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Paggi R, Mariotti F, Mencarini J, Bresci S, Campolmi I, Bartalesi F, Borchi B, Nassi L, Sordi B, Vannucchi AM, Bartoloni A. Orbital Infiltration in a Patient with Waldenström Macroglobulinemia: Need for Multidisciplinary Approach and Comparison with the Literature. Mediterr J Hematol Infect Dis 2023; 15:e2023028. [PMID: 37180207 PMCID: PMC10171213 DOI: 10.4084/mjhid.2023.028] [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: 01/31/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023] Open
Abstract
The use of specific inhibitory drugs of intracellular signalling pathways (such as Bruton-Kinase inhibitors) for the treatment of Waldenström's macroglobulinaemia (WM) is a recognised risk factor for Aspergillus spp. infections. The overlapping clinical manifestations of the two diseases may require the involvement of different medical specialities. We describe the clinical course of a patient with pulmonary and encephalic aspergillosis, with concomitant orbital infiltration, which represented a difficult diagnosis: the case required a multidisciplinary approach to define the ocular lesions and an in-depth study of the literature.
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Affiliation(s)
- Riccardo Paggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Mariotti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Jessica Mencarini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Bresci
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Irene Campolmi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Filippo Bartalesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Luca Nassi
- Hematology Unit, Careggi University Hospital, Florence, Italy
| | - Benedetta Sordi
- Hematology Unit, Careggi University Hospital, Florence, Italy
- Center for Innovation and Research in Myeloproliferative Neoplasms, Hematology Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alessandro Maria Vannucchi
- Center for Innovation and Research in Myeloproliferative Neoplasms, Hematology Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
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2
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Bing–Neel Syndrome: Update on Diagnosis and Treatment. HEMATO 2022. [DOI: 10.3390/hemato3040051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bing–Neel syndrome (BNS) is a rare neurological complication of Waldenström macroglobulinaemia. We highlight key issues in clinical presentation, diagnosis, and treatment while focusing on new and emerging therapies available for patients diagnosed with BNS. It is anticipated that further development of Bruton Tyrosine Kinase (BTK) inhibitors and less toxic chemoimmunotherapies will improve treatment delivery and response.
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3
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Brotis AG, Palassopoulou M, Kapsalaki EZ, Paschalis T, Papastergiou V, Fountas KN. Bing-Neel syndrome presenting with bilateral lumbar radiculopathy: A case report of a rare clinical entity. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:250-253. [PMID: 36084961 DOI: 10.1016/j.neucie.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/20/2021] [Indexed: 06/15/2023]
Abstract
The differential diagnosis of bilateral lower extremity weakness is broad. We present a very rare case of a 48-year old male patient, with walking difficulties due to Bing-Neel syndrome. On clinical examination, there was a significant loss of muscle power in all his lower extremities key-muscle groups. The lumbar spine magnetic resonance imaging (MRI) showed only mild degenerative changes, whereas the MRI of the head indicated a diffuse meningeal thickening at the right temporal region, characterized by significant enhancement after contrast administration. Serum protein electrophoresis detected an IgM-kappa monoclonal protein. The patient received intrathecal chemotherapy with methotrexate and cytarabine, and was started on oral ibrutinib 420mg daily. In conclusion, a past medical history of Waldenstrom macroglobulinemia in conjunction with neurological manifestations should alert the treating physician for Bing-Neel syndrome. A complete diagnostic imaging and serologic protocol helps in setting the final diagnosis. Steroids are part of the treatment, but should be given after the diagnosis is set. Neurosurgical intervention is indicated for histologic confirmation in the case of diagnostic uncertainty.
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Affiliation(s)
- Alexandros G Brotis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece.
