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Ma J, Lin Z, Zhang Y, Ding Y, Tang Q, Qian Y, Jin B, Luo RY, Liao WL, Thyparambil S, Han Z, Chou CJ, Schilling J, Li Q, Zhang M, Lin Y, Ma Y, Sylvester KG, Nagpal S, McElhinney DB, Ling XB, Chen B. Targeted multiplex validation of CSF proteomic biomarkers: implications for differentiation of PCNSL from tumor-free controls and other brain tumors. Front Immunol 2024; 15:1343109. [PMID: 39144147 PMCID: PMC11322575 DOI: 10.3389/fimmu.2024.1343109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction Primary central nervous system lymphoma (PCNSL) is a rare type of non-Hodgkin's lymphoma that affects brain parenchyma, eyes, cerebrospinal fluid, and spinal cord. Diagnosing PCNSL can be challenging because imaging studies often show similar patterns as other brain tumors, and stereotactic brain lesion biopsy conformation is invasive and not always possible. This study aimed to validate a previous proteomic profiling (PMID: 32610669) of cerebrospinal fluid (CSF) and develop a CSF-based proteomic panel for accurate PCNSL diagnosis and differentiation. Methods CSF samples were collected from patients of 30 PCNSL, 30 other brain tumors, and 31 tumor-free/benign controls. Liquid chromatography tandem-mass spectrometry targeted proteomics analysis was used to establish CSF-based proteomic panels. Results Final proteomic panels were selected and optimized to diagnose PCNSL from tumor-free controls or other brain tumor lesions with an area under the curve (AUC) of 0.873 (95%CI: 0.723-0.948) and 0.937 (95%CI: 0.807- 0.985), respectively. Pathways analysis showed diagnosis panel features were significantly enriched in pathways related to extracellular matrices-receptor interaction, focal adhesion, and PI3K-Akt signaling, while prion disease, mineral absorption and HIF-1 signaling were significantly enriched with differentiation panel features. Discussion This study suggests an accurate clinical test panel for PCNSL diagnosis and differentiation with CSF-based proteomic signatures, which may help overcome the challenges of current diagnostic methods and improve patient outcomes.
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Affiliation(s)
- Jingjing Ma
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiguang Lin
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yaqi Zhang
- College of Automation, Guangdong Polytechnic Normal University, Guangzhou, China
| | - Yun Ding
- Research and Development, mProbe Inc.Palo Alto, CA, United States
| | - Qiming Tang
- Research and Development, mProbe Inc.Palo Alto, CA, United States
| | - Yufeng Qian
- Research and Development, mProbe Inc.Palo Alto, CA, United States
| | - Bo Jin
- Research and Development, mProbe Inc.Palo Alto, CA, United States
| | - Ruben Y. Luo
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Wei-Li Liao
- Research and Development, mProbe Inc.Palo Alto, CA, United States
| | | | - Zhi Han
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, United States
| | - C. James Chou
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - James Schilling
- Research and Development, mProbe Inc.Palo Alto, CA, United States
| | - Qing Li
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengxue Zhang
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yunan Lin
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Ma
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Karl G. Sylvester
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Seema Nagpal
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Doff B. McElhinney
- Departments of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, CA, United States
| | - Xuefeng B. Ling
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Bobin Chen
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
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2
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Barranco R, Roncallo A, Candosin S, Bianchi R, Orcioni GF, Ventura F. Histopathological and medico-legal aspects in a case of death related to an undiagnosed cerebral large B-cell lymphoma. Med Leg J 2024:258172241245856. [PMID: 39075869 DOI: 10.1177/00258172241245856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
We report an unusual and undetected case of primary central nervous system lymphoma presenting as multiple lesions in the periventricular occipital lobe in an immunocompetent host, which had manifested as a stroke. The neoplastic diagnosis was made only after death following a thorough autopsy and histopathological examinations which enabled the diagnosis of a rare cancer (primary cerebral lymphoma) which remained undetected and undiagnosed during life.
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Affiliation(s)
- Rosario Barranco
- Department of Legal and Forensic Medicine, University of Genova, Italy
| | - Anna Roncallo
- Department of Legal and Forensic Medicine, University of Genova, Italy
| | - Sara Candosin
- Department of Legal and Forensic Medicine, University of Genova, Italy
| | - Rita Bianchi
- Department of Clinical Pathology, San Martino Hospital, Genova, Italy
| | - Giulio F Orcioni
- Department of Clinical Pathology, San Martino Hospital, Genova, Italy
- Department of Clinical Pathology, S. Croce e Carle Hospital, Cuneo, Italy
| | - Francesco Ventura
- Department of Legal and Forensic Medicine, University of Genova, Italy
- Legal Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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3
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Lim JX, Loh D, Tan L, Lee L. Use of fluorescein sodium to obtain histological diagnosis of primary Central nervous system lymphoma ghost tumour despite disappearance on intraoperative magnetic resonance imaging: technical note and review of the literature. Br J Neurosurg 2024; 38:244-248. [PMID: 33331187 DOI: 10.1080/02688697.2020.1859087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/19/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND IMPORTANCE Corticosteroid pre-treatment in patients with primary central nervous system lymphoma (PCNSL) can lead to the phenomenon of ghost tumours (GhT). This affects the diagnostic yield of biopsies and potentially causes misdiagnosis of the condition. The usual strategy of neuronavigation using preoperative magnetic resonance imaging (MRI) or localisation using intraoperative MRI (iMRI) can be rendered ineffective in this situation. CLINICAL PRESENTATION A middle-aged Chinese male with newly diagnosed human immunodeficiency virus infection was found to have an intracranial lesion suggestive of PCNSL. Preoperatively corticosteroid led to an attenuation of the contrast enhancing lesion on iMRI. However, intraoperative use of FS allowed the successful identification, biopsy and diagnosis of the condition. CONCLUSION FS is useful in the biopsy of PCNSL GhT even when the lesion is not seen in subsequent MRI imaging.
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Affiliation(s)
- Jia Xu Lim
- Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Daniel Loh
- Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Leanne Tan
- Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Lester Lee
- Neurosurgery, National Neuroscience Institute, Singapore, Singapore
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Balikov DA, Conway K, Brown NA, Camelo-Piragua S, Rao RC. Molecular Analysis of Liquid Vitreous Biopsy Reveals Occult Lymphoma Following Cytology-Negative Biopsies of the Brain and Vitreous. Ocul Immunol Inflamm 2023:1-9. [PMID: 38109211 PMCID: PMC11182886 DOI: 10.1080/09273948.2023.2287061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 11/18/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is a rare but deadly malignancy that principally affects adults in the fifth and sixth decades of life. Despite diagnostic advances in analyses of cerebral spinal fluid and neuroimaging, definitive diagnosis of PCNSL requires primary brain tissue biopsy. While small neurosurgical biopsy volumes are pursued to minimize removal of normal brain tissue, the spatial margins to precisely biopsy pathologic tissue are narrow and can result in missed diagnoses. Furthermore, prior steroid treatment can significantly reduce tumor burden increasing the likelihood of a non-diagnostic biopsy. METHODS A retrospective case report from a tertiary referral center using a combination of neuroradiological studies, sterotactic tissue biopsy, and molecular testing for genome mutations. RESULTS A 72-year-old woman with strong suspicion for PCNSL clinically and radiologically, but cerebral spinal fluid and primary brain tissue biopsy were negative for tumor. However, vitreous liquid biopsy molecular testing for a MYD88 mutation as well as B-cell clonality (IGH/IGK rearrangement) were positive, indicating the presence of secondary vitreoretinal lymphoma from PCNSL. Only after autopsy of her brain was histopathological and immunohistochemical evidence of PCNSL confirmed. CONCLUSION This case illustrates the unique contribution of liquid biopsy neuropathology-oriented molecular testing in a challenging case with high clinical suspicion of PCNSL in which gold-standard diagnostic testing failed to yield a diagnosis.
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Affiliation(s)
- Daniel A. Balikov
- Department of Ophthalmology and Visual Science, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Kyle Conway
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Noah A. Brown
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | - Rajesh C. Rao
- Department of Ophthalmology and Visual Science, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Center for RNA Biomedicine, University of Michigan, Ann Arbor, MI, USA
- A. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor, MI, USA
- Division of Ophthalmology, Surgical Service, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Wang Y, Gao F. Research Progress of CXCR4-Targeting Radioligands for Oncologic Imaging. Korean J Radiol 2023; 24:871-889. [PMID: 37634642 PMCID: PMC10462898 DOI: 10.3348/kjr.2023.0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/24/2023] [Accepted: 07/07/2023] [Indexed: 08/29/2023] Open
Abstract
C-X-C motif chemokine receptor 4 (CXCR4) plays a key role in various physiological functions, such as immune processes and disease development, and can influence angiogenesis, proliferation, and distant metastasis in tumors. Recently, several radioligands, including peptides, small molecules, and nanoclusters, have been developed to target CXCR4 for diagnostic purposes, thereby providing new diagnostic strategies based on CXCR4. Herein, we focus on the recent research progress of CXCR4-targeting radioligands for tumor diagnosis. We discuss their application in the diagnosis of hematological tumors, such as lymphomas, multiple myelomas, chronic lymphocytic leukemias, and myeloproliferative tumors, as well as nonhematological tumors, including tumors of the esophagus, breast, and central nervous system. Additionally, we explored the theranostic applications of CXCR4-targeting radioligands in tumors. Targeting CXCR4 using nuclear medicine shows promise as a method for tumor diagnosis, and further research is warranted to enhance its clinical applicability.
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Affiliation(s)
- Yanzhi Wang
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Feng Gao
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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Kandler N, Schilling T, Fakundiny B, Walles T, Lücke E. [Risky confirmation of a diagnosis: case series of three female patients with mediastinal mass syndrome]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01862-5. [PMID: 37191682 DOI: 10.1007/s00104-023-01862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/17/2023]
Abstract
Mediastinal mass syndrome (MMS) is a life-threatening complication of anesthesia for which prevention and treatment are a complication-prone interdisciplinary task. Clinical symptoms vary from asymptomatic patients up to life-threatening cardiorespiratory impairments, depending on the extent and size of a mediastinal tumor as well as the involvement of corresponding anatomical structures. Especially in the context of sedation or general anesthesia, there is a considerable risk of acute cardiopulmonary or respiratory decompensation related to tumor-induced compression of central blood vessels or even the large airways, which may result in severe complications, including death. In this case series three female patients are presented, who were each referred to this hospital with a mediastinal tumor for interventional or surgical confirmation of the diagnosis. Based on the case histories, characteristic complications are demonstrated and strategies to avoid possible adverse events of MMS are discussed. The specific anesthesiological requirements for MMS, the safety aspects of the choice of surgical and anesthesia procedures, circulatory and airway management for the required single-lung ventilation, and various aspects of the selection of the anesthetic agents are discussed in this case series.
