6. [PMID: 34598154 DOI: 10.3171/2021.4.spine21344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurolymphomatosis (NL) is a rare manifestation of lymphoma confined to the peripheral nervous system that is poorly understood. It can be found in the cauda equina, but extraspinal disease can be underappreciated. The authors describe how extraspinal NL progresses to the cauda equina by perineural spread and the implications of this on timely and safe diagnostic options. METHODS The authors used the Mayo Clinic medical records database to find cases of cauda equina NL with sufficient imaging to characterize the lumbosacral plexus diagnosed from tissue biopsy. Demographics (sex, age), clinical data (initial symptoms, cerebrospinal fluid, evidence of CNS involvement, biopsy location, primary or secondary disease), and imaging findings were reviewed. RESULTS Ten patients met inclusion and exclusion criteria, and only 2 of 10 patients presented with cauda equina symptoms at the time of biopsy, with 1 patient undergoing a cauda equina biopsy. Eight patients were diagnosed with diffuse large B-cell lymphoma, 1 with low-grade B-cell lymphoma, and 1 with mantle cell lymphoma. Isolated spinal nerve involvement was identified in 5 of 10 cases, providing compelling evidence regarding the pathophysiology of NL. The conus medullaris was not radiologically involved in any case. Lumbosacral plexus MRI was able to identify extraspinal disease and offered diagnostically useful biopsy targets. FDG PET/CT was relatively insensitive for detecting disease in the cauda equina but was helpful in identifying extraspinal NL. CONCLUSIONS The authors propose that perineural spread of extraspinal NL to infiltrate the cauda equina occurs in two phases. 1) There is proximal and distal spread along a peripheral nerve, with eventual spread to anatomically connected nerves via junction and branch points. 2) The tumor cells enter the spinal canal through corresponding neural foramina and propagate along the spinal nerves composing the cauda equina. To diffusely infiltrate the cauda equina, a third phase occurs in which tumor cells can spread circumdurally to the opposite side of the spinal canal and enter contralateral nerve roots extending proximally and distally. This spread of disease can lead to diffuse bilateral spinal nerve disease without diffuse leptomeningeal spread. Recognition of this phasic mechanism can lead to identification of safer extraspinal biopsy targets that could allow for greater functional recovery after appropriate treatment.
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Affiliation(s)
| | | | | | - Patrick B Johnston
- 3Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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20
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Ghosh S, Azzi J, Chan AM, Nael K, Renteria AS, Steinberg A, Petersen BE. Primary Extranodal NK/T-Cell Lymphoma Presenting as Neurolymphomatosis Involving Multiple Cranial Nerves: A Case Report. Acta Haematol 2021; 145:97-105. [PMID: 34569490 DOI: 10.1159/000518797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022]
Abstract
Neurolymphomatosis (NL) is a rare condition caused by the lymphomatous or leukemic infiltration of nerves and manifests as neuropathy. Most often, NL is associated with B-lineage non-Hodgkin lymphoma (NHL) and only infrequently occurs in conjunction with T- or NK-lineage NHL. Extranodal NK/T-cell lymphoma (ENKTL)-associated NL is exceedingly unusual, with only 9 cases described in the English language literature, in addition to our case. Diagnosis of NL is challenging, as the entity can mimic neuropathies of more common etiologies, and an adequate biopsy may be difficult to obtain. Timely diagnosis demands a high index of suspicion, especially for patients without a history of hematologic malignancy. We expand upon a unique case of NL exclusively involving cranial nerves and cauda equina nerve roots, as the initial manifestation of ENKTL, and contextualize our findings within the framework of previously reported NK/T-lineage NL cases.
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Affiliation(s)
- Sharmila Ghosh
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacques Azzi
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy M Chan
- Department of Medical Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anne S Renteria
- Acute Leukemia & Stem Cell Transplant and Cellular Therapy Programs, Lipson Cancer Institute at Rochester Regional Health, Rochester, New York, USA
| | - Amir Steinberg
- Bone Marrow Transplant Program, Westchester Medical Center, Hawthorne, New York, USA
| | - Bruce E Petersen
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Aboueldahab N, Shafik MA, Megahed A, Vesselle H. Neurolymphomatosis; a case report. Clin Imaging 2021; 80:329-333. [PMID: 34488168 DOI: 10.1016/j.clinimag.2021.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 07/15/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022]
Abstract
We present a case of indolent neurolymphomatosis in a 55-year-old male patient with worsening pain and weakness in his right leg over the past few months. The patient has a past medical history of type II diabetes mellitus, four-year history of worsening left foot drop, left lower limb pain and weakness attributed to diabetic amyotrophy, and back pain. The new right-sided symptoms prompted further imaging which revealed a left sciatic nerve mass which was biopsied. Initial biopsy results were inconclusive. 18F-FDG PET/CT revealed the full extent of this patient's disease and helped plan for a more representative biopsy site, which finally established a diagnosis of diffuse large B-cell lymphoma involving the lumbosacral nerve roots. The patient underwent a course of chemotherapy. 18F-FDG PET/CT was ordered again at the end of treatment showing partial response to therapy. He underwent radiation therapy to the site of residual disease, with complete metabolic response of lesions on follow up PET CT.