| | - Maria Palassopoulou
- Department of Haematology, General University Hospital of Larissa, Larissa, Greece
| | - Eftychia Z Kapsalaki
- Department of Radiology, General University Hospital of Larissa, Larissa, Greece; School of Medicine, University of Thessaly, Larissa, Greece
| | - Thanos Paschalis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece
| | | | - Konstantinos N Fountas
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece; School of Medicine, University of Thessaly, Larissa, Greece
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4
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Brotis AG, Palassopoulou M, Kapsalaki EZ, Paschalis T, Papastergiou V, Fountas KN. Bing-Neel syndrome presenting with bilateral lumbar radiculopathy: A case report of a rare clinical entity. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00045-2. [PMID: 34045126 DOI: 10.1016/j.neucir.2021.03.004] [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: 02/18/2021] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 11/23/2022]
Abstract
The differential diagnosis of bilateral lower extremity weakness is broad. We present a very rare case of a 48-year old male patient, with walking difficulties due to Bing-Neel syndrome. On clinical examination, there was a significant loss of muscle power in all his lower extremities key-muscle groups. The lumbar spine magnetic resonance imaging (MRI) showed only mild degenerative changes, whereas the MRI of the head indicated a diffuse meningeal thickening at the right temporal region, characterized by significant enhancement after contrast administration. Serum protein electrophoresis detected an IgM-kappa monoclonal protein. The patient received intrathecal chemotherapy with methotrexate and cytarabine, and was started on oral ibrutinib 420mg daily. In conclusion, a past medical history of Waldenstrom macroglobulinemia in conjunction with neurological manifestations should alert the treating physician for Bing-Neel syndrome. A complete diagnostic imaging and serologic protocol helps in setting the final diagnosis. Steroids are part of the treatment, but should be given after the diagnosis is set. Neurosurgical intervention is indicated for histologic confirmation in the case of diagnostic uncertainty.
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Affiliation(s)
- Alexandros G Brotis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece.
| | - Maria Palassopoulou
- Department of Haematology, General University Hospital of Larissa, Larissa, Greece
| | - Eftychia Z Kapsalaki
- Department of Radiology, General University Hospital of Larissa, Larissa, Greece; School of Medicine, University of Thessaly, Larissa, Greece
| | - Thanos Paschalis
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece
| | | | - Konstantinos N Fountas
- Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece; School of Medicine, University of Thessaly, Larissa, Greece
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5
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Bouffard MA, Chwalisz BK, Romero JM, Arrillaga-Romany IC, Massoth LR. Case 6-2021: A 65-Year-Old Man with Eye Pain and Decreased Vision. N Engl J Med 2021; 384:745-753. [PMID: 33626257 DOI: 10.1056/nejmcpc2027089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Marc A Bouffard
- From the Department of Neurology, Beth Israel Deaconess Medical Center (M.A.B.), the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Harvard Medical School - all in Boston
| | - Bart K Chwalisz
- From the Department of Neurology, Beth Israel Deaconess Medical Center (M.A.B.), the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Harvard Medical School - all in Boston
| | - Javier M Romero
- From the Department of Neurology, Beth Israel Deaconess Medical Center (M.A.B.), the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Harvard Medical School - all in Boston
| | - Isabel C Arrillaga-Romany
- From the Department of Neurology, Beth Israel Deaconess Medical Center (M.A.B.), the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Harvard Medical School - all in Boston
| | - Lucas R Massoth
- From the Department of Neurology, Beth Israel Deaconess Medical Center (M.A.B.), the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Massachusetts General Hospital, and the Departments of Neurology (B.K.C.), Radiology (J.M.R.), Neuro-oncology (I.C.A.-R.), and Pathology (L.R.M.), Harvard Medical School - all in Boston
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6
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Illarramendi OA, Flynt L, Wong F. 18F-FDG PET/CT in the Evaluation of Bing-Neel Syndrome. J Nucl Med Technol 2019; 47:343-344. [PMID: 31182662 DOI: 10.2967/jnmt.118.225565] [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: 12/28/2018] [Accepted: 03/04/2019] [Indexed: 11/16/2022] Open
Abstract
Waldenström macroglobulinemia is an indolent B-cell lymphoproliferative disorder. When there is involvement of the central nervous system, Waldenström macroglobulinemia is known as Bing-Neel syndrome. We present a case of Bing-Neel syndrome in a patient who presented with confusion and left orbital pain. 18F-FDG PET/CT was utilized in making the diagnosis.
