1
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Whether surgical resection or biopsy makes difference in single lesion primary central nervous system lymphoma: a single center retrospective cohort study. BMC Neurol 2022; 22:411. [PMID: 36333683 PMCID: PMC9636826 DOI: 10.1186/s12883-022-02930-9] [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: 07/23/2022] [Accepted: 10/24/2022] [Indexed: 11/08/2022] Open
Abstract
Background Primary central nervous system lymphoma (PCNSL) is a rare and aggressive disease. The role of surgical resection in PCNSL has always been the center of debate. Here we investigated the clinical and follow-up data of single lesion PCNSL operated in our center, focusing on the comparison between surgical resection and biopsy. Methods All consecutive cases of single lesion PCNSL between October 2004 and December 2019 were retrospectively collected from the database of the Second Affiliated Hospital of Zhejiang University, School of Medicine. Patients were divided into resection group and biopsy group. Clinical information including age, gender, Karnofsky performance status, imaging features and postoperative treatment was collected from the medical records. All the patients were followed for survival analysis. Results A total of 105 patients with PCNSL were finally involved in our analysis. Neither PFS nor OS were significantly different between the resection group and biopsy group. The univariate analysis revealed that age < 60 and therapeutic treatment were significant predictors of longer PFS and OS. In the multivariate analysis, age (HR = 3.09, 95% CI 1.31–7.28, p = 0.01) and therapeutic treatment (HR = 0.25, 95% CI 0.07– 0.83, p = 0.02) were independent prognostic markers with OS. Multivariable Cox regression analyses also revealed that only age (HR = 2.29 (95% CI, 1.11–4.71, p = 0.03) was independent prognostic marker for PFS. Conclusions In single lesion PCNSL, there was no significant difference between the resection group and biopsy group for both PFS and OS. Younger age and postoperative treatment have been proved to be indicators of better prognosis.
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Pons-Escoda A, García-Ruíz A, Naval-Baudin P, Grussu F, Viveros M, Vidal N, Bruna J, Plans G, Cos M, Perez-Lopez R, Majós C. Diffuse Large B-Cell Epstein-Barr Virus-Positive Primary CNS Lymphoma in Non-AIDS Patients: High Diagnostic Accuracy of DSC Perfusion Metrics. AJNR Am J Neuroradiol 2022; 43:1567-1574. [PMID: 36202547 PMCID: PMC9731258 DOI: 10.3174/ajnr.a7668] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/02/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Immunodeficiency-associated CNS lymphoma may occur in different clinical scenarios beyond AIDS. This subtype of CNS lymphoma is diffuse large B-cell and Epstein-Barr virus-positive. Its accurate presurgical diagnosis is often unfeasible because it appears as ring-enhancing lesions mimicking glioblastoma or metastasis. In this article, we describe clinicoradiologic features and test the performance of DSC-PWI metrics for presurgical identification. MATERIALS AND METHODS Patients without AIDS with histologically confirmed diffuse large B-cell Epstein-Barr virus-positive primary CNS lymphoma (December 2010 to January 2022) and diagnostic MR imaging without onco-specific treatment were retrospectively studied. Clinical, demographic, and conventional imaging data were reviewed. Previously published DSC-PWI time-intensity curve analysis methodology, to presurgically identify primary CNS lymphoma, was used in this particular lymphoma subtype and compared with a prior cohort of 33 patients with Epstein-Barr virus-negative CNS lymphoma, 35 with glioblastoma, and 36 with metastasis data. Normalized curves were analyzed and compared on a point-by-point basis, and previously published classifiers were tested. The standard percentage of signal recovery and CBV values were also evaluated. RESULTS Seven patients with Epstein-Barr virus-positive primary CNS lymphoma were included in the study. DSC-PWI normalized time-intensity curve analysis performed the best for presurgical identification of Epstein-Barr virus-positive CNS lymphoma (area under the receiver operating characteristic curve of 0.984 for glioblastoma and 0.898 for metastasis), followed by the percentage of signal recovery (0.833 and 0.873) and CBV (0.855 and 0.687). CONCLUSIONS When a necrotic tumor is found in a potentially immunocompromised host, neuroradiologists should consider Epstein-Barr virus-positive CNS lymphoma. DSC-PWI could be very useful for presurgical characterization, with especially strong performance of normalized time-intensity curves.