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Affiliation(s)
| | | | - Ayah Megahed
- Yale New Haven Health-Bridgeport Hospital, United States of America
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22
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Hsu CH, Yang CS, Chen YJ, Lin TL. Primary neurolymphomatosis in extranodal natural killer/T-cell lymphoma diagnosed by skin biopsy. Leuk Lymphoma 2021; 63:247-249. [PMID: 34448429 DOI: 10.1080/10428194.2021.1971221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chung-Hao Hsu
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chi-Shun Yang
- Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan
| | - Teng-Li Lin
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
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Abstract
Autoimmune neurogenic dysphagia refers to manifestation of dysphagia due to autoimmune diseases affecting muscle, neuromuscular junction, nerves, roots, brainstem, or cortex. Dysphagia is either part of the evolving clinical symptomatology of an underlying neurological autoimmunity or occurs as a sole manifestation, acutely or insidiously. This opinion article reviews the autoimmune neurological causes of dysphagia, highlights clinical clues and laboratory testing that facilitate early diagnosis, especially when dysphagia is the presenting symptom, and outlines the most effective immunotherapeutic approaches. Dysphagia is common in inflammatory myopathies, most prominently in inclusion body myositis, and is frequent in myasthenia gravis, occurring early in bulbar-onset disease or during the course of progressive, generalized disease. Acute-onset dysphagia is often seen in Guillain–Barre syndrome variants and slowly progressive dysphagia in paraneoplastic neuropathies highlighted by the presence of specific autoantibodies. The most common causes of CNS autoimmune dysphagia are demyelinating and inflammatory lesions in the brainstem, occurring in patients with multiple sclerosis and neuromyelitis optica spectrum disorders. Less common, but often overlooked, is dysphagia in stiff-person syndrome especially in conjunction with cerebellar ataxia and high anti-GAD autoantibodies, and in gastrointestinal dysmotility syndromes associated with autoantibodies against the ganglionic acetyl-choline receptor. In the setting of many neurological autoimmunities, acute-onset or progressive dysphagia is a potentially treatable condition, requiring increased awareness for prompt diagnosis and early immunotherapy initiation.
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Clinical manifestations of, diagnostic approach to, and treatment of neurolymphomatosis in the rituximab era. Blood Adv 2021; 5:1379-1387. [PMID: 33661298 DOI: 10.1182/bloodadvances.2020003666] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/19/2021] [Indexed: 12/31/2022] Open
Abstract
Neurolymphomatosis (NL) is a rare manifestation of lymphoma, with limited evidence for optimal management. The largest patient series, 50 cases of lymphoma and leukemia, was published in 2010 with limited rituximab exposure. This study aims to evaluate the clinical presentation, diagnostic testing, and outcomes of NL in the rituximab era. Forty biopsy-proven cases of NL, in association with non-Hodgkin lymphoma (NHL), at the Mayo Clinic were retrospectively evaluated. B-cell NHL was associated with 97% of NL cases, of which diffuse large B-cell lymphoma (DLBCL) was the most common (68%). Primary NL, defined as neural involvement present at the time of diagnosis of lymphoma, was noted in 52% cases. Seventy percent of patients presented with sensorimotor weakness and neuropathic pain. Magnetic resonance imaging (MRI) was positive in 100% patients. Overall survival (OS) was significantly better for primary NL and NL associated with indolent lymphomas. Relapses were seen in 60% (24/40) of patients; 75% involved the peripheral or central nervous system at relapse. The use of rituximab in the frontline setting significantly impacted progression-free survival (PFS). Transplant consolidation was noted to be associated with improved OS. This study adds to the available literature on NL in the rituximab era. The overall outcomes have improved in recent years. In our experience, MRI and positron emission tomography/computed tomography may be required for accurate assessment of the extent of disease involvement and identification of an optimal biopsy site. The use of rituximab was associated with improvement in PFS, and autologous stem cell transplant was associated with OS.
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25
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Lefland A, Proia AD, Shah S. Clinical Reasoning: A 64-Year-Old Man With Multiple Cranial Neuropathies. Neurology 2021; 97:e215-e221. [PMID: 33893198 DOI: 10.1212/wnl.0000000000012081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ariel Lefland
- From the Departments of Neurology (A.L., S.S.) and Pathology and Ophthalmology (A.D.P.), Duke University Medical Center, Durham; and Department of Pathology (A.D.P.), Campbell University School of Osteopathic Medicine, Lillington, NC.
| | - Alan D Proia
- From the Departments of Neurology (A.L., S.S.) and Pathology and Ophthalmology (A.D.P.), Duke University Medical Center, Durham; and Department of Pathology (A.D.P.), Campbell University School of Osteopathic Medicine, Lillington, NC
| | - Suma Shah
- From the Departments of Neurology (A.L., S.S.) and Pathology and Ophthalmology (A.D.P.), Duke University Medical Center, Durham; and Department of Pathology (A.D.P.), Campbell University School of Osteopathic Medicine, Lillington, NC
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26
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Fantaconi N, Walker JJA, Ives EJ. What Is Your Neurologic Diagnosis? J Am Vet Med Assoc 2021; 257:1013-1016. [PMID: 33135979 DOI: 10.2460/javma.2020.257.10.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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27
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Mechanisms of Nerve Damage in Neuropathies Associated with Hematological Diseases: Lesson from Nerve Biopsies. Brain Sci 2021; 11:brainsci11020132. [PMID: 33498362 PMCID: PMC7909400 DOI: 10.3390/brainsci11020132] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 12/15/2022] Open
Abstract
Despite the introduction of non-invasive techniques in the study of peripheral neuropathies, sural nerve biopsy remains the gold standard for the diagnosis of several neuropathies, including vasculitic neuropathy and neurolymphomatosis. Besides its diagnostic role, sural nerve biopsy has helped to shed light on the pathogenic mechanisms of different neuropathies. In the present review, we discuss how pathological findings helped understand the mechanisms of polyneuropathies complicating hematological diseases.