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7
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Imaging spectrum of Bing–Neel syndrome: how can a radiologist recognise this rare neurological complication of Waldenström’s macroglobulinemia? Eur Radiol 2018; 29:102-114. [DOI: 10.1007/s00330-018-5543-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/22/2018] [Accepted: 05/16/2018] [Indexed: 12/19/2022]
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8
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Bing-Neel Syndrome: Illustrative Cases and Comprehensive Review of the Literature. Mediterr J Hematol Infect Dis 2017; 9:e2017061. [PMID: 29181138 PMCID: PMC5667529 DOI: 10.4084/mjhid.2017.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/17/2017] [Indexed: 12/20/2022] Open
Abstract
The Bing-Neel syndrome is a rare neurological complication of Waldenström’s Macroglobulinemia which results from a direct involvement of central nervous system by malignant lymphoplasmacytic cells. The clinical suspicion of Bing-Neel syndrome may be overlooked because neurologic symptoms are heterogeneous, nonspecific and sometimes underhand. A definitive diagnosis of Bing-Neel syndrome can be confidently made using brain and spinal cord magnetic resonance imaging as well as histopathology and/or cerebrospinal fluid analysis to confirm the neoplastic infiltration of central nervous system. The detection in the cerebrospinal fluid of patients with Bing-Neel syndrome of the MYD88 (L265P) somatic mutation, which is highly recurrent in Waldenström’s Macroglobulinemia, proved useful for the diagnosis and monitoring of central nervous system involvement. Despite recommendations recently published, there is still no clear consensus on treatment of Bing-Neel syndrome, which includes systemic immunochemotherapy, intrathecal chemotherapy and brain irradiation as possible options. Ibrutinib, a Bruton kinase inhibitor approved for Waldenström’s Macroglobulinemia, has been recently added to the therapeutic armamentarium of Bing-Neel syndrome due to its ability to pass the blood-brain barrier. However, prospective clinical trials are eagerly awaited with the aim to define the optimal treatment strategy. Here we describe four illustrative cases of Bing-Neel syndrome diagnosed and treated at our Institution and review the literature on this topic.
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Minnema MC, Kimby E, D'Sa S, Fornecker LM, Poulain S, Snijders TJ, Kastritis E, Kremer S, Fitsiori A, Simon L, Davi F, Lunn M, Castillo JJ, Patterson CJ, Le Garff-Tavernier M, Costopoulos M, Leblond V, Kersten MJ, Dimopoulos MA, Treon SP. Guideline for the diagnosis, treatment and response criteria for Bing-Neel syndrome. Haematologica 2016; 102:43-51. [PMID: 27758817 DOI: 10.3324/haematol.2016.147728] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/06/2016] [Indexed: 12/31/2022] Open
Abstract
Bing Neel syndrome is a rare disease manifestation of Waldenström's macroglobulinemia that results from infiltration of the central nervous system by malignant lymphoplasmacytic cells. In this guideline we describe the clinical symptoms, as well as the appropriate laboratory and radiological studies, that can aid in the diagnosis. The presentation of Bing Neel syndrome may be very diverse, and includes headaches, cognitive deficits, paresis, and psychiatric symptoms. The syndrome can present in patients with known Waldenström's macroglobulinemia, even in the absence of systemic progression, but also in previously undiagnosed patients. Diagnostic work-up should include cerebral spinal fluid analysis with multiparameter flow cytometry to establish B-cell clonality, protein electrophoresis and immunofixation for the detection and classification of a monoclonal protein as well as molecular diagnostic testing for immunoglobulin gene rearrangement and mutated MYD88. MRI of the brain and spinal cord is also essential. The second challenge is to expand our knowledge of prognosis and treatment outcome. Prospective clinical trials on Bing Neel syndrome patients that employ uniform treatment along with appropriate laboratory cerebral spinal fluid assessments and standardized MRI protocols will be invaluable, constituting a significant step forward in delineating treatment outcome for this intriguing disease manifestation.
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Affiliation(s)
- Monique C Minnema
- Department of Hematology, UMC Utrecht Cancer Center, the Netherlands
| | - Eva Kimby
- Hematology Center, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Shirley D'Sa
- Cancer Division, University College London Hospitals NHS Foundation Trust, UK
| | - Luc-Matthieu Fornecker
- Department of Oncology and Hematology, Hôpital Universitaires de Strasbourg and Université de Strasbourg, France
| | - Stéphanie Poulain
- Service d'Hématologie-Immunologie-Cytogénétique, Centre Hospitalier de Valenciennes/Laboratoire d'Hématologie, Centre de Biologie et Pathologie, CHRU de Lille/INSERM, France
| | - Tom J Snijders
- Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, UMC Utrecht, The Netherlands
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece
| | - Stéphane Kremer
- Pôle d'Imagerie-Neuroradiologie, Hôpital de Hautepierre/CHU Strasbourg, France
| | - Aikaterini Fitsiori
- Pôle d'Imagerie-Neuroradiologie, Hôpital de Hautepierre/CHU Strasbourg, France
| | - Laurence Simon
- Department of Oncology and Hematology, Hôpital Universitaires de Strasbourg and Université de Strasbourg, France
| | - Frédéric Davi
- Laboratory of Hematology, Hôpital Pitié Salpêtrière, Paris, France
| | - Michael Lunn
- Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Jorge J Castillo
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical; School, Boston, MA, USA
| | - Christopher J Patterson
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical; School, Boston, MA, USA
| | | | | | | | - Marie-José Kersten
- Department of Hematology, Academic Medical Center, Amsterdam, the Netherlands
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece
| | - Steven P Treon
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical; School, Boston, MA, USA
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10
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Kamath S, Patil M, Mendonca N, Nazareth N, Bhat S, Rodrigues FEA, Cestari DM, Randhawa S. Diagnostic and Therapeutic Challenges. Retina 2016; 36:216-20. [DOI: 10.1097/iae.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Abstract
Central nervous system infiltration of Waldenström's macroglobulinemia is referred to as Bing-Neel Syndrome. We describe 2 patients whose clinical presentation was due to isolated involvement of the anterior visual pathways. The mechanism of visual failure in Bing-Neel Syndrome may involve both infiltrative and autoimmune processes.