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Affiliation(s)
- A Pons-Escoda
- From the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
- Neurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - A García-Ruíz
- Radiomics Group (A.G.-R., F.G., R.P.-L.), Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
| | - P Naval-Baudin
- From the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
| | - F Grussu
- Radiomics Group (A.G.-R., F.G., R.P.-L.), Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
| | - M Viveros
- From the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
| | - N Vidal
- Pathology (N.V.)
- Neurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - J Bruna
- Neurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - G Plans
- Neurosurgery (G.P.), Hospital Universitari de Bellvitge, Barcelona, Spain
- Neurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
| | - M Cos
- From the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
| | - R Perez-Lopez
- Radiomics Group (A.G.-R., F.G., R.P.-L.), Vall d'Hebron Institut d'Oncologia, Barcelona, Spain
- Department of Radiology (R.P.-L.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - C Majós
- From the Departments of Radiology (A.P.-E., P.N.-B., M.V., M.C., C.M.)
- Neurooncology Unit (A.P.-E., N.V., J.B., G.P., C.M.), Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
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Yamanaka T, Kanai H, Aihara N, Ohno T, Mase M. A Case of Sarcoidosis-lymphoma Syndrome: Importance of Brain Biopsy. NMC Case Rep J 2019; 6:61-64. [PMID: 31016103 PMCID: PMC6476816 DOI: 10.2176/nmccrj.cr.2018-0223] [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: 09/07/2018] [Accepted: 12/10/2018] [Indexed: 11/21/2022] Open
Abstract
Sarcoidosis is occasionally associated with malignant lymphoma. Cases of sarcoidosis associated with malignant lymphoma are called sarcoidosis-lymphoma syndrome. We report a 63-year-old man with sarcoidosis associated with primary central nervous system lymphoma (PCNSL). Definitive diagnosis by clinical and radiological findings was difficult. Finally, brain biopsy could produce the correct diagnosis. We could provide appropriate treatment for PCNSL and the patient has survived over 2 years. Thus, it is very important to make an early definitive diagnosis by biopsy for intracranial lesion, because it can prolong survival in patients with sarcoidosis.
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Affiliation(s)
- Tomoyasu Yamanaka
- Department of Neurosurgery, Nagoya City University, Nagoya, Aichi, Japan.,Department of Neurosurgery, Nagoya City East Medical Center, Nagoya, Aichi, Japan
| | - Hideki Kanai
- Department of Neurosurgery, Nagoya City East Medical Center, Nagoya, Aichi, Japan
| | - Noritaka Aihara
- Department of Neurosurgery, Nagoya City University, Nagoya, Aichi, Japan
| | - Takayuki Ohno
- Department of Neurosurgery, Nagoya City East Medical Center, Nagoya, Aichi, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University, Nagoya, Aichi, Japan
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4
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Ten H, Adachi K, Yamaguchi F, Matsuno A, Teramoto A, Morita A. Occipital lobe epilepsy was presented in a patient with intracerebral schwannoma: a case report and literature review. Int J Neurosci 2018; 129:308-312. [PMID: 30232919 DOI: 10.1080/00207454.2018.1526797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Schwannoma arising within brain parenchyma is a rare scenario. So far, only 70 cases were reported. We reported a case of intracerebral schwannoma presented with occipital lobe epilepsy, which has never been reported before. A 19-year-old man suffered from intermittent blurred vision and headache. Neuroradiological findings showed a left occipital lesion with cystic and solid components. Histological and electron micrograph features confirmed the diagnosis of schwannoma after the tumor was totally removed. The theories and literature related to this case were reviewed and the possible developmental origin was discussed. We found that this kind of schwannoma is more often in adolescent and young adults.
