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Yamada SM, Tomita Y, Takahashi M, Kawamoto M. A Case of Lymphomatosis Cerebri Presenting with Rapid Progression of Dementia: A Literature Review. NMC Case Rep J 2022; 9:83-88. [PMID: 35646501 PMCID: PMC9119690 DOI: 10.2176/jns-nmc.2021-0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/31/2022] [Indexed: 11/20/2022] Open
Abstract
Lymphomatosis cerebri is an atypical form of primary central nervous system lymphoma (PCNSL), which frequently causes rapid progression of dementia. A 68-year-old woman exhibited rapidly progressing disorientation and a mini-mental state examination score of 9. The fluid-attenuated inversion recovery of a magnetic resonance image (MRI) demonstrated focal areas of high-signal intensity in the right frontal lobe with a small enhancement, which was histologically diagnosed as diffuse large B-cell type lymphoma. The lesion dramatically shrank, and no enhancements were identified on MRI after treatment with high-dose methotrexate (MTX) and whole-brain radiation (WBR). However, her recovery of cognitive function was poor. The patient visited our clinic every 2 months but succumbed to systemic mycotic sepsis 14 months after the biopsy. Autopsy revealed lymphomatosis cerebri in the patient based on a feature of scattered small clusters of lymphoma cells infiltrating into the brain parenchyma in both cerebral hemispheres. Differentiation of lymphomatosis cerebri from other white matter degenerative diseases is usually challenging because lymphomatosis cerebri seldom forms mass lesions. In lymphomatosis cerebri, the lymphoma cells infiltrate into several regions in the brain tissue, including the basal ganglia, brainstem, and corpus callosum, in addition to periventricular and subcortical white matters. The rapid deterioration of cognitive function in the patient suggests a rapid spread of lymphomatosis cerebri, necessitating early histological diagnosis and prompt treatments. If the diagnosis is obtained, administration of high-dose MTX and WBR followed by rituximab and cytarabine can contribute to a longer survival time, based on our literature review.
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Affiliation(s)
- Shoko Merrit Yamada
- Department of Neurosurgery, Teikyo University Hospital Mizonokuchi, Kawasaki, Kanagawa, Japan
| | - Yusuke Tomita
- Department of Neurosurgery, Teikyo University Hospital Mizonokuchi, Kawasaki, Kanagawa, Japan
| | - Mikiko Takahashi
- Department of Diagnostic Pathology, Teikyo University Hospital Mizonokuchi, Kawasaki, Kanagawa, Japan
| | - Masashi Kawamoto
- Department of Diagnostic Pathology, Teikyo University Hospital Mizonokuchi, Kawasaki, Kanagawa, Japan
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Mori Y, Tomita M, Hattori N, Ujihira N, Narita M, Yoshida M. Numerous spindle-shaped lymphoma cells in lymphomatosis cerebri: An autopsy case report. Neuropathology 2022; 42:218-225. [PMID: 35266213 DOI: 10.1111/neup.12796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 11/27/2022]
Abstract
Lymphomatosis cerebri (LC) is a rare variant of primary central nervous system lymphoma (PCNSL). It is characterized by diffuse infiltration of atypical lymphoid cells with no mass formation and little or no contrast enhancement on magnetic resonance imaging (MRI). Interestingly, some lymphoma cells form characteristic spindle shapes; these cells are found in some variants of malignant lymphoma, such as primary cutaneous follicle center lymphoma, but they have not been reported in PCNSL or LC. Here, we provide an autopsy case report of LC in a 69-year-old immunocompetent man who developed rapidly progressive cognitive decline and died on day 68 after the episode despite treatment with intravenous methylprednisolone administration. MRI revealed high signal intensities on T2-weighted images of the cerebral hemispheres, cerebellum, brainstem, and spinal cord without gadolinium enhancement on T1-weighted images. On autopsy, diffuse infiltrative atypical cells were seen; these cells were positive for CD20 and CD79a and negative for GFAP, CD3, and CD5 on immunohistochemistry, resulting in a diagnosis of diffuse large B-cell lymphoma, specifically LC. We found characteristic spindle-shaped cells, especially in the cerebral cortex. This is the first report showing that lymphoma cells in PCNSL can take on a spindle-shaped form. It is difficult to recognize these spindle-shaped cells as lymphoma cells on hematoxylin and eosin staining and diagnose them correctly with small biopsy specimens without immunohistochemistry. This case suggests that we should add atypical, spindle-shaped cells to the differential diagnosis of PCNSL.
