1
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Ge H, Xu L, Gao H, Ji S. Primary intramedullary spinal cord lymphoma misdiagnosed as longitudinally extensive transverse myelitis: a case report and literature review. BMC Neurol 2023; 23:352. [PMID: 37794313 PMCID: PMC10548565 DOI: 10.1186/s12883-023-03383-4] [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: 05/24/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Primary intramedullary spinal cord lymphoma (PISCL) is rare and easily misdiagnosed with the lack of typical clinical features and non-specific imaging manifestations. CASE PRESENTATION A 49-year-old man was admitted to our hospital because of persistent limbs numbness, pinprick-like pain in the posterior neck and unsteady gaits. He has brisk tendon reflexes and positive Babinski's sign. Magnetic resonance imaging (MRI) of the cervical spine showed an abnormal signal with aberrant reinforcement at medulla oblongata and the level of C1-C7. He was clinically diagnosed as longitudinally extensive transverse myelitis (antibody-negative). Steroid pulse therapy was administered and resulted in reduced symptoms. One month later, his situation was exacerbated compared to the onset. We launched a new cascade of steroid pulse therapy. But it did not improve his symptoms. Finally, the biopsy pathology confirmed PISCL. Chemotherapy, radiotherapy and zanubrutinib were administered and until now about 3 years into treatment the patient is still survival. CONCLUSIONS Based on our case and literature review, we recommend that spinal onset patients react ineffectively to standard immunoglobulins or hormonal treatments or experience a relapse after a short time relief should take PISCL into consideration.
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Affiliation(s)
- Huizhen Ge
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huajie Gao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Suqiong Ji
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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2
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Kadri H, Hamed G, Anbari A. Primary non-Hodgkin lymphoma of the chiasm and optic tract in a nonimmunocompromised patient: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22340. [PMID: 36377128 PMCID: PMC9664242 DOI: 10.3171/case22340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Chiasmatic and optic track lymphoma as the primary lesion of the central nervous system (CNS) is extremely rare. OBSERVATIONS The authors report a case of a previously healthy 62-year-old woman who presented with quick and progressive visual impairment leading to bilateral blindness. Brain imaging studies suggested glioma or lymphoma of the chiasm and the posterior visual pathway. Postoperative examination revealed low-grade malignant B-cell lymphoma. No evidence of extracranial lymphoma was found, so a final diagnosis of primary CNS lymphoma (PCNSL) was made. LESSONS To the authors' knowledge, PCNSL confined to the optic chiasm has rarely been reported in nonimmunocompromised patients. The present case of lymphoma affecting the optic chiasm and optic tract is extremely rare.
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Affiliation(s)
| | | | - Anas Anbari
- Ophthalmology, MSRC Damascus, Damascus, Syria; and
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3
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Zhang L, Sun F, Lu X, Wang X, Wang J, Li J, Xu Y, Kou D, Lv H, Don B. Molecular characteristics of immunocytes infiltration in primary central nervous system lymphoma. Front Genet 2022; 13:921823. [PMID: 36061189 PMCID: PMC9428130 DOI: 10.3389/fgene.2022.921823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Primary central nervous system lymphoma (PCNSL) is a rare B-cell lymphoma of central nervous system, which is often found in immunocompromised patients. The common clinical treatment of PCNSL is methotrexate (MTX) and whole brain radiation therapy. With the development of tumour immunology research, the tumour microenvironment of PCNSL is characterised by abnormal expression of different immune signature molecules and patients with PCNSL may benefit from tumour immunotherapy.Methods: In our research, RNA-seq data from 82 PCNSL patients were collated by mining the microarray data from the GEO database. All samples were classified into three types related to tumour immune response by the Cibersort algorithm and consistent clustering. Differential analysis of genes was used to uncover 2 sets of differential genes associated with tumour immunity. The ICI scores of each sample were obtained by PCA algorithm, and the relationship between ICI scores and immune checkpoint expression, immunotherapy and drug sensitivity was investigated. Genes associated with ICI scores and their functional characteristics were investigated by WGCNA analysis and PPI analysis, based on the ICI scores of each sample.Results: The tumour microenvironment in PCNSL has a greater relationship with the tumour immune response. ICI scores obtained from 375 differential genes were associated with multiple immune responses in PCNSL. PCNSL patients with higher ICI scores had a better tumour microenvironment and were sensitive to immunotherapy and some small molecule drug. This study also identified 64 genes associated with ICI scores, which may serve as important therapeutic and prognostic targets for PCNSL.Conclusion: The presence of multiple immunosuppressive responses in the tumour microenvironment of PCNSL which suggested that improving the immune function of PCNSL patients through immunotherapy and targeted therapies can be an effective treatment for PCNSL. And the ICI score and associated genes may also provide a better predictor of the clinical use of immunotherapy.