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Affiliation(s)
- Hirotomo Ten
- a Department of Neurological Surgery , Nippon Medical School Musashi-Kosugi Hospital , Kawasaki , Kanagawa , Japan.,b Department of Neurological Surgery for Community Health , Nippon Medical School , Tokyo , Japan.,c Department of Neurosurgery , Teikyo University School of Medicine , Tokyo , Japan.,d Department of Judo Physical Therapy, Faculty of Health , Teikyo Heisei University , Tokyo , Japan
| | - Koji Adachi
- a Department of Neurological Surgery , Nippon Medical School Musashi-Kosugi Hospital , Kawasaki , Kanagawa , Japan
| | - Fumio Yamaguchi
- b Department of Neurological Surgery for Community Health , Nippon Medical School , Tokyo , Japan
| | - Akira Matsuno
- c Department of Neurosurgery , Teikyo University School of Medicine , Tokyo , Japan
| | - Akira Teramoto
- e Department of Neurosurgery , Japan Labour Health and Welfare Organization, Tokyo Rosai Hospital , Tokyo , Japan
| | - Akio Morita
- b Department of Neurological Surgery for Community Health , Nippon Medical School , Tokyo , Japan
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Gómez Roselló E, Quiles Granado A, Laguillo Sala G, Pedraza Gutiérrez S. Primary central nervous system lymphoma in immunocompetent patients: Spectrum of findings and differential characteristics. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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6
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Gómez Roselló E, Quiles Granado AM, Laguillo Sala G, Pedraza Gutiérrez S. Primary central nervous system lymphoma in immunocompetent patients: spectrum of findings and differential characteristics. RADIOLOGIA 2018; 60:280-289. [PMID: 29482953 DOI: 10.1016/j.rx.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
Primary central nervous system (CNS) lymphomas are uncommon and their management differs significantly from that of other malignant tumors involving the CNS. This article explains how the imaging findings often suggest the diagnosis early. The typical findings in immunocompetent patients consist of a supratentorial intraaxial mass that enhances homogeneously. Other findings to evaluate include multifocality and incomplete ring enhancement. The differential diagnosis of primary CNS lymphomas should consider mainly other malignant tumors of the CNS such as glioblastomas or metastases. Primary CNS lymphomas tend to have less edema and less mass effect; they also tend to spare the adjacent cortex. Necrosis, hemorrhage, and calcification are uncommon in primary CNS lymphomas. Although the findings in morphologic sequences are characteristic, they are not completely specific and atypical types are sometimes encountered. Advanced imaging techniques such as diffusion or especially perfusion provide qualitative and quantitative data that play an important role in differentiating primary CNS lymphomas from other brain tumors.
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Affiliation(s)
- E Gómez Roselló
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España.
| | - A M Quiles Granado
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España
| | - G Laguillo Sala
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España
| | - S Pedraza Gutiérrez
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España
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7
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The role of surgery in intracranial PCNSL. Neurosurg Rev 2018; 41:1037-1044. [PMID: 29383600 DOI: 10.1007/s10143-018-0946-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/05/2018] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
This aimed to evaluate the effect of surgery for overall survival (OS) and progression-free survival (PFS) in intracranial primary CNS lymphoma (PCNSL) of all patients diagnosed at a single center. A prospective database at Oslo University Hospital of PCNSL was reviewed over a 12-year period (2003-2014). Seventy-nine patients with intracranial PCNSL were identified. Deep brain involvement was shown in 63 patients. Thirty-two patients underwent craniotomy with resection, while all other patients had a biopsy. Fifty-seven patients were given chemotherapy: 18 were treated with the MSKCC (Memorial Sloan-Kettering Cancer Center) with rituximab, 21 with the MSKCC without rituximab, and 14 within a Nordic prospective phase II protocol. Forty-four patients achieved complete response (CR) and had OS of 46.3 months. Patients who underwent resection had a median OS of 28.6 versus 11.7 months for those who had a biopsy performed. Resection showed an insignificant prolongation of OS. Multivariate analysis confirmed statistical significance of deep brain involvement only (p < 0.005). Neither chemotherapy regimen, Karnofsky Performance Status (KPS), type of surgery, nor patient age was significant factors for OS or PFS. Resective surgery played no role in significantly improving either OS or PFS and therefore it is not recommended as treatment for PCNSL.
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8
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Wang H, Wang M, Wei J, Wang L, Mao L, Jin J. Primary central nervous system lymphoma: Retrospective analysis of 34 cases in a single centre. J Int Med Res 2017; 46:883-894. [PMID: 28984175 PMCID: PMC5971520 DOI: 10.1177/0300060517734395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To retrospectively analyse outcomes in patients with primary central nervous system lymphoma (PCNSL), which is a malignant CNS non-Hodgkin’s lymphoma with a poor prognosis. Methods This study retrospectively analysed the treatment and outcomes of patients with PCNSL, which were divided into two groups: surgery (S) group and surgery/biopsy+chemotherapy (SC) group. The latter group was further subdivided into four cohorts based on the treatment regimen: cyclophosphamide, epidoxorubicin, vincristine and prednisone (CHOP), high-dose methotrexate (HDM)+dexamethasone+rituximab (HDM+D+R), HDM+D+temozolomide (HDM+D+T), and HDM+D+R+T. Results The study enrolled 34 patients; 10 of which received surgery only. Between the S and SC groups, the median progression-free survival (PFS) and overall survival (OS) of intracranial PCNSLs (n = 32) were 8.5 months versus 29 months, respectively; and 8.5 months versus 54 months, respectively (5-year OS: 10.0% versus 48.7%, respectively; 2-year PFS: 0.0% versus 52.6%, respectively). Comparing the CHOP and HDM-based chemotherapy cohorts, the median PFS and OS were 15 months versus not achieved, respectively, and 25 months versus not achieved, respectively (5-year OS: 20.0% versus 60.8%, respectively; 2-year PFS: 20.0% versus 62.7%, respectively). Conclusion Chemotherapy appears to provide a better OS and PFS for patients with PCNSLs compared with surgery alone. HDM+D+T and HDM+D+R+T may be effective choices for PCNSL treatment.