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Affiliation(s)
- Nadine Kandler
- Klinik für Anaesthesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Thomas Schilling
- Klinik für Anaesthesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Bastian Fakundiny
- Klinik für Herz- und Thoraxchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Thorsten Walles
- Klinik für Herz- und Thoraxchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Eva Lücke
- Klinik für Pneumologie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
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Zhao LM, Hu R, Xie FF, Clay Kargilis D, Imami M, Yang S, Guo JQ, Jiao X, Chen RT, Wei-Hua L, Li L. Radiomic-Based MRI for Classification of Solitary Brain Metastases Subtypes From Primary Lymphoma of the Central Nervous System. J Magn Reson Imaging 2023; 57:227-235. [PMID: 35652509 DOI: 10.1002/jmri.28276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Differential diagnosis of brain metastases subtype and primary central nervous system lymphoma (PCNSL) is necessary for treatment decisions. The application of machine learning facilitates the classification of brain tumors, but prior investigations into primary lymphoma and brain metastases subtype classification have been limited. PURPOSE To develop a machine-learning model to classify PCNSL, brain metastases with primary lung and non-lung origin. STUDY TYPE Retrospective. POPULATION A total of 211 subjects with pathologically confirmed PCNSL or brain metastases (training cohort 168 and testing cohort 43). FIELD STRENGTH/SEQUENCE A 3.0 T axial contrast-enhanced T1-weighted spin-echo inversion recovery sequence (T1WI-CE), axial T2-weighted fluid-attenuation inversion recovery sequence (T2FLAIR) ASSESSMENT: Several machine-learning models (support vector machine, random forest, and K-nearest neighbors) were built with least absolute shrinkage and selection operator (LASSO) using features from T1WI-CE, T2FLAIR, and clinical. The model with the highest performance in the training cohort was selected to differentiate lesions in the testing cohort. Then, three radiologists conducted a two-round classification (with and without model reference) using images and clinical information from testing cohorts. STATISTICAL TESTS Five-fold cross-validation was used for model evaluation and calibration. Model performance was assessed based on sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC). RESULTS Twenty-five image features were selected by LASSO analysis. Random forest classifier was selected for its highest performance on the training set with an AUC of 0.73. After calibration, this model achieved an accuracy of 0.70 on the testing set. Accuracies of all three radiologists improved under model reference (0.49 vs. 0.70, 0.60 vs. 0.77, 0.58 vs. 0.72, respectively). DATA CONCLUSION The random forest model based on conventional MRI and clinical data can diagnose PCNSL and brain metastases subtypes (lung and non-lung origin). Model classification can help foster the diagnostic accuracy of specialists and streamline prognostication workflow. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Lin-Mei Zhao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
| | - Rong Hu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
| | - Fang-Fang Xie
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
| | - Daniel Clay Kargilis
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maliha Imami
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiu-Qing Guo
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Jiao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
| | - Rui-Ting Chen
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
| | - Liao Wei-Hua
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
| | - Lang Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
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Chen X, Huang M, Zhang Z, Jing H, Zou Y, Bu H. Primary meningeal central nervous system lymphoma: A case report and literature review. Medicine (Baltimore) 2022; 101:e32567. [PMID: 36596043 PMCID: PMC9803511 DOI: 10.1097/md.0000000000032567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin lymphoma, and isolated meningeal PCNSL, without evidence of parenchymal involvement, is even less common, occurring in only 10% to 15% of cases. PATIENT CONCERNS A 65-years-old female presented to our hospital with progressive lower extremity motor dysfunction and blurred vision. The initial neurological examination revealed decreased muscle strength in both lower extremities and sensory dysfunction of lower extremities, saddle area, and buttocks. Brain magnetic resonance imaging showed no abnormalities. Lumbar enhanced magnetic resonance imaging showed T11 to L3 horizontal meningeal enhancement. Cerebrospinal fluid (CSF) cytology revealed lymphoma cells. Immunohistochemistry and flow cytometry of the CSF were performed as auxiliary methods to establish the diagnosis of lymphoma. DIAGNOSES The patient was diagnosed primary meningeal central nervous system lymphoma. INTERVENTIONS During hospitalization, the patient was treated with 2 courses of high-dose intrathecal methotrexate and rituximab combined with intrathecal chemotherapy and supportive treatment. OUTCOMES After 2 years of follow-up, the patient was able to walk and take care of herself. LESSONS Cases of PCNSL involving only the meninges are rare. Multimodal analysis of the CSF comprises an important component of the diagnostic work-up for patients with primary meningeal central nervous system lymphoma.
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Affiliation(s)
- Xue Chen
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Min Huang
- Department of Neurology, Yuncheng Central Hospital of Shanxi Province, Shanxi, China
| | - Zhenyuan Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huilan Jing
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yueli Zou
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Bu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- * Correspondence: Hui Bu, Department of Neurology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Shijiazhuang, Hebei 050000, China (e-mail: )
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9
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Cao L, Zhang M, Zhang Y, Ji B, Wang X, Wang X. Progress of radiological‑pathological workflows in the differential diagnosis between primary central nervous system lymphoma and high‑grade glioma (Review). Oncol Rep 2022; 49:20. [PMID: 36484403 PMCID: PMC9773014 DOI: 10.3892/or.2022.8457] [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: 06/24/2022] [Accepted: 11/03/2022] [Indexed: 12/13/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) and high‑grade glioma (HGG) are distinct entities of the CNS with completely distinct treatments. The treatment of PCNSL is chemotherapy‑based, while surgery is the first choice for HGG. However, the clinical features of the two entities often overlap, and a clear pathological diagnosis is important for subsequent management, especially for the management of PCNSL. Stereotactic biopsy is recognized as one of the minimally invasive alternatives for evaluating the involvement of the CNS. However, in the case of limited tissue materials, the differential diagnosis between the two entities is still difficult. In addition, some patients are too ill to tolerate a needle biopsy. Therefore, combining imaging, histopathology and laboratory examinations is essential in order to make a clear diagnosis as soon as possible. The present study reviews the progress of comparative research on both imaging and laboratory tests based on the pathophysiological changes of the two entities, and proposes an integrative and optimized diagnostic process, with the purpose of building a better understanding for neurologists, hematologists, radiologists and pathologists.
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Affiliation(s)
- Luming Cao
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Mengchao Zhang
- Department of Radiology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Ying Zhang
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Bin Ji
- Department of Nuclear Medicine, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Xuemei Wang
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China
| | - Xueju Wang
- Department of Pathology, China-Japan Union Hospital, Jilin University, Changchun, Jilin 130033, P.R. China,Correspondence to: Dr Xueju Wang, Department of Pathology, China-Japan Union Hospital, Jilin University, 126 Xiantai Street, Changchun, Jilin 130033, P.R. China, E-mail:
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10
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Role of Positron Emission Tomography in Primary Central Nervous System Lymphoma. Cancers (Basel) 2022; 14:cancers14174071. [PMID: 36077613 PMCID: PMC9454946 DOI: 10.3390/cancers14174071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Primary central nervous system lymphoma (PCNSL) is a rare but highly aggressive lymphoma with increasing incidence in immunocompetent patients. To date, the only established biomarkers for survival are age and functional status. Currently, the magnetic resonance imaging (MRI) criteria of the International Collaborative Group on Primary Central Nervous System Lymphoma are the only ones recommended for follow-up. However, early occurrence of recurrence after treatment in patients with a complete response on MRI raises the question of its performance in assessing residual disease. While the use of 18F-fluorodeoxyglucose body positron emission tomography for identification of systemic disease has been established and can be pivotal in patient treatment decisions, the role of brain PET scan is less clear. Here we review the potential role of PET in the management of patients with PCNSL, both at diagnosis and for follow-up under treatment. Abstract The incidence of primary central nervous system lymphoma has increased over the past two decades in immunocompetent patients and the prognosis remains poor. A diagnosis and complete evaluation of the patient is needed without delay, but histologic evaluation is not always available and PCNSL can mimic a variety of brain lesions on MRI. In this article, we review the potential role of 18F-FDG PET for the diagnosis of PCNSL in immunocompetent and immunocompromised patients. Its contribution to systemic assessment at the time of diagnosis has been well established by expert societies over the past decade. In addition, 18F-FDG provides valuable information for differential diagnosis and outcome prediction. The literature also shows the potential role of 18F-FDG as a therapeutic evaluation tool during the treatment and the end of the treatment. Finally, we present several new radiotracers that may have a potential role in the management of PCNSL in the future.
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11
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Zheng X, Li P, Dong Q, Duan Y, Yang S, Cai Z, Chen F, Li W. MicroRNAs as Diagnostic Biomarkers in Primary Central Nervous System Lymphoma: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:743542. [PMID: 34604087 PMCID: PMC8484918 DOI: 10.3389/fonc.2021.743542] [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: 07/18/2021] [Accepted: 08/26/2021] [Indexed: 11/24/2022] Open
Abstract
Background Diagnosing primary central nervous system lymphoma (PCNSL) remains a challenge. MicroRNAs (miRNAs) are promising noninvasive markers for the identification of PCNSL. The present study aims to assess the diagnostic value of miRNAs for PCNSL patients as biomarkers. Methods We systematically searched PubMed, Embase, and the Cochrane library from inception to January 31, 2021. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), together with the summary receiver operator characteristic (SROC) curve, and the area under the SROC curve (AUC) value were used to estimate the overall diagnostic performance. We used Q statistic and I2 to test heterogeneity and used subgroup analyses to investigate the source of heterogeneity. The statistical analyses were independently performed by two investigators using Stata 14.0 and Revman 5.3. Results In total, 11 studies from 6 records were included in the current meta-analysis with 281 PCNSL patients and 367 controls. Our statistical analysis demonstrated that the pooled sensitivity, specificity, PLR, NLR, DOR, and AUC were 0.91 (95% CI 0.84–0.95), 0.88 (95% CI 0.84–0.91), 7.48 (95% CI 5.71–9.78), 0.11 (95% CI 0.06–0.19), 70 (95% CI 35–142), and 0.90 (95% CI 0.87–0.92), respectively. The studies had substantial heterogeneity (I2 = 54%, 95% CI 0–100). Two subgroup analyses were conducted based on the type of specimen and miRNAs profiled. Conclusions This meta-analysis indicated that miRNAs were suitable as noninvasive diagnostic biomarkers for PCNSL with high accuracy. In addition, both cerebrospinal fluid-based and blood-based miRNAs assays for PCNSL detection were considered reliable for clinical application. MicroRNA-21 assays also seemed to be more accurate in the diagnosis of PCNSL. Good quality studies with large samples should be conducted to verify our results.
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Affiliation(s)
- Xiaohong Zheng
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Parker Li
- Clinical Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qianqian Dong
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of General Medicine, Ningbo Medical Center, Li Huili Hospital, Zhejiang, China
| | - Yihong Duan
- Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Shoubo Yang
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zehao Cai
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Chen
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenbin Li
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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12
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Paglia F, di Norcia V, D'Angelo L, Berra LV, Santoro A. A rare case of Meckel's cave primary lymphoma: a case report and elaboration of the diagnostic algorithm. Acta Neurol Belg 2021; 121:907-914. [PMID: 31983037 DOI: 10.1007/s13760-020-01281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/11/2020] [Indexed: 11/26/2022]
Abstract
Management of lesions involving Meckel's cave can represent a challenge for neurosurgeons, because of the deep-seated location and the surrounding complex neurovascular structures. Very small lesions arising from MC are generally asymptomatic and radiological follow-up with head MRI and PET-CT is sufficient to control these lesions. In rare cases, the rapid increase in the size of lesions and the alteration of the neurologic status make early histological characterization mandatory in the plethora of lesions arising from Meckel's cave; a very small percentage is represented by central nervous system lymphomas. Primary diffuse large B-cell lymphoma is the most commonly found. Aggressive surgery, in case of suspicious Meckel's cave lesions, is strongly discouraged, because this procedure may increase the risk of postoperative deficit and provides no survival benefit compared with biopsy alone. The aim of the present paper is to report a very rare case of primary Meckel's cave diffuse large B-cell lymphoma (only seven cases were described in literature) and standardize an operative algorithm to avoid the risks of an incorrect surgical conduct.