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Affiliation(s)
- Linyun Zhang
- Department of Neurosurgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fei Sun
- Department of Neurosurgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaona Lu
- Institute of Cancer Stem Cell, Dalian Medical University, Dalian, China
| | - Xiaotong Wang
- Department of Neurosurgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jie Wang
- Department of Neurosurgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jun Li
- Department of Neurosurgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yingsong Xu
- Department of Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Daqing Kou
- Department of Clinical Laboratory, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Daqing Kou, ; Hongtao Lv, ; Bin Dong,
| | - Hongtao Lv
- Department of Neurosurgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Daqing Kou, ; Hongtao Lv, ; Bin Dong,
| | - Bin Don
- Department of Neurosurgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Daqing Kou, ; Hongtao Lv, ; Bin Dong,
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4
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Ali H, Waqar SHB, Majeed M, Sehar A, Mumtaz A. Posttransplant lymphoproliferative disorder in a kidney transplant recipient: a case of Epstein-Barr virus-positive primary central nervous system lymphoma. ENCEPHALITIS 2022; 2:83-88. [PMID: 37469458 PMCID: PMC10295917 DOI: 10.47936/encephalitis.2022.00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/08/2022] [Accepted: 03/22/2022] [Indexed: 07/21/2023] Open
Abstract
Posttransplant lymphoproliferative disorders (PTLDs) are potentially life-threatening complications of chronic immunosuppression in patients who receive solid organ transplants or allogeneic hematopoietic cell transplantation. Most PTLD cases are associated with Epstein-Barr virus (EBV) serology, and their incidence is typically higher in the first year of transplantation. Isolated EBV-positive diffuse large-cell B-cell lymphoma in the renal transplant setting has rarely been reported. Isolated EBV-positive primary central nervous system lymphoma (PCNSL) is rare, even in renal transplant patients with chronic immunosuppression. We report a case of frontal lobe EBV-positive PCNSL in a renal transplant patient who presented with left-sided weakness and was later treated with a consolidated chemotherapeutic regimen without concurrent radiotherapy.