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Affiliation(s)
- Yu Mori
- Department of Neurology, Toyota Kosei Hospital, Toyota, Japan
| | - Minoru Tomita
- Department of Neurology, Toyota Kosei Hospital, Toyota, Japan
| | - Naoki Hattori
- Department of Neurology, Toyota Kosei Hospital, Toyota, Japan
| | - Nobuko Ujihira
- Department of Pathology, Toyota Kosei Hospital, Toyota, Japan.,Department of Pathology, Hekinan Municipal Hospital, Hekinan, Japan
| | | | - Mari Yoshida
- Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
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Amano R, Tsukada S, Kosuge S, Yano S, Ono K, Yoneda M, Taki K. Case Report: Paraneoplastic Hashimoto's Encephalopathy Associated With Lymphomatosis Cerebri With Periodic Synchronous Discharges Resembling Creutzfeldt-Jakob Disease. Front Neurol 2021; 12:701178. [PMID: 34447347 PMCID: PMC8384121 DOI: 10.3389/fneur.2021.701178] [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: 04/27/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Hashimoto's encephalopathy (HE) is an autoimmune encephalopathy that presents with various clinical symptoms, including cognitive deterioration, convulsive seizures, and personality changes. HE is associated with thyroid autoimmunity; however, few cases have been reported to develop as paraneoplastic syndrome. Herein, we report the case of a 73-year-old woman with onset of rapidly progressive dementia. Brain magnetic resonance imaging showed diffuse T2 hyperintensity areas involving the bilateral cerebral white matter, right midbrain tegmental area, left cerebral peduncle, and right middle cerebellar peduncle without clear diffusion hyperintensities and gadolinium enhancement. Her neurological symptoms worsened rapidly, and she presented with the apallic syndrome. Electroencephalogram showed periodic synchronous discharge, suggestive of Creutzfeldt–Jakob disease. However, a brain biopsy revealed infiltration of atypical lymphoid cells expressing CD20, and the anti-NH2 terminal of the α-enolase antibody was detected, diagnosing the complication with lymphomatosis cerebri and HE. High-dose intravenous methylprednisolone therapy and oral prednisolone with whole cranial irradiation enabled her to have simple conversations and consume food orally; however, severe cognitive impairment persisted. Although HE is a rare complication of malignant lymphoma, clinicians should be aware that it could be strongly suspected if the clinical symptoms worsen in the absence of imaging changes.