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Affiliation(s)
- Francesco Paglia
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy.
| | - Valerio di Norcia
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Luca D'Angelo
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Luigi Valentino Berra
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurology and Psychiatry, Neurosurgery, 'Sapienza' University of Rome, Rome, Italy
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13
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Liquid Biopsy and Other Non-Invasive Diagnostic Measures in PCNSL. Cancers (Basel) 2021; 13:cancers13112665. [PMID: 34071407 PMCID: PMC8198992 DOI: 10.3390/cancers13112665] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Primary central nervous system lymphoma (PCNSL) is an uncommon disease accounting for around 3% of primary CNS tumors. PCNSL exhibits aggressive clinical behavior and has an overall poor prognosis. The clinical presentation is variable, and there are no specific symptoms. Despite progress in radiographic neuroimaging, stereotactic brain biopsy remains obligatory for definitive diagnosis. Advanced standard diagnostics, including CSF cytology and flow cytometry, have limited sensitivity. Accordingly, there is an urgent need to improve the diagnostic tools for PCNSL, including novel non-invasive procedures. The aim of this review is to present and discuss modern methods that have the potential to contribute standard clinical diagnostics within the next few years. Abstract Primary central nervous system lymphoma is a rare but highly aggressive form of non-Hodgkin lymphoma that remains confined to the CNS neuroaxis. The diagnosis of PCNSL requires a high level of suspicion as clinical presentation varies depending on the involved CNS areas. Neurological symptoms and MRI findings may mimic gliomas, demyelinating lesions, or infectious and granulomatous diseases. Almost all PCNSL patients undergo invasive surgical procedures for definite diagnosis. Stereotactic biopsy is still the gold standard in achieving a diagnostic accuracy of 73–97%. Both the potential procedural morbidity and mortality, as well as the time to definite histopathologic diagnosis resulting in delays of treatment initiation, have to be considered. On the contrary, minimally invasive procedures, such as MRI, CSF cytology, and flow cytometry, still have limited value due to inferior specificity and sensitivity. Hence, novel diagnostic approaches, including mutation analyses (MYD88) in circulating tumor DNA (ctDNA) and the determination of microRNAs (miR-21, miR-19b, and miR-92) as well as cytokine levels (IL10 and IL6) in blood, cerebrospinal fluid (CSF), and vitreous fluid (VRF), move into the focus of investigation to facilitate the diagnosis of PCNSL. In this review, we outline the most promising approaches that are currently under clinical consideration.
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14
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Sözen M, Yaprak Bayrak B, Selek A, Cantürk Z, Çetinarslan B, Gezer E. Primary hypothalamic lymphoma with clinical findings mimicking pituitary apoplexy: a case report. J Med Case Rep 2021; 15:293. [PMID: 34030739 PMCID: PMC8145818 DOI: 10.1186/s13256-021-02866-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare but well-known extra-nodal lymphoma, which usually presents with non-Hodgkin B-cell lymphomas. PCNSL is generally located around the ventricle and is often detected as multiple lesions. It is rarely seen in the area of the hypothalamus. CASE PRESENTATION We report the case of a 48-year-old Caucasian woman with progressive short-term memory deterioration, headache, mental confusion, diabetes insipidus (DI) and hypopituitarism. Early findings were suggestive of a pituitary apoplexy. The results of tests performed during the initial admission at the tertiary health center revealed hypernatremia, hypopituitarism and DI. Intravenous hydrocortisone treatment was initiated for the secondary adrenal insufficiency, and 75 mcg/day of levothyroxine was started for the secondary hypothyroidism on the fourth day following hydrocortisone treatment. A daily dose of 120 mg desmopressin melt tablet was started twice a day for polyuria/polydipsia after the patient's volume status was balanced. A brain magnetic resonance imaging scan revealed a mass lesion in the hypothalamic area, which was surrounded by marked edema. Anti-edema treatment was initially started considering the suggestion by our neurosurgery team. The patient's clinical and laboratory findings improved after the initiation of the anti-edema therapy. Afterwards, a biopsy was performed, which diagnosed a malignant diffuse large B-cell lymphoma. Subsequently, intravenous high-dose methotrexate-based therapy was started; however, after the second cycle of chemotherapy, the patient died due to sepsis. CONCLUSION In this report, we present a case of hypopituitarism that developed due to the mass effect of hypothalamic lymphoma with clinical findings of pituitary apoplexy. Intracranial masses may cause obvious endocrinological findings related to hypopituitarism, while vague findings may also be observed due to partial failure. Therefore, it is important to perform a comprehensive endocrinological examination at the time of diagnosis in patients with intracranial masses.
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Affiliation(s)
- Mehmet Sözen
- Department of Endocrinology and Metabolism, Kocaeli University College of Medicine, Kocaeli, 41000, Turkey.
| | - Büşra Yaprak Bayrak
- Department of Pathology, Kocaeli University College of Medicine, Kocaeli, Turkey
| | - Alev Selek
- Department of Endocrinology and Metabolism, Kocaeli University College of Medicine, Kocaeli, 41000, Turkey
| | - Zeynep Cantürk
- Department of Endocrinology and Metabolism, Kocaeli University College of Medicine, Kocaeli, 41000, Turkey
| | - Berrin Çetinarslan
- Department of Endocrinology and Metabolism, Kocaeli University College of Medicine, Kocaeli, 41000, Turkey
| | - Emre Gezer
- Department of Endocrinology and Metabolism, Kocaeli University College of Medicine, Kocaeli, 41000, Turkey
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15
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Del Principe MI, Gatti A, Johansson U, Buccisano F, Brando B. ESCCA
/
ISCCA
protocol for the analysis of cerebrospinal fluid by multiparametric flow‐cytometry in hematological malignancies. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 100:269-281. [DOI: 10.1002/cyto.b.21981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/14/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | - Arianna Gatti
- Blood Transfusion Center Legnano General Hospital Legnano Italy
| | - Ulrika Johansson
- SI‐HMDS University Hospitals Bristol and Weston NHS Foundation Trust Bristol United Kingdom
| | - Francesco Buccisano
- Hematology, Department of BioMedicine and Prevention University of Rome “Tor Vergata” Rome Italy
| | - Bruno Brando
- Blood Transfusion Center Legnano General Hospital Legnano Italy
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16
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Abstract
We present a case of secondary central nervous system relapse of lymphoma detected initially on PET/CT without corresponding findings on MRI. A 60-year-old lymphoma patient demonstrated an FDG-avid focus in left cerebellar hemisphere on restaging PET/CT. MRI brain showed no corresponding abnormality, and expectant management ensued. Six months later, she represented with metabolic progression of previously seen FDG-avid focus in left cerebellar hemisphere, now also manifesting as an enhancing mass on MRI. Posttreatment scan for presumed lymphoma relapse showed metabolic response. This case demonstrates the advantage of PET/CT over anatomical imaging to detect metabolic changes before structural changes become apparent.
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17
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Herhaus P, Lipkova J, Lammer F, Yakushev I, Vag T, Slotta-Huspenina J, Habringer S, Lapa C, Pukrop T, Hellwig D, Wiestler B, Buck AK, Deckert M, Wester HJ, Bassermann F, Schwaiger M, Weber W, Menze B, Keller U. CXCR4-Targeted PET Imaging of Central Nervous System B-Cell Lymphoma. J Nucl Med 2020; 61:1765-1771. [PMID: 32332145 DOI: 10.2967/jnumed.120.241703] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/19/2020] [Indexed: 12/21/2022] Open
Abstract
C-X-C chemokine receptor 4 (CXCR4) is a transmembrane chemokine receptor involved in growth, survival, and dissemination of cancer, including aggressive B-cell lymphoma. MRI is the standard imaging technology for central nervous system (CNS) involvement of B-cell lymphoma and provides high sensitivity but moderate specificity. Therefore, novel molecular and functional imaging strategies are urgently required. Methods: In this proof-of-concept study, 11 patients with lymphoma of the CNS (8 primary and 3 secondary involvement) were imaged with the CXCR4-directed PET tracer 68Ga-pentixafor. To evaluate the predictive value of this imaging modality, treatment response, as determined by MRI, was correlated with quantification of CXCR4 expression by 68Ga-pentixafor PET in vivo before initiation of treatment in 7 of 11 patients. Results: 68Ga-pentixafor PET showed excellent contrast with the surrounding brain parenchyma in all patients with active disease. Furthermore, initial CXCR4 uptake determined by PET correlated with subsequent treatment response as assessed by MRI. Conclusion: 68Ga-pentixafor PET represents a novel diagnostic tool for CNS lymphoma with potential implications for theranostic approaches as well as response and risk assessment.
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Affiliation(s)
- Peter Herhaus
- Internal Medicine III, School of Medicine, Technische Universität München, Munich, Germany
| | - Jana Lipkova
- Department of Neuroradiology, School of Medicine, Technische Universität München, Munich, Germany
| | - Felicitas Lammer
- Department of Hematology, Oncology, and Tumor Immunology (Campus Benjamin Franklin), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, School of Medicine, Technische Universität München, Munich, Germany
| | - Tibor Vag
- Department of Nuclear Medicine, School of Medicine, Technische Universität München, Munich, Germany
| | | | - Stefan Habringer
- Department of Hematology, Oncology, and Tumor Immunology (Campus Benjamin Franklin), Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, Universitätsklinikum Würzburg, Würzburg, Germany.,Department of Nuclear Medicine, University Hospital Augsburg, Augsburg, Germany
| | - Tobias Pukrop
- Internal Medicine III, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Dirk Hellwig
- Department of Nuclear Medicine, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, School of Medicine, Technische Universität München, Munich, Germany
| | - Andreas K Buck
- Department of Nuclear Medicine, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Martina Deckert
- Insitute of Neuropathology, Faculty of Medicine, University of Cologne, and University Hospital Cologne, Cologne, Germany
| | - Hans-Jürgen Wester
- Institute of Pharmaceutical Radiochemistry, Technische Universität München, Munich, Germany
| | - Florian Bassermann
- Internal Medicine III, School of Medicine, Technische Universität München, Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, School of Medicine, Technische Universität München, Munich, Germany
| | - Wolfgang Weber
- Department of Neuroradiology, School of Medicine, Technische Universität München, Munich, Germany
| | - Björn Menze
- Informatics Department, Technische Universität München, Munich, Germany
| | - Ulrich Keller
- Internal Medicine III, School of Medicine, Technische Universität München, Munich, Germany .,Department of Hematology, Oncology, and Tumor Immunology (Campus Benjamin Franklin), Charité-Universitätsmedizin Berlin, Berlin, Germany.,Max Delbrück Center for Molecular Medicine, Berlin, Germany; and.,German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
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18
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Abstract
INTRODUCTION Primary Central Nervous System Lymphoma (PCNSL) remains a diagnostic challenge due to the variable clinical manifestations. Liquid biopsies, particularly those involving cell-free DNA (cfDNA) from plasma, are rapidly emerging as important and minimally invasive adjuncts to traditional biopsies. However, conventional pathology may be still essential to obtain a diagnosis. PATIENT CONCERNS A 56-year-old woman presented with a progressive headache, dizziness, blurred vision, and lower limbs weakness with dysesthesia. Atypical clinical and radiological presentations, previous empirical treatment in another hospital, together with the patient's refusal to stereotactic brain biopsy made it challenging to diagnose. Her status deteriorated continuously during hospitalization. DIAGNOSIS Lumber punctual was performed, and CSF cytological analysis revealed malignancy cells with a high nuclear-cytoplasmic ratio. However, these cells were too loose to perform immunohistochemical stains. Genetic aberrations detections with CSF and peripheral blood sample were also inconclusive. We made a "cell-block" using the sedimentary cells collected from CSF collected through multiple aspirations via an Omaya reservoir. We further performed cytopathological and immunohistochemical analysis using this "cell-block," which finally confirmed the diagnosis of diffuse large-B cell PCNSL. INTERVENTIONS Intracranial chemotherapy began afterwards (MTX 15 mg and dexamethasone 5 mg, twice per weeks). OUTCOMES Unfortunately, this patient was dead 2 weeks later due to severe myelosuppression and secondary septic shock. CONCLUSION We provided "cell-block" method, which collects cell components from large amount of CSF for cytology and immunohistochemical analysis. "Cell-block" cytology can be an alternative diagnostic method in diagnosis of PCNSL.