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Affiliation(s)
- Hassam Ali
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, NC, USA
| | - Syed Hamza Bin Waqar
- Department of Internal Medicine, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY, USA
| | - Marwan Majeed
- Department of Pathology, East Carolina University/Vidant Medical Center, Greenville, NC, USA
| | - Alina Sehar
- Department of Internal Medicine, United Medical and Dental College, Karachi, Pakistan
| | - Aqsa Mumtaz
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
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5
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Primary CNS lymphoma of the corpus callosum: presentation and neurocognitive outcomes. J Neurooncol 2022; 158:99-109. [PMID: 35445956 DOI: 10.1007/s11060-022-04014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The corpus callosum (CC) is frequently involved in primary central nervous system lymphomas (PCNSLs). In this cohort study, we described the neurocognition of patients with PCNSL-CC and its posttherapeutic evolution. METHODS Immunocompetent patients with PCNSL-CC were identified retrospectively at the Pitié-Salpêtrière Hospital. We described their clinical presentation. Neuropsychological test scores (MMSE; digit spans; Free and Cued Selective Reminding Test; Image Oral Naming Test; Frontal Assessment Battery; Trail Making Test; Stroop and verbal fluency tests; Rey's Complex Figure test) and factors impacting them were analyzed. RESULTS Twenty-seven patients were included (median age: 67 years, median Karnofsky Performance Status: 70); cognitive impairment and balance disorders were present in 74% and 59%, respectively. At diagnosis, neuropsychological test results were abnormal for global cognitive efficiency (63% of patients), memory (33-80% depending on the test) and executive functions (44-100%). Results for visuospatial and language tests were normal. All patients received high-dose methotrexate-based polychemotherapy, followed in one patient by whole-brain radiotherapy; 67% of patients achieved complete response (CR). With a median follow-up of 48 months (range 6-156), patients in CR had persistent abnormal test results for global cognitive efficiency in 17%, executive function in 18-60%, depending on the test, and memory in 40-60%. Splenium location and age ≥ 60 years were significantly associated with worse episodic memory scores throughout the follow-up. CONCLUSIONS PCNSL-CC is associated with frequent cognitive dysfunctions, especially memory impairment, which may recover only partially despite CR and warrant specific rehabilitation. Older age (≥ 60) and splenium location are associated with worse neurocognitive outcomes.
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6
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DeRon N, Ahmed M, Lopez D, Alobaidi A. A Rare Presentation of Primary Central Nervous System Lymphoma in an Immunocompetent Patient. Cureus 2022; 14:e23858. [PMID: 35530884 PMCID: PMC9072256 DOI: 10.7759/cureus.23858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/05/2022] Open
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7
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Ozturk K, Soylu E, Cayci Z. Differentiation between primary CNS lymphoma and atypical glioblastoma according to major genomic alterations using diffusion and susceptibility-weighted MR imaging. Eur J Radiol 2021; 141:109784. [PMID: 34051685 DOI: 10.1016/j.ejrad.2021.109784] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/26/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to differentiate primary central nervous system lymphoma (PCNSL) from atypical glioblastoma (GB) and distinguish major genomic subtypes between these tumors using susceptibility-weighted imaging (SWI) along with diffusion-weighted imaging (DWI). METHODS Thirty-one immuno-competent patients with PCNSL stratified by BCL2 and MYC rearrangement, and 57 patients with atypical GB (no visible necrosis) grouped according to isocitrate dehydrogenase-1 (IDH1) mutation status underwent 3.0-Tesla MRI before treatment in this retrospective study. Region of interest analysis with apparent diffusion coefficient (ADC) and SWI signal intensity values of the tumors were normalized by dividing those of contralateral white matter. The independent-samples t-test and Kruskal-Wallis test were utilized to compare parameters. The diagnostic ability of each parameter and their optimal combination was evaluated by logistic regression analysis and receiver operating characteristic. RESULTS PCNSL with rearrangement of both MYC and BCL2 (n = 7) [mean relative (r) ADCmean:0.87 ± 0.06, rADCmin:0.72 ± 0.08] demonstrated significantly lower rADCmean, and rADCmin compared to other PCNSLs (n = 24) (rADCmean:1.19 ± 0.18, rADCmin:1.03 ± 0.17;p < 0.001) and GBs (p < 0.001). GB without IDH1 mutation (n = 44) (mean rSWI value:0.95 ± 0.15) demonstrated significantly lower rSWI value compared to GB with IDH1 mutation (n = 13) (rSWI value:1.13 ± 0.09;p < 0.001) and PCNSL (p < 0.001). The incorporation of rADCmean and rSWI parameters distinguished GB with IDH1 mutation [Area under the curve (AUC):0.985] with sensitivity and specificity of 94.3 and 100 % respectively; and PCNSL with rearrangement of both MYC and BCL2 (AUC:0.982) with sensitivity and specificity of 100 % and 95.4 %, respectively. CONCLUSıONS: Combined analysis of SWI and DWI could differentiate atypical GB from PCNSL and distinguish major genomic subtypes between these tumors.
