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Flospergher E, Marino F, Calimeri T, Cangi MG, Ferreri AJM, Ponzoni M, Bongiovanni L. Primary central nervous system marginal zone lymphoma. Br J Haematol 2024; 204:31-44. [PMID: 38054330 DOI: 10.1111/bjh.19238] [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: 07/20/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
Marginal zone lymphoma (MZL) is the most common indolent lymphoma primarily arising in the central nervous system (CNS). To date, 207 cases of primary CNS MZL (PCNSMZL) were published, mostly as single case reports or small case series. It most commonly presents as extra-axial dural-based masses, more frequently in middle-aged women, displaying an insidious onset, with a long history of symptoms preceding the diagnosis. PCNSMZL can be radiographically mistaken for meningioma. PCNSMZL consists of CD20+ , CD3- small B lymphocytes with varying degrees of plasmacytic differentiation and low proliferation index. Trisomy 3, but not MALT1 or IgH translocation, is a common genetic abnormality. Other recurrent genetic abnormalities involve TNFAIP3 and NOTCH2. Ethiopathogenesis was poorly investigated. Due to its rarity, standard of care remains to be defined; it exhibits an excellent prognosis after varied treatments, such as surgery, radiotherapy, chemotherapy or their combinations. Nevertheless, each treatment should be considered after an accurate analysis of overtreatment risk. Short follow-up is a major limitation in reported PCNSMZL cases, which restrains our knowledge on long-term results and iatrogenic sequels. This review was focussed on presentation, differential diagnoses, pathological findings, treatment options and clinical outcomes of PCNSMZL; recommendations for best clinical practice are provided.
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Affiliation(s)
- Elena Flospergher
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Marino
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Teresa Calimeri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrés José María Ferreri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
| | - Maurilio Ponzoni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
| | - Lucia Bongiovanni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
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Fiorentino V, Pizzimenti C, Pierconti F, Lentini M, Ieni A, Caffo M, Angileri F, Tuccari G, Fadda G, Martini M, Larocca LM. Unusual localization and clinical presentation of primary central nervous system extranodal marginal zone B‑cell lymphoma: A case report. Oncol Lett 2023; 26:408. [PMID: 37600340 PMCID: PMC10436157 DOI: 10.3892/ol.2023.13994] [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: 05/08/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Primary central nervous system (CNS) extranodal marginal zone B-cell lymphoma (MZBL) is a rare low-grade non-Hodgkin lymphoma, characterised predominantly by small B cells, plasma cells, monocytoid cells and scattered large immunoblasts. Primary CNS MZBL is a slow-growing tumour that remains localised and is characterised by an excellent clinical prognosis. The present study describes the case of a 48-year-old HIV-negative female patient with a history of head trauma 1 year prior, who presented with worsening neurological symptoms and a magnetic resonance imaging finding of a ~3-cm extra-axial mass within the left lateral ventricle. From histopathology and immunohistochemistry, the lesion was diagnosed as a CNS MZBL; as no other primary lesions were found, the base of the choroid plexuses of the left lateral ventricle was considered the primary site. To the best of our knowledge, the current case is the first study to report on primary CNS MZBL arising in this anatomical site and paves the way for further studies on the role of chronic inflammation (in the present case resulting from trauma) in the pathogenesis not only of primary CNS MZBL but also of lymphoma in general. Additionally, this report could serve as a starting point for studies analysing the role of meningothelial cells in the pathogenesis of primary CNS MZBL.
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Affiliation(s)
- Vincenzo Fiorentino
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Cristina Pizzimenti
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Francesco Pierconti
- Institute of Pathology, Division of Anatomic Pathology and Histology, A. Gemelli-Scientific Institute for Research, Hospitalization and Healthcare University Hospital Foundation, I-00168 Rome, Italy
| | - Maria Lentini
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Antonio Ieni
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Maria Caffo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Neurosurgery, University Hospital ‘G. Martino’, I-98125 Messina, Italy
| | - Filippo Angileri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Neurosurgery, University Hospital ‘G. Martino’, I-98125 Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Guido Fadda
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Maurizio Martini
- Department of Human Pathology in Adult and Developmental Age ‘Gaetano Barresi’, Pathology Section, University Hospital ‘G. Martino’, University of Messina, I-98125 Messina, Italy
| | - Luigi Maria Larocca
- Department of Medicine and Surgery, Unicamillus, Saint Camillus International University of Health Sciences, International Medical University in Rome, I-00131 Rome, Italy
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