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Perez-Roman RJ, Hubbard ZS, Brusko GD, Starke RM. A case of primary central nervous system lymphoma presenting as a shunt complication. Br J Neurosurg 2020:1-4. [PMID: 32164443 DOI: 10.1080/02688697.2020.1735300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The authors describe an 82-year-old female with a right frontal ventriculoperitoneal (VP) shunt for long-standing normal pressure hydrocephalus (NPH) who presented with worsening incontinence and gait instability. She was found to have right lateral ventricle collapse around the shunt catheter and subsequently underwent shunt revision, which failed to improve her symptoms. Magnetic resonance imaging (MRI) was obtained on postoperative day two, which demonstrated a ventricular lesion. Endoscopic brain biopsy was performed and a diagnosis of primary central nervous system lymphoma (PCNSL) was made. The authors believe this is the first published case of PCNSL presenting as a VP shunt complication in a patient with NPH.
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Affiliation(s)
- Roberto J Perez-Roman
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
| | - Zachary S Hubbard
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
| | - G Damian Brusko
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
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20
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Wang FX, Chen K, Huang FQ, Alolga RN, Ma J, Wu ZX, Fan Y, Ma G, Guan M. Cerebrospinal fluid-based metabolomics to characterize different types of brain tumors. J Neurol 2019; 267:984-993. [PMID: 31822990 DOI: 10.1007/s00415-019-09665-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/30/2019] [Accepted: 12/03/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Brain tumors cause significant morbidity and mortality due to rapid progression and high recurrence risks. Reliable biomarkers to improve diagnosis thereof are desirable. OBJECTIVE This work aimed to identify panels of biomarkers for diagnostic purposes using cerebrospinal fluid (CSF)-based metabolomics. METHODS A cohort of 163 histologically-proven patients with brain disorders was involved. Comprehensive CSF-based metabolomics was achieved by liquid chromatography-quadrupole time-of-flight spectrometric (LC-Q/TOF-MS) and multivariate statistical analyses. The diagnostic performance of the metabolic markers was evaluated using receiver operating characteristic curves. RESULTS A total of 508 ion features were detected by the LC-Q/TOF-MS analysis, of which 27 metabolites were selected as diagnostic markers to discriminate different brain tumor types. The area under the curve (AUC) was 0.91 for lung adenocarcinoma patients with brain metastases (MBT) vs. lung adenocarcinoma patients without brain metastases (NMBT), 0.83 for primary central nervous system lymphoma (PCNSL) vs. secondary central nervous system involvement of systemic lymphoma (SCNSL), 0.77 for PCNSL vs. MBT, 0.87 for SCNSL vs. MBT, 0.86 for MBT vs. nontumorous brain diseases (NT), and 0.80 for PCNSL vs. NT. Perturbed metabolic pathways between the comparisons related mainly to amino acids and citrate metabolism. CONCLUSIONS CSF-based metabolomics to a large extent reliably identifies significant metabolic differences between different brain tumors and shows great potential for diagnosis of brain tumors.
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Affiliation(s)
- Feng-Xiang Wang
- Clinical Metabolomics Center, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, China
| | - Kun Chen
- Department of Clinical Laboratory, North Huashan Hospital, Fudan University, Shanghai, China
| | - Feng-Qing Huang
- Clinical Metabolomics Center, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, China
| | - Raphael N Alolga
- Clinical Metabolomics Center, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, China
| | - Jingjing Ma
- Department of Hematology, North Huashan Hospital, Fudan University, Shanghai, China
| | - Zi-Xuan Wu
- Clinical Metabolomics Center, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, China
| | - Yuanming Fan
- Clinical Metabolomics Center, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, China
| | - Gaoxiang Ma
- Clinical Metabolomics Center, China Pharmaceutical University, 639 Longmian Avenue, Jiangning District, Nanjing, China.
| | - Ming Guan
- Central Laboratory, Huashan Hospital, Fudan University, 108 Luxiang Avenue, Baoshan District, Shanghai, China.
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21
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Wu Y, Wang Y, Sun X, Bai X, Qian J, Zhu H, Cui Q, Xing R, Chen Y, Liu Q, Guo J, Ji N, Sun S, Liu Y. Parenchymal central nervous system involvement in aggressive B-cell lymphoma: retrospective analysis of clinical and MRI features in a Chinese population. BMC Neurol 2019; 19:268. [PMID: 31684888 PMCID: PMC6829840 DOI: 10.1186/s12883-019-1511-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/23/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Secondary central nervous system lymphoma (SCNSL) is defined as secondary central nervous system (CNS) involvement in patients with systemic lymphoma. It is considered a profoundly adverse complication with inferior clinical outcome. Parenchymal involvement in the CNS in aggressive B-cell lymphoma is not frequently seen and remains a diagnostic dilemma. METHODS In our study, we retrospectively analyzed the clinical and magnetic resonance imaging (MRI) features of 26 parenchymal SCNSL patients. In addition, we compared MRI features of SCNSL and primary CNS lymphoma (PCNSL) patients after 1:1 propensity score matching. Also we presented two SCNSL cases with atypical MRI appearance. RESULTS Among SCNSL patients, the median CNS relapse time was 3 months, and multiple lesions were found in 76.9% of the cases. In PCNSL, this percentage was 42.3% (p = 0.011). None of the SCNSL patients and 23.1% of the PCNSL patients had solitary infratentorial lesions (p = 0.003). CONCLUSIONS The majority of parenchymal involvement occurred within the first year of systemic lymphoma, in which mostly cases presenting with multiple and supratentorial locations, unlike what was found in PCNSL.
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Affiliation(s)
- Yuchen Wu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Yaming Wang
- Department of Neurosurgery, Navy General Hospital of PLA, Beijing, China
| | - Xuefei Sun
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Xueyan Bai
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Jun Qian
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Hong Zhu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Qu Cui
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Ruixian Xing
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Yuedan Chen
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Qing Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Jiayuan Guo
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shengjun Sun
- Neuroimaging Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanbo Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Nan Si Huan Xi Lu 119, Fengtai District, Beijing, 100070, China.
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22
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Armand M, Costopoulos M, Osman J, Tarfi S, Houillier C, Choquet S, Agnelo H, Bonnemye P, Ronez E, Settegrana C, Soussain C, Hoang‐Xuan K, Le Garff‐Tavernier M, Davi F. Optimization of CSF biological investigations for CNS lymphoma diagnosis. Am J Hematol 2019; 94:1123-1131. [PMID: 31328307 DOI: 10.1002/ajh.25578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/03/2019] [Accepted: 07/13/2019] [Indexed: 01/12/2023]
Abstract
Diagnosis of lymphoma leptomeningeal dissemination is challenging and relies on a wide array of methods. So far, no consensus biological guidelines are available. This increases the chance of intra- and interpractice variations, despite the shared concern to perform the minimum amount of tests while preserving clinically relevant results.We evaluated a training cohort of 371 cerebrospinal fluid (CSF) samples from patients with putative lymphomatous central nervous system (CNS) localization using conventional cytology (CC), flow cytometry (FCM), molecular clonality assesment by PCR and cytokine quantification (CQ). This led us to propose a biological algorithm, which was then verified on a validation cohort of 197 samples. The samples were classified according to the clinical context and the results of each technique were compared. Using all four techniques was not useful for exclusion diagnosis of CNS lymphoma (CNSL), but they proved complementary for cases with suspected CNSL. This was particularly true for CQ in primary CNSL. Overall, diagnosis can be obtained with a two-step approach. The first step comprises CC and FCM, as results are available quickly and FCM is a sensitive method. Both PCR and CQ can be postponed and performed in a second step, depending on the results from the first step and the clinical context.The proposed algorithm missed none of the CNSL samples of the validation cohort. Moreover, applying this algorithm would have spared 30% of PCR tests and 20% of CQ over a one-year period, without compromising clinical management.
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Affiliation(s)
- Marine Armand
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Myrto Costopoulos
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Jennifer Osman
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Sihem Tarfi
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Caroline Houillier
- Department of NeurologyAPHP Pitié‐Salpêtrière, Hospital and Sorbonne Université Paris France
| | - Sylvain Choquet
- Department of HematologyAPHP Pitié‐Salpêtrière, Hospital and Sorbonne Université Paris France
| | - Hervé Agnelo
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Patrick Bonnemye
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Emily Ronez
- Hematology Immunology and Transfusion LaboratoryAPHP Hopital Ambroise Paré Boulogne Billancourt France
| | - Catherine Settegrana
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
| | - Carole Soussain
- Department of HematologyHôpital René Huguenin, Institut Curie Saint‐Cloud France
| | - Khê Hoang‐Xuan
- Department of NeurologyAPHP Pitié‐Salpêtrière, Hospital and Sorbonne Université Paris France
| | | | - Frédéric Davi
- Hematology LaboratoryAPHP Pitié‐Salpêtrière Hospital and Sorbonne Université Paris France
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Morell AA, Shah AH, Cavallo C, Eichberg DG, Sarkiss CA, Benveniste R, Ivan ME, Komotar RJ. Diagnosis of primary central nervous system lymphoma: a systematic review of the utility of CSF screening and the role of early brain biopsy. Neurooncol Pract 2019; 6:415-423. [PMID: 31832211 DOI: 10.1093/nop/npz015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Because less-invasive techniques can obviate the need for brain biopsy in the diagnosis of primary central nervous system lymphoma (PCNSL), it is common practice to wait for a thorough initial work-up, which may delay treatment. We conducted a systematic review and reviewed our own series of patients to define the role of LP and early brain biopsy in the diagnosis of PCNSL. Methods Our study was divided into 2 main sections: 1) systematic review assessing the sensitivity of cerebrospinal fluid (CSF) analysis on the diagnosis of PCNSL, and 2) a retrospective, single-center patient series assessing the diagnostic accuracy and safety of early biopsy in immunocompetent PCNSL patients treated at our institution from 2012 to 2018. Results Our systematic review identified 1481 patients with PCNSL. A preoperative LP obviated surgery in 7.4% of cases. Brain biopsy was the preferred method of diagnosis in 95% of patients followed by CSF (3.1%). In our institutional series, brain biopsy was diagnostic in 92.3% of cases (24/26) with 2 cases that required a second procedure for diagnosis. Perioperative morbidity was noted in 7.6% of cases (n = 2) due to hemorrhages after stereotactic brain biopsy that improved at follow-up. Conclusions The diagnostic yield of CSF analyses for PCNSL in immunocompetent patients remains exceedingly low. Our institutional series demonstrates that early biopsy for PCNSL is safe and accurate, and may avert protracted work-ups. We conclude that performing an early brain biopsy in a suspected case of PCNSL is a valid, safe option to minimize diagnostic delay.
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Affiliation(s)
- Alexis A Morell
- Department of Neurological Surgery, University of Miami Miller School of Medicine, FL
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, FL
| | - Claudio Cavallo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, FL
| | - Christopher A Sarkiss
- Department of Neurological Surgery, University of Miami Miller School of Medicine, FL
| | - Ronald Benveniste
- Department of Neurological Surgery, University of Miami Miller School of Medicine, FL
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, FL
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, FL
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Ghannam M, Mansour S, Jumah F, Berry B, Beard A. Cerebellar large B-cell lymphoma: a case report. J Med Case Rep 2018; 12:341. [PMID: 30446015 PMCID: PMC6240289 DOI: 10.1186/s13256-018-1880-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 10/10/2018] [Indexed: 01/15/2023] Open
Abstract
Background Primary central nervous system lymphoma is a rare, malignant non-Hodgkin lymphoma that can arise in the brain, spinal cord, eye, leptomeninges, or cranial nerves. Primary central nervous system lymphoma is rare, accounting for 2–6% of all primary brain neoplasms and 1–2% of all non-Hodgkin lymphomas, and it usually presents as a solitary lesion. Cerebellar involvement is present in only 9% of cases. We present an unusual case of primary central nervous system lymphoma presenting as multiple lesions in the cerebellum in an immunocompetent host. Case presentation A 71-year-old Caucasian man presented to our hospital with acute onset of dizziness, nausea, vomiting, and gait imbalance. Contrast-enhanced computed tomography revealed three intensely enhancing masses in the right cerebellar hemisphere. Whole-body positron emission tomography and computed tomography failed to demonstrate a primary tumor of origin outside the central nervous system. The patient underwent right suboccipital craniotomy with partial resection of the visible tumor from the right cerebellum. Histopathology revealed diffuse large B-cell lymphoma, non-germinal center type. Conclusions Primary central nervous system lymphoma is rare, even more so in the cerebellum. However, the overall incidence of primary central nervous system lymphoma is rising in both immunocompromised and immunocompetent patients. The highly aggressive nature of primary central nervous system lymphoma necessitates timely diagnosis and intervention. In this report, we review the available literature for a better understanding of the pathophysiology and management of primary central nervous system lymphoma. To the best of our knowledge, this is the first reported case of a patient with primary central nervous system lymphoma presenting with multiple masses in the cerebellum.