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Affiliation(s)
- Kerem Ozturk
- Department of Radiology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Esra Soylu
- Department of Radiology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Zuzan Cayci
- Department of Radiology, University of Minnesota, Minneapolis, MN, 55455, USA.
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8
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Youssef J, Sadera R, Mital D, Ahmed MH. HIV and the Pituitary Gland: Clinical and Biochemical Presentations. J Lab Physicians 2021; 13:84-90. [PMID: 34054243 PMCID: PMC8154342 DOI: 10.1055/s-0041-1723055] [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] [Indexed: 11/18/2022] Open
Abstract
Human immunodeficiency virus (HIV) can have profound impact on the function of the pituitary gland. We have performed an electronic literature search using the following database: PubMed, Medline, Scopus, and Google Scholar. These databases were searched using the keywords HIV, pituitary glands, cancer, pituitary apoplexy, and infertility. HIV can cause hypopituitarism and also can lead to diabetes insipidus. The impact can be slow and insidious, and diagnosis depends on high index of clinical suspicion. The effect on anterior pituitary gland can be associated with growth hormone deficiency, hypothyroidism, adrenal insufficiency, premature menopause, erectile dysfunction, and infertility. HIV can cause pituitary apoplexy, and this should be treated as an endocrine emergency. Importantly, HIV can be associated with pituitary lymphoma and pituitary cancer. Therefore, joined management between HIV physicians, clinical biochemists and endocrinologists may help in establishing pituitary dysfunction.
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Affiliation(s)
- Joyce Youssef
- Medical School, The University of Buckingham, Buckingham, United Kingdom
| | - Rohan Sadera
- Medical School, The University of Buckingham, Buckingham, United Kingdom
| | - Dushyant Mital
- Department of HIV and Blood Borne Viruses, Milton Keynes University Hospital, NHS Foundation Trust, Milton Keynes, United Kingdom
| | - Mohamed H. Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire, United Kingdom
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9
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Lim RMH, Chan JY. Absence of meaningful neurocognitive recovery in comatose patients with primary central nervous system lymphoma despite an effective response to chemotherapy: Case reports. Mol Clin Oncol 2021; 14:44. [PMID: 33575028 PMCID: PMC7818097 DOI: 10.3892/mco.2021.2206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/23/2020] [Indexed: 01/22/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare type of non-Hodgkin's lymphoma that occurs in patients who are elderly and immunocompromised. The most common treatment for PCNSL is high-dose methotrexate-based chemotherapy. Studies have suggested that the radiological response to high-dose methotrexate-based chemotherapy is associated with improved neurocognitive ability that remains stable upon follow-up. However, no study involving patients with an extremely poor neurological status before chemotherapy initiation has been reported, and the neurological prognosis of this group of patients remains unknown. The current case study described 3 patients with PCNSL diagnosed via biopsy who had comatose neurological states due to disease progression prior to treatment. All patients were treated with high-dose methotrexate-based chemotherapy. However, although effective radiological responses to treatment were achieved, no meaningful neurological or cognitive recovery was documented. Patients with PCNSL exhibiting a baseline comatose state have a poor neurological prognosis even with an effective tumour response to chemotherapy. Therefore, rapid detection and prompt treatment are crucial in patients with this disease.