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Simon L, Fitsiori A, Lemal R, Dupuis J, Carpentier B, Boudin L, Corby A, Aurran-Schleinitz T, Gastaud L, Talbot A, Leprêtre S, Mahe B, Payet C, Soussain C, Bonnet C, Vincent L, Lissandre S, Herbrecht R, Kremer S, Leblond V, Fornecker LM. Bing-Neel syndrome, a rare complication of Waldenström macroglobulinemia: analysis of 44 cases and review of the literature. A study on behalf of the French Innovative Leukemia Organization (FILO). Haematologica 2015; 100:1587-94. [PMID: 26385211 DOI: 10.3324/haematol.2015.133744] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/18/2015] [Indexed: 11/09/2022] Open
Abstract
Central nervous system involvement by malignant cells is a rare complication of Waldenström macroglobulinemia, and this clinicopathological entity is referred to as the Bing-Neel syndrome. There is currently no consensus on the diagnostic criteria, therapeutic approaches and response evaluation for this syndrome. In this series, we retrospectively analyzed 44 French patients with Bing-Neel syndrome. Bing-Neel syndrome was the first manifestation of Waldenström macroglobulinemia in 36% of patients. When Waldenström macroglobulinemia was diagnosed prior to Bing-Neel syndrome, the median time interval between this diagnosis and the onset of Bing-Neel syndrome was 8.9 years. This study highlights the possibility of the occurrence of Bing-Neel syndrome without any other evidence of progression of Waldenström macroglobulinemia. The clinical presentation was heterogeneous without any specific signs or symptoms. Biologically, the median lymphocyte count in the cerebrospinal fluid was 31/mm(3). Magnetic resonance imaging revealed abnormalities in 78% of the cases. The overall response rate after first-line treatment was 70%, and the overall survival rate after the diagnosis of Bing-Neel syndrome was 71% at 5 years. Altogether, these results suggest that Bing-Neel syndrome should be considered in the context of any unexplained neurological symptoms associated with Waldenström macroglobulinemia. The diagnostic approach should be based on cerebrospinal fluid analysis and magnetic resonance imaging of the brain and spinal axis. It still remains difficult to establish treatment recommendations or prognostic factors in the absence of large-scale, prospective, observational studies.