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Affiliation(s)
- Ryota Amano
- Department of Internal Medicine, Fujiyoshida Municipal Medical Center, Fujiyoshida, Japan
| | - Setsuro Tsukada
- Department of Internal Medicine, Fujiyoshida Municipal Medical Center, Fujiyoshida, Japan
| | - Shota Kosuge
- Department of Internal Medicine, Fujiyoshida Municipal Medical Center, Fujiyoshida, Japan
| | - Satoshi Yano
- Division of Neurology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kenjiro Ono
- Division of Neurology, Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Makoto Yoneda
- Faculty of Nursing and Social Welfare Science, Fukui Prefectural University, Fukui, Japan
| | - Katsumi Taki
- Department of Internal Medicine, Fujiyoshida Municipal Medical Center, Fujiyoshida, Japan
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Li L, Rong JH, Feng J. Neuroradiological features of lymphomatosis cerebri: A systematic review of the English literature with a new case report. Oncol Lett 2018; 16:1463-1474. [PMID: 30008825 PMCID: PMC6036370 DOI: 10.3892/ol.2018.8839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/04/2018] [Indexed: 12/14/2022] Open
Abstract
Lymphomatosis cerebri is a rare form of diffusely infiltrating primary central nervous system (CNS) lymphoma (PCNSL). The neuroradiological findings of lymphomatosis cerebri have not been adequately characterized, as the relevant literature consists only of case reports and small case series. The present study describes an unusual presentation of lymphomatosis cerebri in a 56-year-old immunocompetent woman who presented with diffusely infiltrating lesions with perivascular curvilinear enhancement on initial magnetic resonance imaging (MRI) and multiple nodules on the later follow-up computed tomography (CT) scan. A systematic review of the literature is also performed searching PubMed between January 1996 and December 2016 to collect all pertinent case reports and series written in the English language with pathologically confirmed lymphomatosis cerebri and diffuse infiltrative PCNSL without cohesive masses on initial MRI. A total of 45 cases were identified from 39 articles and the present case report. The patient ages ranged from 28 to 85 years (mean, 57.3 years). Only 3 patients (6.7%) were immunosuppressed (acquired immune deficiency syndrome patients). The most common clinical presentation was cognitive changes or dementia (46.7%). Cerebrospinal fluid analysis in all cases was non-specific. Diffuse and asymmetric abnormal T2-hyperintensity in deep and subcortical white matter was observed in all cases. Gray matter involvement (17.8%), spreading along the corticospinal tract (35.6%) and a slight mass effect (51.1%) also were observed. Contrast-enhanced patterns on MRI could be divided into three forms of non-enhancement (64.4%) and non-mass-like enhancement (35.6%) on initial MRI, as well as nodular or mass-like enhancement on the later follow-up MRI (15.6%). There were non-specific findings on magnetic resonance spectroscopy for 4 patients, on positron emission tomography/CT for 12 patients and on single-photon emission CT for 1 patient. Diagnosis was established by brain biopsy in 35 cases (77.8%) and autopsy in 9 cases (20%), involving B-cell lymphoma in 40 cases (88.9%) and T-cell lymphoma in 4 cases (8.9%). In conclusion, lymphomatosis cerebri, namely diffuse PCNSL or diffuse lymphoma of the CNS, is characterized by rapidly progressive dementia in the elderly, diffusely infiltrated CNS white matter along the corticospinal tract, possible involvement of the gray matter, a slight mass effect and varied contrast-enhancement patterns on MRI. Non-enhancement or non-mass-like enhancement on MRI may be a special form of diffuse PCNL during disease development and progression.
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Affiliation(s)
- Long Li
- Department of Radiology, Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou Medical University, Guangzhou, Guangdong 510507, P.R. China
| | - Jia-Hui Rong
- Department of Radiology, Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou Medical University, Guangzhou, Guangdong 510507, P.R. China
| | - Jie Feng
- Diagnostic Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Izquierdo C, Velasco R, Vidal N, Sánchez JJ, Argyriou AA, Besora S, Graus F, Bruna J. Lymphomatosis cerebri: a rare form of primary central nervous system lymphoma. Analysis of 7 cases and systematic review of the literature. Neuro Oncol 2015; 18:707-15. [PMID: 26415875 DOI: 10.1093/neuonc/nov197] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/19/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphomas may present as diffuse, nonenhancing infiltrative lesions. This rare variant is termed lymphomatosis cerebri (LC). We did a systematic review and analysis of the literature, adding our own cases, to better characterize LC in order to improve early diagnosis and treatment. METHODS PubMed, ISI Web of Knowledge, and hospital databases were reviewed. Information was extracted regarding demographic, clinical, histological, cerebrospinal fluid (CSF), neuroimaging, and treatment variables. The impact of single parameters on overall survival (OS) was determined by applying univariate and multivariate analyses. RESULTS Forty-two patients were included (median age: 58 y; range: 28-80 y). At consultation, 52% of patients had a poor KPS. The most common presenting symptom was cognitive decline (59.5%). Imaging studies showed supratentorial and infratentorial infiltration in 55% of patients and bilateral hemispheric involvement in 95%. CSF pleocytosis was present in 51.5% of the patients. Median time to diagnosis was 4.5 (range: 1-30) months, and the diagnosis was not established until autopsy for 33% of patients. The median OS was 2.95 (range: 0.33-56) months; however, those patients who received methotrexate had a median OS of 13.8 (range: 0.7-56) months. Analysis identified KPS ≥ 70 (HR: 0.32; 95% CI: 0.114-0.894; P = .03) and treatment with methotrexate (HR: 0.19; 95% CI: 0.041-0.886; P = .034) as independent favorable prognostic factors, whereas T-cell lymphoma was independently related with a worse outcome (HR: 6.62; 95% CI: 1.317-33.316; P = .022). CONCLUSIONS LC is a misdiagnosed entity associated with considerable diagnostic delay. MRI evidence of bilateral hemispheric involvement and CSF pleocytosis should be alerts for this diagnosis. Treatment with methotrexate-based chemotherapy must be considered, especially for patients with good KPS.