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Affiliation(s)
- Huafeng Wang
- 1 Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,2 Institute of Haematology, Zhejiang University, Hangzhou, Zhejiang Province, China.,3 Key Laboratory of Haematological Malignancies of Zhejiang Province, Hangzhou, Zhejiang Province, China.,*These authors contributed equally to the work
| | - Ming Wang
- 4 Department of Neurosurgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,*These authors contributed equally to the work
| | - Juying Wei
- 1 Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,2 Institute of Haematology, Zhejiang University, Hangzhou, Zhejiang Province, China.,3 Key Laboratory of Haematological Malignancies of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Lei Wang
- 1 Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,2 Institute of Haematology, Zhejiang University, Hangzhou, Zhejiang Province, China.,3 Key Laboratory of Haematological Malignancies of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Liping Mao
- 1 Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,2 Institute of Haematology, Zhejiang University, Hangzhou, Zhejiang Province, China.,3 Key Laboratory of Haematological Malignancies of Zhejiang Province, Hangzhou, Zhejiang Province, China
| | - Jie Jin
- 1 Department of Haematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.,2 Institute of Haematology, Zhejiang University, Hangzhou, Zhejiang Province, China.,3 Key Laboratory of Haematological Malignancies of Zhejiang Province, Hangzhou, Zhejiang Province, China
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9
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Tabouret E, Houillier C, Martin-Duverneuil N, Blonski M, Soussain C, Ghesquières H, Houot R, Larrieu D, Soubeyran P, Gressin R, Gyan E, Chinot O, Taillandier L, Choquet S, Alentorn A, Leclercq D, Omuro A, Tanguy ML, Hoang-Xuan K. Patterns of response and relapse in primary CNS lymphomas after first-line chemotherapy: imaging analysis of the ANOCEF-GOELAMS prospective randomized trial. Neuro Oncol 2017; 19:422-429. [PMID: 27994065 DOI: 10.1093/neuonc/now238] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Our aim was to review MRI characteristics of patients with primary CNS lymphoma (PCNSL) enrolled in a randomized phase II trial and to evaluate their potential prognostic value and patterns of relapse, including T2 fluid attenuated inversion recovery (FLAIR) MRI abnormalities. Methods Neuroimaging findings in 85 patients with PCNSL enrolled in a prospective trial were reviewed blinded to outcomes. MRI characteristics and responses according to International PCNSL Collaborative Group (IPCG) criteria were correlated with progression-free survival (PFS) and overall survival (OS). Results Multivariate analysis showed that objective response at 2 months (P < .001) and at end of treatment (P = .015) were predictors of prolonged OS. Infratentorial location (P = .008) and large (>11.4 cm3) enhancing tumor volume (P = .006) were associated with poor OS and PFS, respectively. Ratio of change in product of largest diameters at early MRI evaluation but not timing of complete response achievement (early vs delayed) was prognostic for OS. Sixty-nine patients relapsed. Relapse in the brain (n = 52) involved an initial enhancing site, a different site, or both in 46%, 40%, and 14% of patients, respectively. At baseline, non-enhancing T2-FLAIR hypersignal lesions distant from the enhancing tumor site were detected in 18 patients. These lesions markedly decreased (>50%) in 16 patients after chemotherapy, supporting their neoplastic nature. Of these patients, 10/18 relapsed, half (n = 5) in the initially non-enhancing T2-FLAIR lesions. Conclusions Baseline tumor size and infratentorial localization are of prognostic value in PCNSL. Our findings provide evidence that non-enhancing FLAIR abnormalities may add to overall tumor burden, suggesting that response criteria should be refined to incorporate evaluation of T2-weighted/FLAIR sequences.