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Affiliation(s)
- Laurence Simon
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Aikaterini Fitsiori
- Department of Radiology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Richard Lemal
- Department of Cell Therapy and Clinical Hematology, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil, France
| | | | - Laurys Boudin
- Department of Medical Oncology, Hôpital d'Instruction des Armées, Toulon, France
| | - Anne Corby
- Department of Hematology, Centre Hospitalier Universitaire, Angers, France
| | | | - Lauris Gastaud
- Department of Onco-Hematology, Centre Antoine Lacassagne, Nice, France
| | - Alexis Talbot
- Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Sorbonne Paris Cité, France
| | | | - Béatrice Mahe
- Department of Hematology, Centre Hospitalier Universitaire, Nantes, France
| | - Camille Payet
- Department of Hematology, Centre Hospitalier Universitaire, Besançon, France
| | - Carole Soussain
- Department of Hematology, Institut Curie-Hôpital René Huguenin, Saint-Cloud, France
| | - Charlotte Bonnet
- Department of Neurosurgery, Centre Hospitalier Universitaire, Bordeaux, France
| | - Laure Vincent
- Department of Hematology, Centre Hospitalier Universitaire, Montpellier, France
| | - Séverine Lissandre
- Department of Hematology, Centre Hospitalier Universitaire, Tours, France
| | - Raoul Herbrecht
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Stéphane Kremer
- Department of Radiology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Véronique Leblond
- Department of Hematology, APHP Hôpital Pitié-Salpêtrière, UPMC Paris, GRECHY, France
| | - Luc-Matthieu Fornecker
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
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Cuenca Hernández R, Guzman de Villoria Lebiedziejewski J, Roa Martínez E, Menarguez Diaz J. Síndrome de Bing-Neel como debut de una macroglobulinemia de Waldenström asociada a infiltración orbitaria. Neurologia 2015; 30:252-5. [DOI: 10.1016/j.nrl.2013.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 04/06/2013] [Indexed: 11/16/2022] Open
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14
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Cuenca Hernández R, Guzman de Villoria Lebiedziejewski J, Roa Martínez E, Menarguez Diaz J. Bing-Neel syndrome as an initial sign of Waldenström macroglobulinaemia associated with orbital infiltration. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2013.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Optic nerve involvement of Waldenström's macroglobulinemia: with autopsy findings. Neurol Sci 2014; 35:1299-302. [PMID: 25027010 DOI: 10.1007/s10072-014-1865-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/25/2014] [Indexed: 10/25/2022]
Abstract
Waldenström's macroglobulinemia (WM) is an indolent chronic lymphoproliferative disorder within the spectrum of lymphoplasmacytic lymphoma (LPL), characterized by a proliferation of plasmacytoid lymphocytes and the production of monoclonal IgM. Although, peripheral neurologic complications commonly occurs due to hyperviscosity in WM, central nervous system (CNS) involvement is very rare. Herein, we present the case of a 67-year-old man who initially presented with progressive visual loss and was diagnosed as WM/LPL with a very aggressive clinical course. He underwent chemotherapy with high dose methotrexate (MTX) plus cytarabine (Ara-C). However, he died and findings of a subsequent autopsy revealed the presence of lymphoplasmacytoid cells in the optic nerve.
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Morita K, Yoshimi A, Masuda A, Ichikawa M, Yatomi Y, Kurokawa M. Unique association of Waldenström macroglobulinemia with optic neuritis and monoclonal T cell expansion. Int J Hematol 2013; 98:247-9. [PMID: 23743950 DOI: 10.1007/s12185-013-1372-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 05/15/2013] [Accepted: 05/15/2013] [Indexed: 11/24/2022]
Abstract
Waldenström macroglobulinemia is a lymphoplasmacytic lymphoma characterized by production of the immunoglobulin M (IgM) monoclonal protein. Commonly involved sites are the bone marrow, lymph nodes, and spleen. Lymphoplasmacytic infiltration of the central nervous system (CNS), in contrast, is referred to as Bing-Neel syndrome, and is an extremely rare phenomenon. Here, we present a unique case of Waldenström macroglobulinemia with optic neuritis accompanied by monoclonal expansion of T cells, which recovered after administration of CNS-targeting chemotherapy. Although the underlying causal relationships in this case remain obscure, aberrantly expanded T cells may have contributed to the development of optic neuritis, and we should be reminded that some types of cranial neuropathy in Waldenström macroglobulinemia may be reversible.
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Affiliation(s)
- Ken Morita
- Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Abstract
Introduction. We report the case of a Bing and Neel syndrome revealed by an isolated left ptosis. Case Report. a 57-year-old man was followed up since October 2003 for a typical Waldenström's macroglobulinemia. A first complete remission was obtained with chlorambucil. In August 2004, he relapsed. A second complete remission was obtained with RFC chemotherapy regimen (rituximab, fludarabine, and cyclophosphamide). In October 2009, the patient presented with an isolated left ptosis revealing a Bing and Neel syndrome. The diagnosis was suspected on MRI and confirmed by the detection in the CSF of a monoclonal IgM similar to the one found in the plasma. A quite good partial remission has been obtained after one course of RDHAP (rituximab, dexamethasone, cytarabine, and cisplatin) and 3 courses of RDHOx (rituximab, dexamethasone, cytarabine, and oxaliplatin), in addition to ten intrahectal chemotherapy injections. The treatment was followed by intensification and autologous stem cell transplantation. At D58, the patient died due to a septic shock. Conclusion. BNS is a rare and potentially treatable complication of WM. It should be considered in patients with neurologic symptoms and a history of WM.
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