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Affiliation(s)
- Ryan Mao Heng Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Republic of Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Republic of Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore 169857, Republic of Singapore.,Duke-NUS Medical School, Singapore 169857, Republic of Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore 117599, Republic of Singapore
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10
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Rudresha AH, Chaudhuri T, Lakshmaiah KC, Babu G, Lokesh KN, Rajeev LK. Primary central nervous system lymphoma in immunocompetent patients: A regional cancer center experience. South Asian J Cancer 2020; 6:165-168. [PMID: 29404295 PMCID: PMC5763627 DOI: 10.4103/2278-330x.221341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Primary central nervous system lymphoma (PCNSL) is a rare form of aggressive extranodal non-Hodgkin's lymphoma which occurs in both immunocompromised and immunocompetent patients. It has an overall poor prognosis in spite of a multimodality treatment approach including chemotherapy and radiotherapy. This study attempts to further delineate the clinicopathological, immunohistochemical, and radiological profile of PCNSL at Kidwai Memorial Institute of Oncology, Karnataka, India. Materials and Methods: All the pathologically confirmed PCNSL cases between January 2010 and June 2016, at our center, were analyzed retrospectively. The influence of potential prognostic parameters on overall survival (OS) was investigated by log-rank test and Cox regression analysis. Results: Of the 26 PCNSL patients, 17 (65.3%) were males. Median age at diagnosis was 42.5 years. None of the patients had HIV or Epstein-Barr virus positivity and only four patients (15.4%) had B-symptoms. The most common location in the brain was cerebral hemispheres in 15 patients (57%) and 10 patients (38.5%) had multiple intracranial lesions. Histologically, all were diffuse large B-cell lymphomas, except one case of anaplastic large cell lymphoma. Immunohistochemically, 18 patients (69%) had MUM 1 positivity and 20 cases (77%) belonged to nongerminal center subtype. DeAngelis protocol was followed in 24 patients (92%), and among this cohort, Memorial Sloan Kettering Cancer Center Class 1 (n = 17) and Class 2 (n = 7) patients had a median OS of 25 months and 11 months, respectively. Conclusion: None of the potential prognostic factors had a statistically significant influence on OS in our patients. High-dose methotrexate combined with radiation is an effective therapeutic approach. However, further prospective studies with a large number of patients are needed to identify more effective primary chemotherapy regimens to further improve the treatment outcome.
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Affiliation(s)
- A H Rudresha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Tamojit Chaudhuri
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | | | - Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K N Lokesh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - L K Rajeev
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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11
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Nagarajan E, Yerram SY, Digala LP, Bollu PC. Primary Central Nervous System Lymphoma Presenting as Parkinsonism with Atypical MRI Findings and Elevated 14-3-3 Protein. J Neurosci Rural Pract 2020; 11:492-494. [PMID: 32753821 PMCID: PMC7394633 DOI: 10.1055/s-0040-1713300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare neoplasm with an incidence of 2 to 3% of all CNS malignancies. The diagnosis can be challenging, especially with atypical presentations. Movement disorders can be one of the rare presentations of PCNSL. Here, we present an unusual case of gradually progressing Parkinsonism with an elevation of cerebrospinal fluid (CSF) 14–3-3 protein and atypical imaging findings found to have PCNSL. A 76-year-old female patient presented with gait and intermittent speech difficulty. Initial workup revealed a contrast-enhancing lesion in the bilateral putamen and head of caudate without any mass effect. Her symptoms were rapidly progressed over 6 months and presented with mild dysarthria, bradykinesia, mild rigidity, and reduced left arm swinging. These features were consistent with Parkinsonism. The repeat imaging showed the progression of hyperintensities in the bilateral putamen. The patient underwent a stereotypic biopsy of the right caudate nucleus, which revealed PCNSL. She was treated with high-dose methotrexate and is currently in remission. Diagnosis of movement disorders remains clinical and rapid progression of symptoms, and atypical presentation must warrant further imaging and workup.