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Jeong J, Kim SW, Sung DH. Neurolymphomatosis: a single-center experience of neuromuscular manifestations, treatments, and outcomes. J Neurol 2020; 268:851-859. [PMID: 33098033 DOI: 10.1007/s00415-020-10202-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Neurolymphomatosis (NL) is a disease characterized by the infiltration of malignant lymphocytes into the peripheral nervous system. We report clinical features, radiographic findings, modes of treatment, and outcomes of patients with NL. METHODS We retrospectively investigated patients with NL. We extracted data, including clinical features, magnetic resolution imaging (MRI), 18F-fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans, cerebrospinal fluid cytology findings, the results of electrodiagnostic studies, as well as patient treatments and outcomes. RESULTS Ten NL patients were identified. All patients reported pain/paresthesia and weakness in the affected area. The MRI scans were abnormal in eight out of nine patients with an enhancement of the spinal nerve root, plexus, peripheral nerve trunk, and cranial nerve. The FDG PET/CT scans were positive in all patients. Radiculopathy or radiculoplexopathy was the most common electrodiagnostic finding. Neurological improvement was observed in only three patients. The condition of the nine patients who underwent multimodality treatments for cancer eventually deteriorated and the patients died. CONCLUSIONS NL should be considered in the differential diagnosis of any type of neuropathy in patients with lymphoma. Because it could be confused with other neuropathies in lymphoma and various musculoskeletal diseases, a high index of suspicion and familiarity with clinical manifestation of NL are key. FDG PET/CT was the most sensitive diagnostic imaging modality to detect relevant neural invasion. The root within the spinal neural foramen was the most frequently affected neural structure. Early diagnosis of this rare neurologic manifestation of lymphoma may improve treatment outcomes.
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Affiliation(s)
- Jisun Jeong
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Sun Woong Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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Rastogi P, Singh H, Gupta P, Bal A, Dutta U, Gupta N. Extra-hepatic biliary obstruction due to diffuse large B-cell lymphoma: an autopsy case report with unattended yet significant pathologies. Clin J Gastroenterol 2020; 14:269-274. [PMID: 32996112 DOI: 10.1007/s12328-020-01252-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
Autopsy practice has been an invaluable tool to understand the pathobiology of various disease processes. We herein have given the description of a case of malignant extra-hepatic biliary obstruction secondary to a diffuse large B-cell lymphoma. The patient disease could only be adequately characterized at autopsy in the form of exact origin and subtyping of lymphoma. The autopsy revealed certain unattended and exciting, yet significant pathological findings in the form of portal vein thrombosis, neurolymphomatosis, the exact track of the lymphomatous cells from abdominal to thoracic cavity, and the terminal events which led to the patient's demise. The plausible clinical correlates of these pathological findings have been discussed. This can serve as a useful clue to the clinicians for managing such cases in the future.
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Affiliation(s)
- Pulkit Rastogi
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Room no. 503, Level 5, Research Block A, Chandigarh, India, 160012.
| | - Harjeet Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Room no. 503, Level 5, Research Block A, Chandigarh, India, 160012
| | - Usha Dutta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Nalini Gupta
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
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30
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Fatima N, Zaman MU, Zaman A, Zaman SU. Neurolymphomatosis - Rare presentation in non-Hodgkin's lymphoma: The role of 18F-fluorodeoxyglucose positron-emission tomography and computerized tomography imaging. World J Nucl Med 2020; 19:159-161. [PMID: 32939208 PMCID: PMC7478293 DOI: 10.4103/wjnm.wjnm_22_19] [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: 03/16/2019] [Accepted: 07/01/2019] [Indexed: 11/18/2022] Open
Abstract
Neurolymphomatosis (NLS) is infiltration of lymphoma cells into the peripheral or cranial nervous system and is a rare manifestation of non-Hodgkin lymphoma (NHL). Nerve biopsy is considered as the gold standard for diagnosis but not a preferred choice, and magnetic resonance imaging has lower reported sensitivity. 18F-Fluorodeoxyglucose (18FDG) positron-emission tomography and computerized tomography (PET/CT) has a higher sensitivity for diagnosing and assessing the neurological and nonneurological metabolic tumor volume and response evaluation to therapy. We present the case of a lady, known to have NHL in remission. She presented with a short history of severe pain and weakness of the right lower limb. Baseline and interim 18FDG PET/CT played a crucial role in diagnosing and assessing the extent of NLS and nonneurological disease burden and also in evaluation of response to treatment.
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Affiliation(s)
- Nosheen Fatima
- Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Maseeh Uz Zaman
- Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Areeba Zaman
- Department of Medicine, Civil Hospital Karachi, Karachi, Pakistan
| | - Sidra Uz Zaman
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Primary Central Nervous System Lymphoma With Diffuse Neurolymphomatosis Involving Multiple Cranial and Spinal Nerve Roots. Clin Nucl Med 2020; 45:e285-e287. [PMID: 32332304 DOI: 10.1097/rlu.0000000000003018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary central nervous system lymphoma is an extranodal lymphoma originating in the brain, spinal cord, and leptomeninges, which rarely spreads outside the nervous system. Neurolymphomatosis is the term used to describe lymphomatous involvement of the cranial nerves (except optic nerve) and peripheral nerve roots or plexus. We report a case of a 23-year-old man presented with progressive weakness of all 4 limbs. F-FDG PET/CT revealed FDG-avid thickening along the multiple cranial nerve roots, spinal nerve roots, and brain parenchymal lesion. Core biopsy from the peripheral nerve root demonstrated the lymphomatous involvement.