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Affiliation(s)
- Emeline Tabouret
- APHM, service de Neuro-Oncologie, CHU Timone, Marseille, France.,Aix-Marseille Universite, UMR911, Marseille, France.,APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Caroline Houillier
- APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Marie Blonski
- Service de Neurologie, Centre Hospitalier de Nancy, Nancy, France
| | - Carole Soussain
- Service d'Hématologie, Institut Curie-René Huguenin, Saint-Cloud, France
| | - Herve Ghesquières
- Department of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Roch Houot
- Service d'Hématologie Clinique, CHU-Hôpital Pontchaillou de Rennes, Rennes, France
| | | | | | - Remy Gressin
- Hématologie Clinique, Hôpital A Michallon, Grenoble, France
| | - Emmanuel Gyan
- Service d'Hématologie Clinique de Tours, Tours, France
| | - Olivier Chinot
- APHM, service de Neuro-Oncologie, CHU Timone, Marseille, France.,Aix-Marseille Universite, UMR911, Marseille, France
| | - Luc Taillandier
- Service de Neurologie, Centre Hospitalier de Nancy, Nancy, France
| | - Sylvain Choquet
- Service d'Hématologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Agusti Alentorn
- APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Delphine Leclercq
- Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Antonio Omuro
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Marie-Laure Tanguy
- Service de biostatistiques, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Khe Hoang-Xuan
- APHP, Sorbonne Universités, UPMC Univ Paris 06, Service de neurologie Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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10
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Fragoso YD. Differential diagnosis of multiple sclerosis in Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317714279. [PMID: 28979790 PMCID: PMC5617098 DOI: 10.1177/2055217317714279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/06/2017] [Accepted: 05/15/2017] [Indexed: 12/19/2022] Open
Abstract
Improvement of multiple sclerosis (MS) diagnoses leads to earlier and correct disease management. The differential diagnostic workup for MS comprises a large variety of medical conditions. There are general guidelines and criteria for diagnosing MS worldwide, but awareness of regional differences needs to be kept in mind. Latin American patients who are screened for MS diagnoses may require an approach that is not exactly the same as that used for patients in North America, western Europe or Asia. In the present review, the conditions that are important for the differential diagnoses of MS in Latin America are reviewed. They include infections, metabolic diseases, nutritional deficits and other autoimmune conditions that physicians in charge of these patients need to be familiar with.
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Affiliation(s)
- YD Fragoso
- MS Unit, Department of Neurology, Universidade Metropolitana de Santos, SP, Brazil
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11
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Primary central nervous system lymphoma: essential points in diagnosis and management. Med Oncol 2017; 34:61. [PMID: 28315229 DOI: 10.1007/s12032-017-0920-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/14/2017] [Indexed: 12/19/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is an extra-nodal non-Hodgkin lymphoma. PCNSL is defined as lymphoma involving the brain, leptomeninges, eyes, or spinal cord without evidence of lymphoma outside the CNS. Treatment includes induction with chemotherapy and consolidation with whole-brain radiotherapy or high-dose chemotherapy supported by autologous stem cell transplantation. High-dose methotrexate is the most important drug in cases with PCNSL, and this drug will be used in combination with small molecules, BTK inhibitors, new monoclonal antibodies, and checkpoint blockers.
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12
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Bathla G, Hegde A. Lymphomatous involvement of the central nervous system. Clin Radiol 2016; 71:602-9. [PMID: 27038652 DOI: 10.1016/j.crad.2016.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 01/21/2016] [Accepted: 02/10/2016] [Indexed: 12/15/2022]
Abstract
Lymphoma may arise within the central nervous system (CNS), known as primary CNS lymphoma (PCNSL) or may involve the CNS secondary to systemic disease. Clinical features are non-specific. A provisional diagnosis of PCNSL can be made on imaging, potentially changing the management algorithm from neurosurgical resection to biopsy. PCNSL in immunocompetent patients generally presents late, is solid, is bright on diffusion weighted imaging and shows uniform enhancement. Contiguity with a cerebrospinal fluid (CSF) surface and perivascular enhancement are useful clues. Immunocompromised patients, on the other hand, present earlier and often have multiple, necrotic, haemorrhagic lesions with irregular or rim enhancement. Secondary CNS involvement predominantly affects the leptomeninges. This review illustrates the varied imaging features of CNS lymphoma, atypical presentations, and differential diagnoses.