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Affiliation(s)
- Elanagan Nagarajan
- Department of Neurology, Columbia University, New York, New York, United States
| | - Sushma Y Yerram
- Department of Neurology, University of Missouri, Columbia, Missouri, United States
| | - Lakshmi P Digala
- Department of Neurology, University of Missouri, Columbia, Missouri, United States
| | - Pradeep C Bollu
- Department of Neurology, University of Missouri, Columbia, Missouri, United States
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12
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Maeyama M, Sasayama T, Tanaka K, Nakamizo S, Tanaka H, Nishihara M, Fujita Y, Sekiguchi K, Kohta M, Mizukawa K, Hirose T, Itoh T, Kohmura E. Multi-marker algorithms based on CXCL13, IL-10, sIL-2 receptor, and β2-microglobulin in cerebrospinal fluid to diagnose CNS lymphoma. Cancer Med 2020; 9:4114-4125. [PMID: 32314548 PMCID: PMC7300423 DOI: 10.1002/cam4.3048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/18/2022] Open
Abstract
Tumor biopsy is essential for the definitive diagnosis of central nervous system (CNS) lymphoma. However, the biopsy procedure carries the risk of complications such as bleeding, convulsions, and infection. Cerebrospinal fluid (CSF) β2‐microglobulin (β2‐MG), soluble IL‐2 receptor (sIL‐2R), and interleukin‐10 (IL‐10) are known to be useful diagnostic biomarkers for CNS lymphoma. The C‐X‐C motif chemokine ligand 13 (CXCL13) was recently reported to be another useful biomarker for CNS lymphoma. The purpose of this study is to establish a diagnostic algorithm that can avoid biopsy by combining these diagnostic biomarkers. In the first, we conducted a case‐control study (n = 248) demonstrating that the CSF CXCL13 concentration was significantly increased in CNS lymphoma patients compared with various other brain diseases (AUC = 0.981). We established a multi‐marker diagnostic model using CSF CXCL13, IL‐10, β2‐MG, and sIL‐2R from the results of the case‐control study and then applied the model to a prospective study (n = 104) to evaluate its utility. The multi‐marker diagnostic algorithms had excellent diagnostic performance: the sensitivity, specificity, positive predictive value, and negative predictive value were 97%, 97%, 94%, and 99%, respectively. In addition, CSF CXCL13 was a prognostic biomarker for CNS lymphoma patients. Our study suggests that multi‐marker algorithms are important diagnostic tools for patients with CNS lymphoma.
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Affiliation(s)
- Masahiro Maeyama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoshi Nakamizo
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirotomo Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Yuichi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Sekiguchi
- Division of Neurology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaaki Kohta
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsu Mizukawa
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takanori Hirose
- Division of Pathology for Regional Communication, Kobe University School of Medicine, Kobe, Japan.,Department of Diagnostic Pathology, Hyogo Cancer Center, Akashi, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
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13
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Galarza Fortuna GM, Dvir K, Febres-Aldana C, Schwartz M, Medina AM. Primary Central Nervous System Lymphoma in an Immunocompetent Patient Presenting as Multiple Cerebellar Lesions: A Case Report and Review of Literature. J Investig Med High Impact Case Rep 2019; 7:2324709619893548. [PMID: 31818145 PMCID: PMC6904776 DOI: 10.1177/2324709619893548] [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] [Indexed: 11/20/2022] Open
Abstract
Primary central nervous system (CNS) lymphoma (PCNSL) is an uncommon extranodal
non-Hodgkin lymphoma often presenting as a single brain lesion within the CNS.
On histopathological evaluation of PCNSL a positive CD10, which is frequently
observed in systemic diffuse large B-cell lymphoma, is present in approximately
10% of PCNSL. We describe a case of CD10-positive PCNSL presenting with multiple
posterior fossa enhancing lesions in an immunocompetent older woman with a
history of breast cancer successfully treated by the RTOG 0227 protocol
consisting of pre-irradiation chemotherapy with high-dose methotrexate,
rituximab, and temozolomide for 6 cycles, followed by low-dose whole-brain
radiation and post-irradiation temozolomide.