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32
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Briani C, Visentin A, Cerri F, Quattrini A. From pathogenesis to personalized treatments of neuropathies in hematological malignancies. J Peripher Nerv Syst 2020; 25:212-221. [PMID: 32686258 DOI: 10.1111/jns.12405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022]
Abstract
The peripheral nervous system may be involved at any stage in the course of several hematological diseases, the most common being monoclonal gammopathies (of undetermined significance or malignant) or lymphomas. The underlying pathogenic mechanisms are different and therapies aim at targeting the dangerous either B-cell or plasma cell clones. Recently, high-throughput technologies, and next-generation sequencing have increased our knowledge of hematological diseases pathogenesis by the identification of somatic mutation affecting pivotal signaling pathways. Accordingly, new target therapies are used that may also be borrowed for treatment of neuropathies in hematological diseases.
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Affiliation(s)
- Chiara Briani
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Federica Cerri
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
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33
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Campagnolo M, Cacciavillani M, Cavallaro T, Ferrari S, Gasparotti R, Zambello R, Briani C. Neurolymphomatosis, a rare manifestation of peripheral nerve involvement in lymphomas: Suggestive features and diagnostic challenges. J Peripher Nerv Syst 2020; 25:312-315. [PMID: 32627254 DOI: 10.1111/jns.12401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022]
Abstract
Neurolymphomatosis, the infiltration of the peripheral nervous system from lymphoid cells, represents an uncommon manifestation of lymphomas. We describe the challenging diagnostic work-up in a patient with neurolymphomatosis. A 58-year-old woman with previous breast diffuse large B-cell lymphoma treated with chemo- and radiation-therapy, presented with dysesthesias, neuropathic pain at left abdomen and thigh, and weakness at left lower limb 9 years after disease remission. Neurophysiology revealed left T10-L4 radiculo-plexopathy with no abnormalities at cerebrospinal fluid (CSF), nerve ultrasound, and 18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT). MR-neurography disclosed left rectus abdominis muscle atrophy, neurogenic edema, and denervation. Radiation-induced damage, paraneoplastic, infectious radiculo-plexopathies, and atypical chronic inflammatory demyelinating polyradiculoneuropathy were ruled out. Neurolymphomatosis was suspected, and the patient treated with rituximab with improvement. Despite treatment, the radiculo-plexopathy eventually extended to the right side and sacral roots. Later in the disease course, sural nerve biopsy confirmed the diagnosis. Maintenance therapy was continued, until cutaneous localizations occurred, requiring salvage therapy and autologous stem cell transplant. Although rare, neurolymphomatosis should be considered in all patients with lymphomas and unexplained peripheral nervous system involvement. Hematological, CSF, and neuroimaging findings may be unremarkable, and a high index of suspicion required in order to achieve the diagnosis.
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Affiliation(s)
- Marta Campagnolo
- Neurology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Tiziana Cavallaro
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Roberto Gasparotti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Renato Zambello
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neurosciences, University of Padova, Padova, Italy
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Murthy NK, Hébert-Blouin MN, Capek S, Prasad NK, Amrami KK, Spinner RJ. Understanding the Pathognomonic Tumefactive Appearance of Neurolymphomatosis: A Unifying Theory of Neurolymphoma. World Neurosurg 2020; 141:e490-e497. [PMID: 32492544 DOI: 10.1016/j.wneu.2020.05.228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The diagnosis of peripheral neurolymphomatosis (NL) is difficult and often delayed, because patients can have isolated, nonspecific nerve symptoms. Magnetic resonance imaging will usually show nonspecific findings of enlarged, contrast-enhancing nerves. We aimed to elucidate the mechanism behind an imaging finding we believe is pathognomonic of NL and likely of other hematologic diseases with peripheral nerve involvement. METHODS We reviewed the imaging studies of a previously reported cohort of patients, in addition to those from more recent patients, all with tumefactive NL, in which enlarged nerve bundles were surrounded by tumor. We reviewed the demographic data, clinical data (e.g., primary or secondary disease, biopsy-proven diagnosis), and imaging findings (e.g., tumefactive appearance, primary involved nerve, location of epicenter of tumefactive appearance, vascular involvement). RESULTS All cases showed a maximum tumefactive appearance at branch or junction points, with a gradual decrease of this appearance moving proximally and distally from the epicenter in a "crescendo-decrescendo" pattern. We have described this as a phasic mechanism with 3 phases: malignant cells fill the intraneural space; extrude at a weak spot of the nerve, which often occurs at a branch or junction point; and then expand and fill the subparaneurial space, creating the grossly tumefactive appearance with proximal and distal spread. CONCLUSIONS We have presented a novel, unifying theory explaining the pathognomonic tumefactive appearance of NL. Our theory offers the first rational explanation for the radiological appearance of NL with peripheral nerve involvement. We believe that with earlier recognition of NL on imaging studies, patients will be able to receive an earlier diagnosis and undergo earlier treatment.