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Affiliation(s)
- Malik Ghannam
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
| | - Shaden Mansour
- An-Najah National University, Nablus, West Bank, Palestine
| | - Fareed Jumah
- An-Najah National University, Nablus, West Bank, Palestine
| | - Brent Berry
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Albertine Beard
- Minneapolis Veterans Affairs Healthcare System, Section of Hospital Medicine, Minneapolis, MN, USA.,Department of Internal Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
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van der Meulen M, Bromberg JE, Lam KH, Dammers R, Langerak AW, Doorduijn JK, Kros JM, van den Bent MJ, van der Velden VH. Flow cytometry shows added value in diagnosing lymphoma in brain biopsies. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 94:928-934. [PMID: 29747221 PMCID: PMC6585701 DOI: 10.1002/cyto.b.21641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/10/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023]
Abstract
Background To assess the sensitivity, specificity and turnaround time of flow cytometric analysis on brain biopsies compared to histology plus immunohistochemistry analysis in tumors with clinical suspicion of lymphoma. Methods All brain biopsies performed between 2010 and 2015 at our institution and analyzed by both immunohistochemistry and flow cytometry were included in this retrospective study. Immunohistochemistry was considered the gold standard. Results In a total of 77 biopsies from 71 patients, 49 lymphomas were diagnosed by immunohistochemistry, flow cytometry results were concordant in 71 biopsies (92.2%). We found a specificity and sensitivity of flow cytometry of 100% and 87.8%, respectively. The time between the biopsy and reporting the result (turnaround time) was significantly shorter for flow cytometry, compared to immunohistochemistry (median: 1 vs. 5 days). Conclusions Flow cytometry has a high specificity and can confirm the diagnosis of a lymphoma significantly faster than immunohistochemistry. This allows for rapid initiation of treatment in this highly aggressive tumor. However, since its sensitivity is less than 100%, we recommend to perform histology plus immunohistochemistry in parallel to flow cytometry. © 2018 The Authors. Cytometry Part B: Clinical Cytometry published by Wiley Periodicals, Inc. on behalf of International Clinical Cytometry Society
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Affiliation(s)
- Matthijs van der Meulen
- Department of Neuro‐OncologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Jacoline E.C. Bromberg
- Department of Neuro‐OncologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - King H. Lam
- Department of PathologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | - Ruben Dammers
- Department of NeurosurgeryErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Anton W. Langerak
- Department of Immunology, Laboratory Medical ImmunologyErasmus MC, University Medical CenterRotterdamthe Netherlands
| | - Jeanette K. Doorduijn
- Department of HematologyErasmus MC Cancer Institute, University Medical CenterRotterdamthe Netherlands
| | - Johan M. Kros
- Department of PathologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Martin J. van den Bent
- Department of Neuro‐OncologyErasmus MC Cancer Institute, Brain Tumor Center, University Medical CenterRotterdamthe Netherlands
| | - Vincent H.J. van der Velden
- Department of Immunology, Laboratory Medical ImmunologyErasmus MC, University Medical CenterRotterdamthe Netherlands
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26
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Lin FH, Zhang XH, Zhang J, He ZQ, Duan H, Ke C, Sai K, Jiang XB, AL-Nahari F, Xi SY, Mou YG. Fluorescein sodium-guided biopsy or resection in primary central nervous system lymphomas with contrast-enhancing lesion in MRI. J Neurooncol 2018; 139:757-765. [DOI: 10.1007/s11060-018-2924-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/03/2018] [Indexed: 12/14/2022]
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27
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Thaler FS, Laurent SA, Huber M, Mulazzani M, Dreyling M, Ködel U, Kümpfel T, Straube A, Meinl E, von Baumgarten L. Soluble TACI and soluble BCMA as biomarkers in primary central nervous system lymphoma. Neuro Oncol 2018; 19:1618-1627. [PMID: 28521029 DOI: 10.1093/neuonc/nox097] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background B-cell survival is regulated through interactions of B-cell-activating factor and a proliferation-inducing ligand with their receptors transmembrane activator and CAML interactor (TACI) and B-cell maturation antigen (BCMA). We evaluated the diagnostic potential of soluble TACI (sTACI) and soluble BCMA (sBCMA) in CSF and serum as biomarkers in primary CNS lymphoma (PCNSL). Methods CSF (n = 176) and serum samples (n = 105) from patients with clinically or radiologically suspected PCNSL as well as from control patients were collected prospectively. Levels of sTACI and sBCMA were analyzed by enzyme-linked immunosorbent assay. Additionally, in patients with PCNSL, CSF was analyzed during disease course (time of diagnosis, n = 26; relapse, n = 10; remission, n = 14), and in 2 patients long-term longitudinal analysis was performed. Results Soluble TACI and sBCMA are significantly increased in patients with PCNSL (sTACI, median: 445 pg/mL; sBCMA, median: 760 pg/mL) compared with control patients (sTACI, median: 0 pg/mL; sBCMA, median: 290 pg/mL). At a cutoff value of 68.4 pg/mL, sTACI shows high sensitivity (87.9%) and specificity (88.3%) for the diagnosis of active PCNSL. Soluble BCMA is less sensitive (72.7%) and specific (71.8%) (cutoff: 460 pg/mL). When both markers are combined, specificity increases, however, at the cost of a lower sensitivity. In serum, both sTACI and sBCMA are not increased in PCNSL patients. Both soluble receptors correlate with clinical course and therapy response. Conclusions Our results suggest that sTACI and sBCMA in the CSF are promising new biomarkers for diagnosis and therapy monitoring in PCNSL. However, our findings need to be validated in an independent cohort.
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Affiliation(s)
- Franziska S Thaler
- Institute of Clinical Neuroimmunology, Biomedical Center and Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Neurology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Medicine III, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - Sarah A Laurent
- Institute of Clinical Neuroimmunology, Biomedical Center and Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Neurology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Medicine III, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - Marion Huber
- Institute of Clinical Neuroimmunology, Biomedical Center and Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Neurology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Medicine III, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - Matthias Mulazzani
- Institute of Clinical Neuroimmunology, Biomedical Center and Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Neurology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Medicine III, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - Martin Dreyling
- Institute of Clinical Neuroimmunology, Biomedical Center and Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Neurology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Medicine III, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - Uwe Ködel
- Institute of Clinical Neuroimmunology, Biomedical Center and Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Neurology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Medicine III, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Biomedical Center and Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Neurology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Medicine III, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - Andreas Straube
- Institute of Clinical Neuroimmunology, Biomedical Center and Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Neurology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Medicine III, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - Edgar Meinl
- Institute of Clinical Neuroimmunology, Biomedical Center and Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Neurology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Medicine III, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany
| | - Louisa von Baumgarten
- Institute of Clinical Neuroimmunology, Biomedical Center and Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Neurology, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany; Department of Medicine III, Klinikum Grosshadern, Ludwig Maximilian University, Munich, Germany
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Hovhannisyan N, Fillesoye F, Guillouet S, Ibazizene M, Toutain J, Gourand F, Valable S, Plancoulaine B, Barré L. [ 18F]Fludarabine-PET as a promising tool for differentiating CNS lymphoma and glioblastoma: Comparative analysis with [ 18F]FDG in human xenograft models. Am J Cancer Res 2018; 8:4563-4573. [PMID: 30214639 PMCID: PMC6134939 DOI: 10.7150/thno.26754] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/30/2018] [Indexed: 12/27/2022] Open
Abstract
This paper investigated whether positron emission tomography (PET) imaging with [18F]fludarabine ([18F]FDB) can help to differentiate central nervous system lymphoma (CNSL) from glioblastoma (GBM), which is a crucial issue in the diagnosis and management of patients with these aggressive brain tumors. Multimodal analyses with [18F]fluorodeoxyglucose ([18F]FDG), magnetic resonance imaging (MRI) and histology have also been considered to address the specificity of [18F]FDB for CNSL. Methods: Nude rats were implanted with human MC116 lymphoma-cells (n = 9) or U87 glioma-cells (n = 4). Tumor growth was monitored by MRI, with T2-weighted sequence for anatomical features and T1-weighted with gadolinium (Gd) enhancement for blood brain barrier (BBB) permeability assessment. For PET investigation, [18F]FDB or [18F]FDG (~11 MBq) were injected via tail vein and dynamic PET images were acquired up to 90 min after radiotracer injection. Paired scans of the same rat with the two [18F]-labelled radiotracers were investigated. Initial volumes of interest were manually delineated on T2w images and set on co-registered PET images and tumor-to-background ratio (TBR) was calculated to semi-quantitatively assess the tracer accumulation in the tumor. A tile-based method for image analysis was developed in order to make comparative analysis between radiotracer uptake and values extracted from immunohistochemistry staining. Results: In the lymphoma model, PET time-activity curves (TACs) revealed a differential response of [18F]FDB between tumoral and healthy tissues with average TBR varying from 2.45 to 3.16 between 5 to 90 min post-injection. In contrast, [18F]FDG demonstrated similar uptake profiles for tumoral and normal regions with TBR varying from 0.84 to 1.06 between these two time points. In the glioblastoma (GBM) model, the average TBRs were from 2.14 to 1.01 for [18F]FDB and from 0.95 to 1.65 for [18F]FDG. Therefore, inter-model comparisons showed significantly divergent responses (p < 0.01) of [18F]FDB between lymphoma and GBM, while [18F]FDG demonstrated overlap (p = 0.04) between the groups. Tumor characterization with histology (based mainly on Hoechst and CD79), as well as with MRI was overall in better agreement with [18F]FDB-PET than [18F]FDG with regard to tumor selectivity. Conclusions: [18F]FDB-PET demonstrated considerably greater specificity for CNSL when compared to [18F]FDG. It also permitted a more precise definition of target volume compared to contrast-enhanced MRI. Therefore, the potential of [18F]FDB-PET to distinguish CNSL from GBM is quite evident and will be further investigated in humans.
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Is deep brain involvement in intracranial primary central nervous system lymphoma of importance for penetration of chemotherapeutic agents? Neuroradiology 2018; 60:703-713. [DOI: 10.1007/s00234-018-2038-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/16/2018] [Indexed: 12/14/2022]
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30
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Hiemcke-Jiwa LS, Leguit RJ, Snijders TJ, Jiwa NM, Kuiper JJW, de Weger RA, Minnema MC, Huibers MMH. Molecular analysis in liquid biopsies for diagnostics of primary central nervous system lymphoma: Review of literature and future opportunities. Crit Rev Oncol Hematol 2018; 127:56-65. [PMID: 29891112 DOI: 10.1016/j.critrevonc.2018.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/03/2018] [Accepted: 05/14/2018] [Indexed: 01/01/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is an aggressive lymphoma with a poor prognosis, for which accurate and timely diagnosis is of utmost importance. Unfortunately, diagnosis of PCNSL can be challenging and a brain biopsy (gold standard for diagnosis) is an invasive procedure with the risk of major complications. Thus, there is an urgent need for an alternative strategy to diagnose and monitor these lymphomas. Currently, liquid biopsies from cerebrospinal fluid (CSF) are used for cytomorphologic and flow cytometric analysis. Recently, new biomarkers such as genetic mutations and interleukins have been identified in these liquid biopsies, further expanding the diagnostic armamentarium. In this review we present an overview of genetic aberrations (>70) reported in this unique lymphoma. Of these genes, we have selected those that are reported in ≥3 studies. Half of the selected genes are implicated in the NFκB pathway (CARD11, CD79B, MYD88, TBL1XR1 and TNFAIP3), while the other half are not related to this pathway (CDKN2A, ETV6, PIM1, PRDM1 and TOX). Although this underlines the crucial role of the NFκB pathway in PCNSL, CD79B and MYD88 are at present the only genes mentioned in liquid biopsy analysis. Finally, a stepwise approach is proposed for minimally invasive liquid biopsy analysis and work-up of PCNSL, incorporating molecular analysis. Prioritization and refinements of this approach can be constructed based upon multidisciplinary collaboration as well as novel scientific insights.