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Affiliation(s)
- Cristina Izquierdo
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (C.I., R.V., N.V., S.B., J.B.); Department Cell Biology, Institute of Neurosciences, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain (R.V., J.B.); Department of Radiology, Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (J.J.S.); Department of Neurology, St. Andrew's State General Hospital of Patras, Patras, Greece (A.A.A.); Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain (F.G.)
| | - Roser Velasco
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (C.I., R.V., N.V., S.B., J.B.); Department Cell Biology, Institute of Neurosciences, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain (R.V., J.B.); Department of Radiology, Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (J.J.S.); Department of Neurology, St. Andrew's State General Hospital of Patras, Patras, Greece (A.A.A.); Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain (F.G.)
| | - Noemí Vidal
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (C.I., R.V., N.V., S.B., J.B.); Department Cell Biology, Institute of Neurosciences, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain (R.V., J.B.); Department of Radiology, Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (J.J.S.); Department of Neurology, St. Andrew's State General Hospital of Patras, Patras, Greece (A.A.A.); Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain (F.G.)
| | - Juan José Sánchez
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (C.I., R.V., N.V., S.B., J.B.); Department Cell Biology, Institute of Neurosciences, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain (R.V., J.B.); Department of Radiology, Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (J.J.S.); Department of Neurology, St. Andrew's State General Hospital of Patras, Patras, Greece (A.A.A.); Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain (F.G.)
| | - Andreas A Argyriou
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (C.I., R.V., N.V., S.B., J.B.); Department Cell Biology, Institute of Neurosciences, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain (R.V., J.B.); Department of Radiology, Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (J.J.S.); Department of Neurology, St. Andrew's State General Hospital of Patras, Patras, Greece (A.A.A.); Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain (F.G.)
| | - Sarah Besora
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (C.I., R.V., N.V., S.B., J.B.); Department Cell Biology, Institute of Neurosciences, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain (R.V., J.B.); Department of Radiology, Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (J.J.S.); Department of Neurology, St. Andrew's State General Hospital of Patras, Patras, Greece (A.A.A.); Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain (F.G.)
| | - Francesc Graus
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (C.I., R.V., N.V., S.B., J.B.); Department Cell Biology, Institute of Neurosciences, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain (R.V., J.B.); Department of Radiology, Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (J.J.S.); Department of Neurology, St. Andrew's State General Hospital of Patras, Patras, Greece (A.A.A.); Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain (F.G.)
| | - Jordi Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (C.I., R.V., N.V., S.B., J.B.); Department Cell Biology, Institute of Neurosciences, Physiology and Immunology, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain (R.V., J.B.); Department of Radiology, Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge-ICO Duran i Reynals, Barcelona, Spain (J.J.S.); Department of Neurology, St. Andrew's State General Hospital of Patras, Patras, Greece (A.A.A.); Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain (F.G.)
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