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Affiliation(s)
- Nikhil K Murthy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Stepan Capek
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Nikhil K Prasad
- Department of Surgery, University of Maryland, Baltimore, Maryland, USA
| | | | - Robert J Spinner
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
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35
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Fitzgerald L, Stephens DM. Burkitt Lymphoma Presenting as Cranial Multineuritis Secondary to Primary Neurolymphomatosis: A Diagnostic Challenge. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2020; 20:e201-e204. [PMID: 32113890 DOI: 10.1016/j.clml.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Affiliation(s)
- Lindsey Fitzgerald
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
| | - Deborah M Stephens
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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36
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Protean Manifestations and Diagnostic Challenges Including Discordance Between Electrodiagnostic-Radiologic Studies in Neurolymphomatosis. Neurologist 2020; 25:4-9. [DOI: 10.1097/nrl.0000000000000245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Bourque PR, Sampaio ML, Warman-Chardon J, Samaan S, Torres C. Neurolymphomatosis of the lumbosacral plexus and its branches: case series and literature review. BMC Cancer 2019; 19:1149. [PMID: 31775683 PMCID: PMC6882218 DOI: 10.1186/s12885-019-6365-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022] Open
Abstract
Background Neurolymphomatosis (NL) is a direct process of invasion of peripheral nerves by lymphoma. It occurs in roughly 5% of patients with lymphoma and represents a particularly difficult diagnostic dilemma when it is the presenting focal manifestation of occult lymphoma. Case presentation We present 3 examples of invasion of the lumbosacral plexus and its branches. These cases demonstrate a protean clinical picture with regards to the time relationship to the clinical course of lymphoma and the neuroanatomical extent of lumbosacral plexus invasion. We demonstrate the complementary role of different imaging modalities. A review of the literature summarizes 23 reports where lumbosacral plexus invasion was the index manifestation, at the time of first diagnosis or recurrence of lymphoma. This series confirms the strong preponderance of B-cell type (92%). There is a marked predilection for involvement of the sciatic nerve (74%), either focally or in a longitudinally extensive fashion, from the ischium to the popliteal fossa. There can also be restricted and discrete involvement of tibial and fibular branches. In recent years, ultrasound and CT have been given a more limited role, as screening tools or as a guide for biopsy. MRI neurography and PET-CT have become leading diagnostic modalities for diagnosis, staging and assessment of treatment response. Conclusion The diagnosis of NL may be challenging, and it was once only reached at autopsy. Improved diagnostic imaging of focal or even asymptomatic disease offers new hope for earlier diagnosis and successful targeted therapy.
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Affiliation(s)
- Pierre R Bourque
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marcos Loreto Sampaio
- The Ottawa Hospital Research Institute, Ottawa, Canada. .,Department of Radiology, University of Ottawa, Ottawa, Canada.
| | - Jodi Warman-Chardon
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sam Samaan
- Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Carlos Torres
- The Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Radiology, University of Ottawa, Ottawa, Canada
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Ben Salah R, Kammoun S, Frikha F, Bouattour Y, Chabchoub I, Feki J, Bahloul Z. Disseminated lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy. Eur J Ophthalmol 2019; 31:NP131-NP135. [PMID: 31476885 DOI: 10.1177/1120672119873275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dysfunction of the third cranial nerve can be provoked by a number of different conditions. An isolated cranial neuropathy as a first clinical sign of a non-Hodgkin lymphoma is very infrequent. We represent here an atypical case of lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy. The patient was managed by alternating cycles of cyclophosphamide, vincristine, and prednisone. She made a full recovery with a complete resolution of the symptomatology.
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Affiliation(s)
- Raida Ben Salah
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
| | - Sonda Kammoun
- Department of Ophthalmology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Faten Frikha
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
| | - Yosra Bouattour
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
| | - Imen Chabchoub
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
| | - Jamel Feki
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
| | - Zouhir Bahloul
- Department of Internal Medicine, Hedi Chaker Hospital, Sfax, Tunisia
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39
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Brand C, Pala A, Scheuerle A, Scheglmann K, König R, Kratzer W, Wirtz CR, Antoniadis G, Pedro MT. [Neurolymphomatosis : Two case reports]. DER NERVENARZT 2019; 89:701-704. [PMID: 29181546 DOI: 10.1007/s00115-017-0460-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- C Brand
- Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ludwig-Heilmeyer-Str. 2, 89312, Günzburg, Deutschland.
| | - A Pala
- Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ludwig-Heilmeyer-Str. 2, 89312, Günzburg, Deutschland
| | - A Scheuerle
- Abteilung Neuropathologie am BKH Günzburg, Universitätsklinikum Ulm, Günzburg, Deutschland
| | | | - R König
- Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ludwig-Heilmeyer-Str. 2, 89312, Günzburg, Deutschland
| | - W Kratzer
- Innere Medizin, Universitätsklinikum Ulm, Ulm, Deutschland
| | - C R Wirtz
- Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ludwig-Heilmeyer-Str. 2, 89312, Günzburg, Deutschland
| | - G Antoniadis
- Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ludwig-Heilmeyer-Str. 2, 89312, Günzburg, Deutschland
| | - M T Pedro
- Klinik für Neurochirurgie, Universitätsklinikum Ulm, Ludwig-Heilmeyer-Str. 2, 89312, Günzburg, Deutschland
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Araz M, Soydal C, Ozturk C, Ozkan E, Demirer T. An uncommon presentation of diffuse large B cell lymphoma with multiple peripheral nerve involvement demonstrated BY 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 2019; 47:218-219. [PMID: 31346757 DOI: 10.1007/s00259-019-04428-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Mine Araz
- Nuclear Medicine Department, Ankara University Medical School, Ankara, Turkey.