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Affiliation(s)
- G Bathla
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, USA
| | - A Hegde
- Department of Radiology, Raffles Hospital, 585 North Bridge Drive, Singapore 188770, Singapore.
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13
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Cellina M, Fetoni V, Baron P, Orsi M, Oliva G. Unusual primary central nervous system lymphoma location involving the fourth ventricle and hypothalamus. Neuroradiol J 2015; 28:120-5. [PMID: 25923685 DOI: 10.1177/1971400915576671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A previously healthy 65-year-old man presented with a two-week history of weight loss, headaches, blurred vision, asthenia and quickly worsening walking impairment. He denied photophobia, neck stiffness, fever, nausea or vomiting.Neurological examination showed global motor slowing, tendency to fall asleep during the clinical examination, generalized weakness against resistance to head and limbs, and osteotendon reflexes present in the upper limbs, but not evoked in the lower limbs. No sensitive deficit or focal neurologic sign was recognizable.Non-contrast multislice computed tomography (MSCT) of the head was performed in the emergency department, showing diffuse periventricular white matter and thalamic mild hyperdensity.Lumbar puncture, blood tests, including serology for HIV and other infections, were negative.On the third day the patient, showing decreased consciousness, underwent magnetic resonance imaging (MRI) with contrast medium injection. MRI revealed the presence of multiple pseudonodular avidly enhancing lesions, supra and infratentorial, crossing the midline, involving the ventricular system, including the fourth ventricle, with extension into the surrounding white matter, the corpus callosum, the thalamus and the hypothamalus.A stereotactic biopsy led to a diagnosis of diffuse large B-cell lymphoma, primarily located in the central nervous system (PCNSL).After the completion of the first phase of treatment (immunotherapy with intravenous Rituximab and corticosteroid), the MRI showed a marked regression of tumor masses.
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Affiliation(s)
| | - Vincenza Fetoni
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
| | - Pierluigi Baron
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
| | - Marcello Orsi
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
| | - Giancarlo Oliva
- Radiology Department, A.O. Fatebenefratelli e Oftalmico, Italy
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14
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Abstract
Neuroimaging plays a crucial role in diagnosis of brain tumors and in the decision-making process for therapy. Functional imaging techniques can reflect cellular density (diffusion imaging), capillary density (perfusion techniques), and tissue biochemistry (magnetic resonance [MR] spectroscopy). In addition, cortical activation imaging (functional MR imaging) can identify various loci of eloquent cerebral cortical function. Combining these new tools can increase diagnostic specificity and confidence. Familiarity with conventional and advanced imaging findings facilitates accurate diagnosis, differentiation from other processes, and optimal patient treatment. This article is a practical synopsis of pathologic, clinical, and imaging spectra of most common brain tumors.
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Affiliation(s)
- Danai Chourmouzi
- Diagnostic Radiology Department, Interbalcan Medical Centre, Asklipiou 10, Thessaloniki 57001, Greece.
| | - Elissabet Papadopoulou
- Diagnostic Radiology Department, Interbalcan Medical Centre, Asklipiou 10, Thessaloniki 57001, Greece
| | - Kostantinos Marias
- Computational Medicine Laboratory, Institute of Computer Science, Plastira 100 Vasilika Vouton, FORTH, Heraklion, Greece
| | - Antonios Drevelegas
- Diagnostic Radiology Department, Interbalcan Medical Centre, Asklipiou 10, Thessaloniki 57001, Greece
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15
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Mansour A, Qandeel M, Abdel-Razeq H, Abu Ali HA. MR imaging features of intracranial primary CNS lymphoma in immune competent patients. Cancer Imaging 2014; 14:22. [PMID: 25608570 PMCID: PMC4331827 DOI: 10.1186/1470-7330-14-22] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 11/18/2022] Open
Abstract
We aimed to characterize specific MRI findings seen in immune competent patients with intracranial primary CNS lymphoma (PCNSL) and to determine their value in the management of such patients. Pre-treatment MRI examinations of 21 immunocompetent patients with biopsy-proven PCNSL were retrospectively evaluated. T1 and T2 signal characteristics as well as contrast enhancement features are described in all patients. Diffusion, perfusion and proton-MR-spectroscopy features are described in a subset of these patients. In the proper clinical and radiologic setting, suggesting the diagnosis of PCNSL can help institute proper treatment in a timely fashion and avoid unnecessary attempts at surgical resection and the associated morbidity.
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