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Affiliation(s)
- Laura S Hiemcke-Jiwa
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Roos J Leguit
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Tom J Snijders
- Department of Neurology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - N Mehdi Jiwa
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jonas J W Kuiper
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Roel A de Weger
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht Cancer Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Manon M H Huibers
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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31
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Zou Y, Tong J, Leng H, Jiang J, Pan M, Chen Z. Diagnostic value of using 18F-FDG PET and PET/CT in immunocompetent patients with primary central nervous system lymphoma: A systematic review and meta-analysis. Oncotarget 2018; 8:41518-41528. [PMID: 28514747 PMCID: PMC5522282 DOI: 10.18632/oncotarget.17456] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/12/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) and PET/CT have become two of the most powerful tools for malignant lymphoma exploration, but their diagnostic role in primary central nervous system lymphoma (PCNSL) is still disputed. The purpose of our study is to identify the usefulness of 18F-FDG PET and PET/CT for detecting PCNSL. RESULTS A total of 129 patients, obtained from eight eligible studies, were included for this systematic review and meta-analysis. The performance of 18F-FDG PET and PET/CT for diagnosing PCNSL were as follows: the pooled sensitivity was 0.88 (95% CI: 0.80-0.94), specificity was 0.86 (95% CI: 0.73-0.94), positive likelihood ratio (PLR) was 3.99 (95% CI: 2.31-6.90), negative likelihood ratio (NLR) was 0.11 (95% CI: 0.04-0.32), and diagnostic odds ratio (DOR) was 33.40 (95% CI: 10.40-107.3). In addition, the area under the curve (AUC) and Q index were 0.9192 and 0.8525, respectively. MATERIALS AND METHODS PubMed/MEDLINE, Embase and Cochrane Library were systematically searched for potential publications (last updated on July 16th, 2016). Reference lists of included articles were also checked. Original articles that reported data on patients who were suspected of having PCNSL were considered suitable for inclusion. The sensitivities and specificities of 18F-FDG PET and PET/CT in each study were evaluated. The Stata software and Meta-Disc software were employed in the process of data analysis. CONCLUSIONS 18F-FDG PET and PET/CT showed considerable accuracy in identifying PCNSL in immunocompetent patients and could be a valuable radiological diagnostic tool for PCNSL.
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Affiliation(s)
- Yaru Zou
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jianjing Tong
- Exclusive Medical Care Center, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Haiyan Leng
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jingwei Jiang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Meng Pan
- Department of Dermatology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zi Chen
- Quintiles Asia Medical Oncology, Shanghai 200032, China.,Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, China
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32
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Zheng W, Song Y, Xie Y, Lin N, Tu M, Liu W, Ping L, Ying Z, Zhang C, Deng L, Wang X, Lu Y, Zhu J. Cerebrospinal Fluid Proteins Identification Facilitates the Differential Diagnosis of Central Nervous System Diffuse Large B Cell Lymphoma. J Cancer 2017; 8:3631-3640. [PMID: 29151949 PMCID: PMC5687180 DOI: 10.7150/jca.20267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 08/06/2017] [Indexed: 11/05/2022] Open
Abstract
Background: Diagnosis of central nervous system (CNS) lymphoma remains a challenge. This study aimed to identify cerebrospinal fluid (CSF) proteins that distinguish patients with and without CNS lymphoma. Methods: We used one-dimensional SDS-polyacrylamide gel electrophoresis coupled with liquid chromatography- electrospray ionization-quadrupole-time of flight-mass spectrometry (LC-ESI-Q-TOF MS) to identify CSF proteins in CNS diffuse large B cell lymphoma (DLBCL) patients and controls. Results: Approximately 166 CSF proteins were identified, 12 for the first time in the CSF of lymphoma patients. Three proteins with significantly increased expression in CNS lymphoma patients compared with controls - haemopexin, apolipoprotein A1, and transferrin were verified by immunohistochemistry, and found to be strongly expressed in CNS DLBCL and nodal DLBCL. These proteins were found to be localized in the cytoplasm of a human DLBCL cell line by indirect immunofluorescence. ELISA confirmed expression at higher concentrations in the CSF of CNS lymphoma patients. CSF haemopexin, apolipoprotein A1, and transferrin concentrations were detected in CNS lymphoma patients and had diagnostic sensitivities of 80%, 83%, and 70%, and specificities of 75%, 89%, and 90%, respectively. Conclusion: Our study suggests that CSF proteins may be potential diagnostic biomarker for CNS lymphoma, especially for patients in which imaging and cytology do not provide a clear diagnosis.
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Affiliation(s)
- Wen Zheng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - YuQin Song
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - Yan Xie
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - NingJing Lin
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - MeiFeng Tu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - WeiPing Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - LingYan Ping
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - ZhiTao Ying
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - Chen Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - LiJuan Deng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - XiaoPei Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - YouYong Lu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
| | - Jun Zhu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute. No. 52 Fucheng Road, Haidian District Beijing 100142, China
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Role of 18 F-FDG PET/CT in primary brain lymphoma. Rev Esp Med Nucl Imagen Mol 2017. [DOI: 10.1016/j.remnie.2017.07.002] [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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Schmitz N, Nickelsen M, Savage KJ. Central Nervous System Prophylaxis for Aggressive B-cell Lymphoma: Who, What, and When? Hematol Oncol Clin North Am 2017; 30:1277-1291. [PMID: 27888881 DOI: 10.1016/j.hoc.2016.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Central nervous system (CNS) relapse of aggressive B-cell lymphoma is a rare but serious complication with poor survival. Different approaches have been used to define risks factors for CNS relapse and establish prophylactic measures. Although patients with low or intermediate risk of CNS relapse should not undergo special diagnostic or therapeutic measures, CNS MRI as well as cytology and flow cytometry of the cerebrospinal fluid are suggested for high-risk patients (and patients with testicular involvement) at diagnosis, and prophylactic high-dose methotrexate in patients without proven CNS involvement. Future risk and treatment models may include molecular features and new treatment options.
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Affiliation(s)
- Norbert Schmitz
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, Hamburg D-20099, Germany.
| | - Maike Nickelsen
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Lohmuehlenstrasse 5, Hamburg D-20099, Germany
| | - Kerry J Savage
- Department of Medical Oncology, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia V5Z 4E6, Canada.
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Liang XG, Meng WT, Hu LJ, Li L, Xing H, Xie G, Wang AQ, Jia YQ. MicroRNA-184 Modulates Human Central Nervous System Lymphoma Cells Growth and Invasion by Targeting iASPP. J Cell Biochem 2017; 118:2645-2653. [PMID: 28012196 DOI: 10.1002/jcb.25856] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/21/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Xiao-gong Liang
- Department of Hematology; West China Hospital; Sichuan University; Chengdu 610041 China
- Department of Hematology; Mianyang Central Hospital; Chengdu 621000 China
| | - Wen-tong Meng
- Department of Hematology; West China Hospital; Sichuan University; Chengdu 610041 China
| | - Lian-jie Hu
- Department of Hematology; West China Hospital; Sichuan University; Chengdu 610041 China
| | - Lin Li
- Department of Pathology, West China Hospital; Sichuan University; Chengdu 610041 China
| | - Hongyun Xing
- Department of Hematology; Affiliated Southwest Medical University; Luzhou 646000 China
| | - Gan Xie
- Department of Pathology; Mianyang Central Hospital; Mianyang 621000 China
| | - An-qiong Wang
- Department of Pathology; Mianyang Central Hospital; Mianyang 621000 China
| | - Yong-qian Jia
- Department of Hematology; West China Hospital; Sichuan University; Chengdu 610041 China
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36
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de-Bonilla-Damiá Á, Fernández-López R, Capote-Huelva FJ, de la Cruz-Vicente F, Egea-Guerrero JJ, Borrego-Dorado I. Role of 18F-FDG PET/CT in primary brain lymphoma. Rev Esp Med Nucl Imagen Mol 2017; 36:298-303. [PMID: 28438519 DOI: 10.1016/j.remn.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/02/2017] [Accepted: 03/15/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To study the usefulness of 18F-FDG PET/CT in the initial evaluation and in the response assessment in primary brain lymphoma. MATERIAL AND METHODS A retrospective analysis was carried out on 18 patients diagnosed with primary brain lymphoma, a histological subtype of diffuse large B-cell lymphoma, on whom an initial 18F-FDG PET/CT and MRI was performed, with 7 of the cases being analysed after the completion of treatment in order to assess response and clinical follow up. RESULTS Initial 18F-FDG PET/CT showed 26 hypermetabolic foci, whereas 46 lesions were detected by MRI. The average SUV maximum of the lesions was 17.56 with T/N 3.55. The concordance of both tests for identifying the same number of lesions was moderate, obtaining a kappa index of 0.395 (P<.001). In the evaluation of treatment, MRI identified 16 lesions compared to 7 pathological accumulations observed by 18F-FDG PET/CT. The concordance of both tests to assess type of response to treatment was moderate (kappa index 0.41) (P=.04). In both the initial evaluation and the assessment of the response to treatment, PET/CT led to a change strategy in 22% of patients who had lesions outside the cerebral parenchyma. CONCLUSIONS MRI appears to be the method of choice for detecting brain disease in patients with primary brain lymphoma, whereas 18F-FDG PET/CT seems to play a relevant role in the assessment of extra-cerebral disease.
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Affiliation(s)
- Á de-Bonilla-Damiá
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - R Fernández-López
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - F J Capote-Huelva
- Unidad de Gestión Clínica de Hematología y Hemoterapia, Hospital Universitario Puerta del Mar, Cádiz, España
| | - F de la Cruz-Vicente
- Unidad de Gestión Clínica de Hematología y Hemoterapia, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - J J Egea-Guerrero
- Unidad de Gestión Clínica de Medicina Intensiva, Hospital Universitario Virgen del Rocío, IBiS, CSIC, Universidad de Sevilla, Sevilla, España
| | - I Borrego-Dorado
- Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
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Galicia N, Dégano R, Díez P, González-González M, Góngora R, Ibarrola N, Fuentes M. CSF analysis for protein biomarker identification in patients with leptomeningeal metastases from CNS lymphoma. Expert Rev Proteomics 2017; 14:363-372. [DOI: 10.1080/14789450.2017.1307106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- N. Galicia
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - R. Dégano
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - P. Díez
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - M. González-González
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - R. Góngora
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - N. Ibarrola
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
| | - M. Fuentes
- Proteomics Unit, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
- Department of Medicine and General Service of Cytometry, Cancer Research Centre, IBSAL, University of Salamanca-CSIC, Salamanca, Spain
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Peñalver FJ, Sancho JM, de la Fuente A, Olave MT, Martín A, Panizo C, Pérez E, Salar A, Orfao A. Guidelines for diagnosis, prevention and management of central nervous system involvement in diffuse large B-cell lymphoma patients by the Spanish Lymphoma Group (GELTAMO). Haematologica 2016; 102:235-245. [PMID: 27846613 DOI: 10.3324/haematol.2016.149120] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/07/2016] [Indexed: 02/01/2023] Open
Abstract
Diffuse large B-cell lymphoma patients have a 5% overall risk of central nervous system events (relapse or progression), which account for high morbidity and frequently fatal outcomes,1 and shortened overall survival of <6 months.2 Early diagnosis of central nervous system events is critical for successful treatment and improved prognosis. Identification of patients at risk of central nervous system disease is critical to accurately identify candidates for central nervous system prophylaxis vs. THERAPY 3-5 This report by the Spanish Lymphoma Group (GELTAMO) aims to provide useful guidelines and recommendations for the prevention, diagnosis, and treatment of central nervous system diffuse large B-cell lymphoma patients with, or at risk of, leptomeningeal and/or brain parenchyma lymphoma relapse. A panel of lymphoma experts working on behalf of GELTAMO reviewed all data published on these topics available in PubMed up to May 2016. Recommendations were classified according to the Grading of Recommendations Assessment Development and Evaluation (GRADE) approach.6 A practical algorithm based on the proposed recommendations was then developed (Figure 1). Initial discussions among experts were held in May 2014, and final consensus was reached in June 2016. The final manuscript was reviewed by all authors and the Scientific Committee of GELTAMO.