| | - Cigdem Soydal
- Nuclear Medicine Department, Ankara University Medical School, Ankara, Turkey
| | - Cemaleddin Ozturk
- Hematology Department, Ankara University Medical School, Ankara, Turkey
| | - Elgin Ozkan
- Nuclear Medicine Department, Ankara University Medical School, Ankara, Turkey
| | - Taner Demirer
- Hematology Department, Ankara University Medical School, Ankara, Turkey
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B-cell peripheral neurolymphomatosis: MRI and 18F-FDG PET/CT imaging characteristics. Skeletal Radiol 2019; 48:1043-1050. [PMID: 30666391 DOI: 10.1007/s00256-019-3145-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/27/2018] [Accepted: 01/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the MRI and 18F-FDG PET/CT imaging characteristics of peripheral neurolymphomatosis. MATERIALS AND METHODS All institutional cases of neurolymphomatosis with an MRI or 18F-FDG PET/CT from 2000 to 2017 were retrospectively reviewed. Included cases were biopsy-proven neurolymphomatosis or lymphoma patients with clinical and imaging evidence of neurolymphomatosis that resolved after chemotherapy. Multiple imaging parameters and clinical characteristics were recorded. RESULTS There were 27 cases of B-cell neurolymphomatosis in 25 patients (18 M, 7 F; mean age 64.6 ± 10.0 years). Of the total cases, 85% (23/27) were biopsy-proven. Most were diagnosed after disease progression or recurrence (20/27, 74%), and presented with isolated nerve involvement (18/27, 67%). Bone marrow biopsy (17/19, 89%) and CSF cytology (16/23, 70%) were usually negative. On 18F-FDG PET/CT, neurolymphomatosis presented as a linear or fusiform (23/26, 88%), FDG-avid (average SUVmax: 7.1 ± 4.5, range, 1.5-17.0) mass, and on MRI as a T2-weighted hyperintense (21/22, 95%), enhancing (21/22, 95%), linear or fusiform mass (19/22, 86%), with associated muscle denervation (14/22, 64%). FDG avidity was significantly higher in patients with muscular denervation on MRI (mean SUVmax 8.2 ± 4.6 vs. 4.3 ± 2.3, p = 0.04). CONCLUSIONS B-cell neurolymphomatosis most commonly manifests as T2-weighted hyperintense, enhancing linear or fusiform neural enlargement associated with muscular denervation on MRI, with intense FDG activity on PET/CT. It is most often an isolated site of disease, presenting after progression or recurrence. A familiarity with the imaging appearance of neurolymphomatosis can help refine the differential diagnosis, direct biopsy, and aid in accurate diagnosis.
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Briani C, Visentin A, Campagnolo M, Salvalaggio A, Ferrari S, Cavallaro T, Manara R, Gasparotti R, Piazza F. Peripheral nervous system involvement in lymphomas. J Peripher Nerv Syst 2019; 24:5-18. [PMID: 30556258 DOI: 10.1111/jns.12295] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/01/2018] [Accepted: 12/08/2018] [Indexed: 12/11/2022]
Abstract
The peripheral nervous system may be involved at any stage in the course of lymphoproliferative diseases. The different underlying mechanisms include neurotoxicity secondary to chemotherapy, direct nerve infiltration (neurolymphomatosis), infections, immune-mediated, paraneoplastic or metabolic processes and nutritional deficiencies. Accordingly, the clinical features are heterogeneous and depend on the localization of the damage (ganglia, roots, plexi, and peripheral nerves) and on the involved structures (myelin, axon, and cell body). Some clinical findings, such a focal or diffuse involvement, symmetric or asymmetric pattern, presence of pain may point to the correct diagnosis. Besides a thorough medical history and neurological examination, neurophysiological studies, cerebrospinal fluid analysis, nerve biopsy (in selected patients with suspected lymphomatous infiltration) and neuroimaging techniques (magnetic resonance neurography and nerve ultrasound) may be crucial for a proper diagnostic workup.
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Affiliation(s)
- Chiara Briani
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | | | | | - Sergio Ferrari
- Department of Neurology, Azienda Ospedaliera Universitaria Integrata, University Hospital G.B. Rossi, Verona, Italy
| | - Tiziana Cavallaro
- Department of Neurology, Azienda Ospedaliera Universitaria Integrata, University Hospital G.B. Rossi, Verona, Italy
| | - Renzo Manara
- Neuroradiology, Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - Roberto Gasparotti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
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Beasley MJ, Hiebert EC, Daw DN, Alexander KJ, Gambino JM. Neurolymphomatosis caused by T-cell lymphosarcoma in a cat: imaging description and treatment review. JFMS Open Rep 2019; 5:2055116919833534. [PMID: 30828460 PMCID: PMC6390221 DOI: 10.1177/2055116919833534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CASE SUMMARY A 16-year-old domestic shorthair cat was evaluated for acute-onset right pelvic limb monoparesis localized to the sciatic nerve. MRI revealed a homogeneously contrast-enhancing, well-demarcated mass effacing the right sciatic nerve from its intravertebral origin to the end of the viewable field (mid-femur). Abdominal ultrasound revealed thickened small intestinal loops and enlarged mesenteric lymph nodes. Cytology of the small intestine was suggestive of lymphosarcoma. T-cell lymphosarcoma of the sciatic nerve and small intestines was confirmed with incisional biopsy. Treatment consisted of systemic chemotherapy with vincristine followed by the Wisconsin-Madison feline lymphosarcoma protocol, but despite treatment the patient neurologically worsened and was euthanized after 54 days. RELEVANCE AND NOVEL INFORMATION We present herein one of the first descriptions of neurolymphomatosis in the domestic cat that included post-intravenous contrast MRI. Treatment options based on recommendations for people with neurolymphomatosis include systemic chemotherapy, intrathecal chemotherapy and/or localized radiation chemotherapy. The authors recommend that all cats be screened for concurrent non-neuronal areas of lymphosarcoma before undergoing treatment for neurolymphomatosis, regardless of clinical signs.