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Affiliation(s)
| | - Kathrin Dvir
- Mount Sinai Medical Center, Miami Beach, FL, USA
| | | | | | - Ana Maria Medina
- Mount Sinai Medical Center, Miami Beach, FL, USA.,Florida International University, Miami, FL, USA
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14
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Tu S, Zhou X, Guo Z, Huang R, Yue C, He Y, Li M, Chen Y, Liu Y, Chang LJ, Li Y. CD19 and CD70 Dual-Target Chimeric Antigen Receptor T-Cell Therapy for the Treatment of Relapsed and Refractory Primary Central Nervous System Diffuse Large B-Cell Lymphoma. Front Oncol 2019; 9:1350. [PMID: 31867275 PMCID: PMC6904344 DOI: 10.3389/fonc.2019.01350] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/15/2019] [Indexed: 12/29/2022] Open
Abstract
Background: The therapeutic efficacy of chimeric antigen receptor (CAR) T-cells targeting CD19 has been illustrated in the treatment of diffuse large B-cell lymphoma (DLBCL). However, there is a 21-35% relapse rate after anti-CD19 CAR T-cell induced remission. In addition, CAR T-cell therapy has severe adverse reactions, such as cytokine release syndrome (CRS) and CART-related encephalopathy syndrome (CRES). Because of the potential mortality associated with severe CRES, patients with primary central nervous system lymphoma (PCNSL) are usually excluded from clinical trials involving CAR T-cell therapy. Here, we report a case of refractory and relapsed primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL). Case Presentation: The patient is a 67-year-old male who was diagnosed with PCNSL in 2011. He achieved complete remission (CR) after receiving 6 cycles of temozolomide and high-dose methotrexate. In December 2016, he experienced his first relapse and was treated with surgery and multicourse chemotherapy. He achieved CR again after the treatment. However, he experienced a second relapse in August 2017. MRI revealed a residual mass of 26 mm*35 mm*30 mm on the right side of the post-operative cavity and stale hemorrhage in the left basal ganglia. After confirming the expression of CD19 and CD70 in his tumor samples, the patient was given lymphodepletion chemotherapy followed by infusion of 4th generation CD19-CAR T-cells (4SCART19) and 4th generation CD70-CAR T-cells (4SCART70). One month later, the patient had symptomatic improvement, and brain MRI showed CR. Both CART19 and CART70 cells were detected in the 10th month after CAR T-cell infusion. Notably, neither CRS nor CRES occurred during treatment and follow-up. To date, the patient has maintained disease-free survival with more than 17 months of follow-up. Conclusions: The results of this study indicate that combination of CD19- and CD70-specific CAR T-cells may effectively target PCNSL and maintain disease-free survival without inducing CRS or CRES. Therefore, central nervous system lymphoma is not an absolute contraindication for dual-target CAR T-cell therapy.
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Affiliation(s)
- Sanfang Tu
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xuan Zhou
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenling Guo
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rui Huang
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chunyan Yue
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yanjie He
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Meifang Li
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yiran Chen
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - YuChen Liu
- Department of Research and Development, Geno-Immune Medical Institute, Shenzhen, China
| | - Lung-ji Chang
- Department of Research and Development, Geno-Immune Medical Institute, Shenzhen, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Yuhua Li
- Department of Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Atilla E, Sahin U, Atilla PA, Merter M, Ozyurek E, Ceyhan K, Bozdag SC. Allogeneic stem cell transplantation for relapsed primary central nervous system lymphoma: Is it feasible? Hematol Oncol Stem Cell Ther 2019; 12:220-225. [DOI: 10.1016/j.hemonc.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/12/2018] [Accepted: 02/20/2018] [Indexed: 11/17/2022] Open
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Yuan XG, Huang YR, Yu T, Xu Y, Liang Y, Zhang XH, Sun CR, Zhao XY. Primary central nervous system lymphoma in China: a single-center retrospective analysis of 167 cases. Ann Hematol 2019; 99:93-104. [PMID: 31758262 DOI: 10.1007/s00277-019-03821-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin's lymphoma and a limited number of cases have been reported from China. This study aimed to investigate the clinicopathological features of newly diagnosed PCNSLs from a single center in eastern China and to identify the potential prognostic factors for overall survival (OS) and progression-free survival (PFS). All consecutive patients with histopathologically diagnosed PCNSLs at our center between January 2003 and October 2017 were recruited. Demographic and clinicopathological data were collected and reviewed retrospectively. The potential risk factors for OS and PFS were identified using the log-rank test and Cox regression analysis. A total of 167 immunocompetent cases were enrolled. The median age was 58 years (range 17-96 years), and the male:female ratio was 3:2. Headache (n = 65; 39%) and cerebral hemisphere (n = 96; 57%) were the most common presenting complaint and location, respectively. Out of 167 cases, 150 cases were diffuse large B cell lymphomas. With a median follow-up of 25 months (range 1-152 ), the median OS and PFS were 37 months (95% CI, 25-49) and 17 months (95% CI, 13-20), respectively. Residual tumor after operation, chemotherapy without HD-MTX and palliative treatment was revealed as independent prognostic markers. Moreover, ECOG > 3, multifocal lesions, and palliative treatment were revealed as unfavorable independent prognostic markers for PFS. In conclusion, Chinese patients with PCNSL have distinct characteristics. Further studies are warranted to confirm the prognostic value of these factors and to optimize treatments for these patients.