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Affiliation(s)
| | - Juan-Manuel Sancho
- Clinical Hematology Department, ICO-IJC Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - María-Teresa Olave
- Department of Hematology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Alejandro Martín
- Department of Hematology, Hospital Universitario de Salamanca, Department of Medicine, Cytometry Service (NUCLEUS) and Cancer Research Center (IBMCC-USAL-CSIC) and IBSAL, University of Salamanca, Pamplona, Spain
| | - Carlos Panizo
- Department of Hematology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Elena Pérez
- Department of Hematology, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Antonio Salar
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - Alberto Orfao
- Department of Hematology, Hospital Universitario de Salamanca, Department of Medicine, Cytometry Service (NUCLEUS) and Cancer Research Center (IBMCC-USAL-CSIC) and IBSAL, University of Salamanca, Pamplona, Spain
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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: 95] [Impact Index Per Article: 11.9] [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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Schmitz N, Zeynalova S, Nickelsen M, Kansara R, Villa D, Sehn LH, Glass B, Scott DW, Gascoyne RD, Connors JM, Ziepert M, Pfreundschuh M, Loeffler M, Savage KJ. CNS International Prognostic Index: A Risk Model for CNS Relapse in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP. J Clin Oncol 2016; 34:3150-6. [PMID: 27382100 DOI: 10.1200/jco.2015.65.6520] [Citation(s) in RCA: 271] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To develop and validate a risk score for relapse in the CNS in patients with diffuse large B-cell lymphoma (DLBCL). PATIENTS AND METHODS A total of 2,164 patients (18 to 80 years old) with aggressive B-cell lymphomas (80% DLBCL) treated with rituximab and CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)-like chemotherapy, who were enrolled in studies from the German High-Grade Non-Hodgkin Lymphoma Study Group and the MabThera International Trial, were analyzed for occurrence of relapse/progression in the CNS. The resulting risk model was validated in an independent data set of 1,597 patients with DLBCL identified in the British Columbia Cancer Agency Lymphoid Cancer database. RESULTS The risk model consists of the International Prognostic Index (IPI) factors in addition to involvement of kidneys and/or adrenal glands (CNS-IPI). In a three-risk group model, the low-risk group (46% of all patients analyzed), the intermediate-risk group (41%), and the high-risk group (12%) showed 2-year rates of CNS disease of 0.6% (CI, 0% to 1.2%), 3.4% (CI, 2.2% to 4.4%), and 10.2% (CI, 6.3% to 14.1%), respectively. Patients from the validation British Columbia Cancer Agency data set showed similar rates of CNS disease for low-risk (0.8%; CI, 0.0% to 1.6%), intermediate-risk (3.9%; CI, 2.3% to 5.5%), and high-risk (12.0%; CI, 7.9% to 16.1%) groups. CONCLUSION The CNS-IPI is a robust, highly reproducible tool that can be used to estimate the risk of CNS relapse/progression in patients with DLBCL treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. Close to 90% of patients with DLBCL belong to the low- and intermediate-risk groups and have a CNS relapse risk < 5%; they may be spared any diagnostic and therapeutic intervention. In contrast, those in the high-risk group have a > 10% risk of CNS relapse and should be considered for CNS-directed investigations and prophylactic interventions.
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Affiliation(s)
- Norbert Schmitz
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
| | - Samira Zeynalova
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Maike Nickelsen
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Roopesh Kansara
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Diego Villa
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Bertram Glass
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - David W Scott
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Randy D Gascoyne
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Joseph M Connors
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Marita Ziepert
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Michael Pfreundschuh
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Markus Loeffler
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Kerry J Savage
- Norbert Schmitz, Maike Nickelsen, and Bertram Glass, Asklepios Hospital St Georg, Hamburg; Samira Zeynalova, Marita Ziepert, and Markus Loeffler, University of Leipzig, Leipzig; Michael Pfreundschuh, Saarland University Medical School, Homburg, Germany; Roopesh Kansara, Diego Villa, Laurie H. Sehn, David W. Scott, Randy D. Gascoyne, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Strehlow F, Bauer S, Martus P, Weller M, Roth P, Schlegel U, Seidel S, Scheibenbogen C, Korfel A, Kreher S. Osteopontin in cerebrospinal fluid as diagnostic biomarker for central nervous system lymphoma. J Neurooncol 2016; 129:165-71. [PMID: 27294357 DOI: 10.1007/s11060-016-2162-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/02/2016] [Indexed: 02/03/2023]
Abstract
Central nervous system lymphoma (CNSL) is diagnostically challenging. The identification of reliable and easy to measure biomarkers is desirable to facilitate diagnosis. Here, we evaluated the value of cerebrospinal fluid (CSF) osteopontin (OPN) as a diagnostic biomarker for CNSL. OPN concentrations in CSF from 37 patients with CNSL (29 with primary CNSL and 8 with secondary CNS involvement of systemic lymphoma) and 36 controls [6 patients with inflammatory CNS disease other than multiple sclerosis (MS), 8 with MS, 9 with glioblastoma (GBM) and 13 healthy controls] were determined using an enzyme-linked immunosorbent assay. Non-parametric tests and receiver operating characteristic (ROC) curves were performed for determination of diagnostic accuracy. Median CSF OPN level in all CNSL patients was 620 ng/mL and higher than in patients with inflammatory CNS disease (356 ng/mL); P < .05, MS (163 ng/mL); P < .01, GBM (41 ng/mL); P < .01, or healthy controls (319 ng/mL); P < .01. The area under the ROC curve was 0.865 [95 % confidence interval (CI) 0.745-0.985] for differentiating CNSL and patients with inflammatory CNS disease; 0.956 (95 % CI 0.898-1.000) for CNSL and MS patients; 0.988 (95 % CI 0.964-1.000) for CNSL and GBM patients, and 0.915 (95 % CI 0.834-0.996) for CNSL patients and healthy controls. In multivariate analysis, high CSF OPN level was associated with shorter progression-free (HR 1.61, 95 % CI 1.13-2.31; P = .009) and overall survival (HR 1.52, 95 % CI 1.04-2.21; P = .029). CSF OPN is a potential biomarker in CNSL.
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Affiliation(s)
- Felicitas Strehlow
- Department of Hematology, Oncology and Tumour Immunology, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Sandra Bauer
- Department of Medical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Applied Biostatistics, University Tuebingen, Tuebingen, Germany
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Roth
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Uwe Schlegel
- Department of Neurology, Knappschaftskrankenhaus, University Hospital Bochum, Bochum, Germany
| | - Sabine Seidel
- Department of Neurology, Knappschaftskrankenhaus, University Hospital Bochum, Bochum, Germany
| | - Carmen Scheibenbogen
- Department of Medical Immunology, Charité University Medicine Berlin, Berlin, Germany
| | - Agnieszka Korfel
- Department of Hematology, Oncology and Tumour Immunology, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Stephan Kreher
- Department of Hematology, Oncology and Tumour Immunology, Charité University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
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Cognitive improvement with remission in primary CNS lymphoma. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rabah F, Elmanzalawy A, Bhuyan D, El-Banna N, Beshlawi I. A Demyelinating Disease; What Lies Beneath? Indian J Pediatr 2016. [PMID: 26204979 DOI: 10.1007/s12098-015-1849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Fatma Rabah
- Department of Child Health, Sultan Qaboos University Hospital, PO Box: 38 Alkhoud, PC 123, Muscat, Oman.
| | | | - Dipali Bhuyan
- Department of Pediatric Oncology, Royal Hospital, Muscat, Oman
| | - Nagwa El-Banna
- Department of Pediatric Oncology, Royal Hospital, Muscat, Oman
| | - Ismail Beshlawi
- Department of Child Health, Sultan Qaboos University Hospital, PO Box: 38 Alkhoud, PC 123, Muscat, Oman
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Tang YT, Jiao XY, Chang XL, Huang DY. Risk factors for the evaluation of potential central nervous system metastasis in Burkitt's lymphoma: a case study and literature review. Hematol Oncol 2016; 34:36-41. [PMID: 25312095 DOI: 10.1002/hon.2159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 05/10/2014] [Accepted: 07/10/2014] [Indexed: 02/05/2023]
Abstract
Burkitt's lymphoma (BL) is a malignancy of B lymphocytes. The rapid growth rate and frequent systemic spread result in most patients presenting with advanced disease at diagnosis. Cerebrospinal fluid cytology is the gold standard (with very high accuracy) for diagnosing BL central nervous system (CNS) metastasis; however, the low sensitivity of this method limits its clinical applications. Here, we report a case of BL with CNS metastasis. The levels of vascular endothelial growth factor (VEGF)-A and VEGF-C in the serum and cerebrospinal fluid were used to evaluate the status of BL remission and recurrence. Comparisons were made between VEGF and the other risk factors used in evaluating CNS metastasis. Although not in strict accordance, VEGF levels mirrored the disease course. Therefore, VEGF may reflect the status of BL CNS metastasis. Understanding the role of VEGF in CNS metastasis may help to improve the staging and risk classification of BL as well as the investigation of targeted therapy.
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Affiliation(s)
- Yue-Ting Tang
- Department of Hematology Laboratory, First Affiliated Hospital Of Shantou University Medical College, Guangdong, China
| | - Xiao-Yang Jiao
- Department of cell biology and genetics, Shantou University Medical College, Guangdong, China
- Department of Hematology Laboratory, First Affiliated Hospital Of Shantou University Medical College, Guangdong, China
| | - Xiao-Lan Chang
- Department of cell biology and genetics, Shantou University Medical College, Guangdong, China
| | - Dong-Yang Huang
- Department of cell biology and genetics, Shantou University Medical College, Guangdong, China
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Siasios I, Fotiadou A, Fotakopoulos G, Ioannou M, Anagnostopoulos V, Fountas K. Primary Diffuse Large B-Cell Lymphoma of Central Nervous System: Is Still Surgery an Unorthodox Treatment? J Clin Med Res 2015; 7:1007-12. [PMID: 26566417 PMCID: PMC4625808 DOI: 10.14740/jocmr2376w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 01/08/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is characterized as an extra-nodal non-Hodgkin lymphoma which develops from the neuraxis. The purpose was to report a case of a patient with a supra-tentorial tumor who underwent subtotal resection of his tumor as his biopsy was not indicative of a PCNSL tumor and had uneventful recovery until his last follow-up. A 42-year-old man was admitted to our department for generalized epileptic seizures. CT and MRI examinations revealed a tumor in his right parietal-occipital lobe that was surrounded by edema and was enhancing after gadolinium administration. The patient underwent a navigation-assisted parieto-occipital craniotomy and posterior parietal transcortical approach for tumor biopsy which was not indicative of PCNSL tumor. The surgical team decided to remove the tumor on site. Histological analysis of the resected specimen showed primary diffuse large B-cell lymphoma. Combined chemotherapy and radiation therapy was applied to the patient, and at his last follow-up (16 months), he is tumor free. In our case as in several other studies during the last decade, the outcome after the surgical resection of a PCNSL tumor in combination to radiation and chemotherapy was unexpectedly good. The role of surgery probably should be reconsidered for single lesion PCNSL tumors.