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Affiliation(s)
- Michaela J Beasley
- Department of Clinical Sciences, College
of Veterinary Medicine, Mississippi State University, Mississippi State, MS,
USA
| | | | - Danielle N Daw
- Department of Clinical Sciences, College
of Veterinary Medicine, Mississippi State University, Mississippi State, MS,
USA
| | - Kayla J Alexander
- Department of Clinical Sciences, College
of Veterinary Medicine, Mississippi State University, Mississippi State, MS,
USA
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Mustafa R, Klein CJ, Martinez-Thompson J, Johnson AC, Engelstad JK, Spinner RJ, Crum BA. Recurrent Brachial Neuritis Attacks in Presentation of B-Cell Lymphoma. Mayo Clin Proc Innov Qual Outcomes 2018; 2:382-386. [PMID: 30560241 PMCID: PMC6260480 DOI: 10.1016/j.mayocpiqo.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/28/2018] [Accepted: 10/05/2018] [Indexed: 12/03/2022] Open
Abstract
We describe a 51-year-old woman who over 5 years had 9 painful monophasic attacks affecting the brachial plexus before a fascicular plexus biopsy diagnosed large B-cell lymphoma. The initial attacks were responsive to steroids with clinical resolution. At last attack, magnetic resonance imaging showed multifocal T2 hyperintensities and nodular gadolinium enhancement in the right brachial plexus not seen previously. Also seen were similar changes in the thoracic spinal cord, basal ganglia, cerebellum, and brainstem. Positron emission tomography revealed marked hypermetabolic activity of the plexus facilitating targeted fascicular brachial plexus biopsy, making the pathological diagnosis. Neurolymphomatosis affecting the peripheral nervous system typically presents with insidious painful progressive infiltration of nerves, roots, or plexi. Recurrent idiopathic brachial neuritis attacks (ie, Parsonage-Turner syndrome) in contrast most commonly are seen in persons with a family history and a discoverable genetic cause by SEPT9 mutations, which tested negative in this patient. This case illustrates how neurolymphomatosis, which represents a malignant transformation of B cells within peripheral nerves, can sometimes present with paraneoplastic immune-responsive neuritis mimicking Parsonage-Turner syndrome. Recurrence, an immune-refractory course or insidious progressive involvement of the nervous system, should raise suspicion of neurolymphomatosis.
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Affiliation(s)
- Rafid Mustafa
- Department of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN
| | | | - Adam C Johnson
- Department of Radiology, Mayo Clinic College of Medicine & Science, Rochester, MN
| | - JaNean K Engelstad
- Department of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN
| | - Robert J Spinner
- Department of Neurologic Surgery, Orthopedics, and Anatomy, Mayo Clinic College of Medicine & Science, Rochester, MN
| | - Brian A Crum
- Department of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN
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Bjornard KL, Leventaki V, Nichols K, Sandlund JT, Prockop S, Ehrhardt MJ. Two-year-old female with EBV-positive diffuse large B-cell lymphoma and subsequent CNS involvement with neurolymphomatosis. Pediatr Blood Cancer 2018; 65:e27415. [PMID: 30151967 PMCID: PMC8244825 DOI: 10.1002/pbc.27415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 01/04/2023]
Abstract
We describe a case of Epstein-Barr virus (EBV) positive, diffuse large B-cell lymphoma in a 2-year-old female who went on to develop relapsed/refractory central nervous system (CNS) disease, manifesting as cranial nerve neurolymphomatosis. Although her atypical presentation was thought to be associated with an immune deficiency, extensive work-up was negative. Despite subsequent treatment with third-party EBV-specific cytotoxic T-lymphocytes, she died of progressive disease. This case report raises questions as to whether tailored treatment approaches should be considered for atypical presentations of pediatric lymphoma (e.g., CNS and virus-associated).
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Affiliation(s)
- Kari L. Bjornard
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Vasiliki Leventaki
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Kim Nichols
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - John T. Sandlund
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Susan Prockop
- Department of Pediatrics, Memorial Sloan Kettering, New York, NY
| | - Matthew J. Ehrhardt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN,Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
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Abstract
Peripheral nervous system damage from hematologic malignancies is related to neoplastic cells infiltration of peripheral nerves or to monoclonal antibody production cross-reacting with peripheral nerves' antigens. Neurolymphomatosis (NL), a rare manifestation of hematologic malignancies, occurs when malignant cells invade the peripheral nerves leading to various manifestations. Here, we report a case of NL with 2 hematologic malignancies in a 79-year-old woman presenting with lower extremity pain/weakness. Investigation revealed anemia, IgM kappa monoclonal gammopathy, and elevated anti-MAG titer. Electrodiagnostic studies were consistent with mononeuropathy multiplex while imaging suggested malignancy in her ovaries and right S1 nerve root. Bone marrow and ovarian biopsies revealed chronic myelomonocytic leukemia, Waldenstrom macroglobulinemia, and diffuse large B-cell lymphoma. She received standard chemotherapy resulting in radiographic resolution of disease and symptomatic relief. NL can precede the diagnosis of hematologic malignancy but its symptoms are not easily identifiable, whereas management depends on the treatment of the underlying tumor.
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Duchesne M, Roussellet O, Maisonobe T, Gachard N, Rizzo D, Armand M, Viala K, Richard L, Delage-Corre M, Jaccard A, Corcia P, Vallat JM, Magy L. Pathology of Nerve Biopsy and Diagnostic Yield of PCR-Based Clonality Testing in Neurolymphomatosis. J Neuropathol Exp Neurol 2018; 77:769-781. [DOI: 10.1093/jnen/nly055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Mathilde Duchesne
- Service et Laboratoire de Neurologie, Centre National de Référence “Neuropathies Périphériques rares”, CHRU Limoges, Limoges, France
- Laboratoire d'Anatomie Pathologique, CHRU Limoges, Limoges, France
| | - Olivier Roussellet
- Service et Laboratoire de Neurologie, Centre National de Référence “Neuropathies Périphériques rares”, CHRU Limoges, Limoges, France
| | - Thierry Maisonobe
- Département de Neurophysiologie Clinique, CHU Pitié-Salpêtrière, Paris, France
| | | | - David Rizzo
- Service d'Hématologie Biologique, CHRU Limoges, Limoges, France
| | - Marine Armand
- Service d'Hématologie Biologique, CHU Pitié-Salpêtrière, Paris, France
| | - Karine Viala
- Département de Neurologie Clinique, CHU Pitié-Salpêtrière, Paris, France
| | - Laurence Richard
- Service et Laboratoire de Neurologie, Centre National de Référence “Neuropathies Périphériques rares”, CHRU Limoges, Limoges, France
| | | | - Arnaud Jaccard
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHRU Limoges, Limoges, France
| | | | - Jean-Michel Vallat
- Service et Laboratoire de Neurologie, Centre National de Référence “Neuropathies Périphériques rares”, CHRU Limoges, Limoges, France
| | - Laurent Magy
- Service et Laboratoire de Neurologie, Centre National de Référence “Neuropathies Périphériques rares”, CHRU Limoges, Limoges, France
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Marquardt RJ, Li Y. Lumbosacral Radiculoplexopathy as the Initial Presentation of Lymphoma: A Report of 4 Cases. J Clin Neuromuscul Dis 2018; 19:196-202. [PMID: 29794574 DOI: 10.1097/cnd.0000000000000213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate the clinical, laboratory, and radiological features of 4 cases of biopsy-proven lymphomatous lumbosacral radiculoplexopathy. METHODS Retrospective chart review. RESULTS All patients suffered from diffuse large B-cell lymphoma. A mean diagnostic delay of 10 months was encountered. Presenting symptoms in all 4 patients included back pain, radicular leg pain, and leg weakness, similar to spondylotic radiculopathy. Electrodiagnostic study showed axon loss radiculoplexopathy and magnetic resonance imaging of the lumbar spine or pelvis demonstrated nerve or nerve root enhancement. Increased uptake by lumbosacral roots/plexus on fluorodeoxyglucose-positron emission tomography aided diagnosis in 3 cases. Cytology was positive in 1 of 10 cerebrospinal fluid samples. Combined chemotherapy and radiation treatment led to clinicoradiological improvement, with residual neurological symptoms in all patients. CONCLUSIONS Lymphomatous lumbosacral radiculoplexopathy should be considered in patients with progressive lumbosacral radicular symptoms. Magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography, but not cerebrospinal fluid, are helpful in achieving early diagnosis. Treatment responses seem favorable.
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Affiliation(s)
- Robert J Marquardt
- Department of Neurology, Neuromuscular Center, Neurological Institute, Cleveland Clinic Cleveland, OH
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Diagnostic accuracy of 18-F FDG-PET/CT in evaluation of malignant neuronal involvement in neurologically manifested cancer patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Isolated Third Cranial Nerve Palsy Leading to the Diagnosis of Disseminated Burkitt Lymphoma: A Case Report and Literature Review. Neurologist 2018; 22:182-185. [PMID: 28859023 DOI: 10.1097/nrl.0000000000000130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Dysfunction of the third cranial nerve can result from lesions anywhere along its course between the midbrain and the orbit. Lymphoma is a rare cause of isolated oculomotor nerve palsy (OMP), with only 19 cases reported in the literature. We describe a case of an isolated OMP leading to the diagnosis of disseminated Burkitt lymphoma (BL). CASE REPORT A 37-year-old man presented with acute onset diplopia and right ptosis and was found to have a right pupillary sparing OMP. The diagnostic workout was unremarkable, including contrast-enhanced brain and orbital magnetic resonance imaging, MR angiography, exhaustive laboratory tests, and cerebrospinal fluid analysis. After a course of high-dose intravenous steroid therapy, the patient recovered almost completely. Three weeks after the discharge, he developed lumbar radicular pain and lower limbs weakness followed by the relapse of the right OMP. A second lumbar puncture revealed the presence of "small monomorphic lymphocytes," consistent with leptomeningeal lymphomatosis. A whole-body positron emission tomography scan disclosed a mediastinal mass, whose histopathologic "starry sky" appearance was pathognomonic for BL. CONCLUSIONS Reviewing the literature, we were able to find only 3 cases of OMP as the presenting manifestation of BL, all occurring in patients with predisposing HIV infection.Our case of isolated OMP highlights some "red flags" for a lymphomatous etiology, including young age, a progressive course, a response to high-dose steroid therapy, and relapse upon steroid discontinuation; these cases require a comprehensive evaluation, including repeated cytological cerebrospinal fluid analysis and sensitive imaging techniques to detect a possible primary lesion.
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