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Affiliation(s)
- Ioannis Siasios
- Department of Neurosurgery, University Hospital of Larissa, Mezourlo 1, Larissa 41110, Greece
| | - Aggeliki Fotiadou
- Department of Neurosurgery, University Hospital of Larissa, Mezourlo 1, Larissa 41110, Greece
| | - George Fotakopoulos
- Department of Neurosurgery, University Hospital of Larissa, Mezourlo 1, Larissa 41110, Greece
| | - Maria Ioannou
- Department of Pathology, University Hospital of Larissa, Mezourlo 1, Larissa 41110, Greece
| | | | - Konstantinos Fountas
- Department of Neurosurgery, University Hospital of Larissa, Mezourlo 1, Larissa 41110, Greece
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Baraniskin A, Zaslavska E, Nöpel-Dünnebacke S, Ahle G, Seidel S, Schlegel U, Schmiegel W, Hahn S, Schroers R. Circulating U2 small nuclear RNA fragments as a novel diagnostic biomarker for primary central nervous system lymphoma. Neuro Oncol 2015; 18:361-7. [PMID: 26250566 DOI: 10.1093/neuonc/nov144] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 06/29/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphomas (PCNSLs) are highly aggressive tumors. Chemotherapy has improved prognosis significantly; however, early diagnosis is crucial for effective treatment. Presently, the diagnosis of PCNSL depends on histopathology of tumor biopsies. We have previously demonstrated differential expression of microRNAs in cerebrospinal fluid (CSF) samples from patients with PCNSL. Based on promising findings about circulating U2 small nuclear RNA fragments (RNU2-1f) as novel blood-based biomarkers for pancreatic, colorectal, and lung cancer, we investigated RNU2-1f in the CSF of PCNSL patients. METHODS CSF was collected from patients with PCNSL (n = 72) and control patients with various neurologic disorders (n = 47). Sequential CSF samples were collected from 9 PCNSL patients. RNU2-1f levels were measured by real-time polymerase chain reaction. RESULTS Measurement of RNU2-1f levels in CSF enabled the differentiation of patients with PCNSL from controls with an area under the curve (AUC) of 0.909 with a sensitivity of 68.1% and a specificity of 91.4%. The diagnostic accuracy was further improved by combined determination of RNU2-1f and miR-21, resulting in AUC of 0.987 with a sensitivity of 91.7% and a specificity of 95.7%. In consecutive measurements of RNU2-1f, which were performed in 9 patients at different stages of the disease course, RNU2-1f CSF levels paralleled the course of the disease. CONCLUSIONS Our data suggest that the measurement of RNU2-1f detected in CSF can be used as a diagnostic marker and also as a possible marker for treatment monitoring. These promising results need to be evaluated within a larger patient cohort.
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Affiliation(s)
- Alexander Baraniskin
- Department of Medicine, Hematology and Oncology, Ruhr-University of Bochum, Bochum, Germany (A.B., E.Z., S.N.-D., W.S., R.S.); Center of Clinical Research, Ruhr-University of Bochum, Bochum, Germany (A.B., S.N.-D., S.H.); Department of Neurology, Ruhr-University of Bochum, Bochum, Germany (S.S., U.S.); Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France (G.A.)
| | - Elena Zaslavska
- Department of Medicine, Hematology and Oncology, Ruhr-University of Bochum, Bochum, Germany (A.B., E.Z., S.N.-D., W.S., R.S.); Center of Clinical Research, Ruhr-University of Bochum, Bochum, Germany (A.B., S.N.-D., S.H.); Department of Neurology, Ruhr-University of Bochum, Bochum, Germany (S.S., U.S.); Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France (G.A.)
| | - Stefanie Nöpel-Dünnebacke
- Department of Medicine, Hematology and Oncology, Ruhr-University of Bochum, Bochum, Germany (A.B., E.Z., S.N.-D., W.S., R.S.); Center of Clinical Research, Ruhr-University of Bochum, Bochum, Germany (A.B., S.N.-D., S.H.); Department of Neurology, Ruhr-University of Bochum, Bochum, Germany (S.S., U.S.); Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France (G.A.)
| | - Guido Ahle
- Department of Medicine, Hematology and Oncology, Ruhr-University of Bochum, Bochum, Germany (A.B., E.Z., S.N.-D., W.S., R.S.); Center of Clinical Research, Ruhr-University of Bochum, Bochum, Germany (A.B., S.N.-D., S.H.); Department of Neurology, Ruhr-University of Bochum, Bochum, Germany (S.S., U.S.); Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France (G.A.)
| | - Sabine Seidel
- Department of Medicine, Hematology and Oncology, Ruhr-University of Bochum, Bochum, Germany (A.B., E.Z., S.N.-D., W.S., R.S.); Center of Clinical Research, Ruhr-University of Bochum, Bochum, Germany (A.B., S.N.-D., S.H.); Department of Neurology, Ruhr-University of Bochum, Bochum, Germany (S.S., U.S.); Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France (G.A.)
| | - Uwe Schlegel
- Department of Medicine, Hematology and Oncology, Ruhr-University of Bochum, Bochum, Germany (A.B., E.Z., S.N.-D., W.S., R.S.); Center of Clinical Research, Ruhr-University of Bochum, Bochum, Germany (A.B., S.N.-D., S.H.); Department of Neurology, Ruhr-University of Bochum, Bochum, Germany (S.S., U.S.); Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France (G.A.)
| | - Wolff Schmiegel
- Department of Medicine, Hematology and Oncology, Ruhr-University of Bochum, Bochum, Germany (A.B., E.Z., S.N.-D., W.S., R.S.); Center of Clinical Research, Ruhr-University of Bochum, Bochum, Germany (A.B., S.N.-D., S.H.); Department of Neurology, Ruhr-University of Bochum, Bochum, Germany (S.S., U.S.); Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France (G.A.)
| | - Stephan Hahn
- Department of Medicine, Hematology and Oncology, Ruhr-University of Bochum, Bochum, Germany (A.B., E.Z., S.N.-D., W.S., R.S.); Center of Clinical Research, Ruhr-University of Bochum, Bochum, Germany (A.B., S.N.-D., S.H.); Department of Neurology, Ruhr-University of Bochum, Bochum, Germany (S.S., U.S.); Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France (G.A.)
| | - Roland Schroers
- Department of Medicine, Hematology and Oncology, Ruhr-University of Bochum, Bochum, Germany (A.B., E.Z., S.N.-D., W.S., R.S.); Center of Clinical Research, Ruhr-University of Bochum, Bochum, Germany (A.B., S.N.-D., S.H.); Department of Neurology, Ruhr-University of Bochum, Bochum, Germany (S.S., U.S.); Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France (G.A.)
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Diagnostic delay and prognosis in primary central nervous system lymphoma compared with glioblastoma multiforme. Neurol Sci 2015; 37:23-29. [DOI: 10.1007/s10072-015-2353-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
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Viaccoz A, Ducray F, Tholance Y, Barcelos GK, Thomas-Maisonneuve L, Ghesquières H, Meyronet D, Quadrio I, Cartalat-Carel S, Louis-Tisserand G, Jouanneau E, Guyotat J, Honnorat J, Perret-Liaudet A. CSF neopterin level as a diagnostic marker in primary central nervous system lymphoma. Neuro Oncol 2015; 17:1497-503. [PMID: 26014047 DOI: 10.1093/neuonc/nov092] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/01/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The diagnosis of primary central nervous system lymphoma (PCNSL) can be challenging. PCNSL lesions are frequently located deep within the brain, and performing a cerebral biopsy is not always feasible. The aim of this study was to investigate the diagnostic value of CSF neopterin, a marker of neuroinflammation, in immunocompetent patients with suspected PCNSL. METHODS We retrospectively reviewed the characteristics of 124 patients with brain tumor (n = 82) or an inflammatory CNS disorder (n = 42) in whom CSF neopterin levels were assessed. Twenty-eight patients had PCNSL, 54 patients had another type of brain tumor (glioma n = 36, metastasis n = 13, other n = 5), and 13 patients had a pseudotumoral inflammatory brain lesion. RESULTS CSF neopterin levels were significantly higher in the patients with PCNSL than in those with other brain tumors (41.8 vs 5.1 nmol/L, P < .001), those with pseudotumoral inflammatory brain lesions (41.8 vs 4.3 nmol/L, P < .001), and those with nontumefactive inflammatory CNS disorders (41.8 vs 3.8 nmol/L, P < .001). In the 95 patients with space-occupying brain lesions, at a cutoff of 10 nmol/L, the sensitivity of this approach was 96% and the specificity was 93% for the diagnosis of PCNSL. The positive and negative predictive values were 84% and 98%, respectively. CONCLUSION Assessing CSF neopterin levels in patients with a suspected brain tumor might be helpful for the positive and differential diagnosis of PCNSL. A prospective study is warranted to confirm these results.
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Affiliation(s)
- Aurélien Viaccoz
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - François Ducray
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - Yannick Tholance
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - Gleicy Keli Barcelos
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - Laure Thomas-Maisonneuve
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - Hervé Ghesquières
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - David Meyronet
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - Isabelle Quadrio
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - Stéphanie Cartalat-Carel
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - Guy Louis-Tisserand
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - Emmanuel Jouanneau
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - Jacques Guyotat
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - Jérôme Honnorat
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
| | - Armand Perret-Liaudet
- Neuro-oncology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (A.V., F.D., L.T.-M., S.C.-C., J.H.); INSERM U1028/CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France (A.V., F.D., Y.T., G.K.B., L.T.-M., D.M., I.Q., J.H., A.P.-L.); Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France (A.V., F.D., L.T.-M., J.H.); Neurochemistry Unit, Biochemistry Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (Y.T., I.Q., A.P.-L.); Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland (G.K.B.); Hematology Department, Centre Léon Bérard, Lyon, France (H.G.); Neuroradiology Department, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (G.L.-T.); Neurosurgery Department B, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (E.J.); Neurosurgery Department D, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France (J.G.)
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Baraniskin A, Schroers R. Modern cerebrospinal fluid analyses for the diagnosis of diffuse large B-cell lymphoma of the CNS. CNS Oncol 2015; 3:77-85. [PMID: 25054902 DOI: 10.2217/cns.13.63] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CNS lymphomas represent rare and aggressive variants of extranodal non-Hodgkin's lymphomas, which may present with diverse neurological symptoms and are often diagnostically challenging. Primary CNS lymphomas develop within the CNS and characteristically involve the brain, leptomeninges, eyes and, in rare cases, spinal cord. Secondary CNS lymphomas are characterized by expansion of systemic lymphomas to the CNS. Multimodal investigation of cerebrospinal fluid (CSF) comprises an important component of the diagnostic work-up for patients with suspected CNS lymphomas. Cytopathological examination of the CSF is still regarded as the 'gold standard' for the diagnosis of leptomeningeal malignant disease. However, cytopathology has only a low sensitivity in detecting leptomeningeal lymphoma involvement. Modern technologies including proteochemical and immunophenotypic studies by flow cytometry, and molecular genetic analyses of CSF may increase sensitivity and specificity, therefore, facilitating the diagnosis of CNS lymphomas. This review gives an overview and discussion of the current aspects of CSF analyses in CNS lymphomas.
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Affiliation(s)
- Alexander Baraniskin
- Department of Medicine, Hematology & Oncology, Ruhr-University of Bochum, Germany
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Hämatologische Spezialdiagnostik und Therapieoptionen bei okulären Lymphomen unter Berücksichtigung einer ZNS-Beteiligung. Ophthalmologe 2015; 112:231-6. [DOI: 10.1007/s00347-014-3207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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