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Affiliation(s)
- Xiang-Gui Yuan
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Yu-Rong Huang
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Teng Yu
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Yang Xu
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Yun Liang
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Xiao-Hong Zhang
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China
| | - Chong-Ran Sun
- Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China.
| | - Xiao-Ying Zhao
- Department of Hematology, the Second Affiliated Hospital, Zhejiang University School of Medicine, #88 Jiefang Road, Hangzhou, 310009, China.
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Contrast-Enhanced MRI Texture Parameters as Potential Prognostic Factors for Primary Central Nervous System Lymphoma Patients Receiving High-Dose Methotrexate-Based Chemotherapy. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:5481491. [PMID: 31777472 PMCID: PMC6875177 DOI: 10.1155/2019/5481491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 08/26/2019] [Indexed: 02/05/2023]
Abstract
Introduction The purpose of this study was to evaluate the prognostic value of texture features on contrast-enhanced magnetic resonance imaging (MRI) for patients with primary central nervous system lymphoma (PCNSL). Methods In this retrospective study, fifty-two patients diagnosed with PCNSL were enrolled from October 2010 to March 2017. The texture feature of tumor tissue on the histogram-based matrix (histo-) and the grey-level co-occurrence matrix (GLCM) was retrieved by contrast-enhanced T1-weighted imaging before any antitumor treatment. Receiver operating characteristic curve analyses were performed to obtain their optimal cutoff values, based on which we dichotomized patients into subgroups. The Kaplan–Meier analyses were conducted to compare overall survival (OS) of subgroups, and multivariate Cox regression analyses were used to determine if they could be taken as independent prognostic factors. Results Ten texture features were extracted from the MR image, including Energy, Entropy, Kurtosis, Skewness on the histogram-based matrix, and Correlation, Contrast, Dissimilarity, Energy, Entropy, and Homogeneity on the grey-level co-occurrence matrix. Three of them (GLCM-Contrast, GLCM-Dissimilarity, and GLCM-Homogeneity) are shown to be significant in relation to overall survival (OS). The multivariate Cox regression analyses suggest that GLCM-Homogeneity could be taken as independent predictors. Conclusions The texture features of contrast-enhanced magnetic resonance imaging (MRI) could potentially serve as prognostic biomarkers for PCNSL patients.
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O'Connor T, Zhou X, Kosla J, Adili A, Garcia Beccaria M, Kotsiliti E, Pfister D, Johlke AL, Sinha A, Sankowski R, Schick M, Lewis R, Dokalis N, Seubert B, Höchst B, Inverso D, Heide D, Zhang W, Weihrich P, Manske K, Wohlleber D, Anton M, Hoellein A, Seleznik G, Bremer J, Bleul S, Augustin HG, Scherer F, Koedel U, Weber A, Protzer U, Förster R, Wirth T, Aguzzi A, Meissner F, Prinz M, Baumann B, Höpken UE, Knolle PA, von Baumgarten L, Keller U, Heikenwalder M. Age-Related Gliosis Promotes Central Nervous System Lymphoma through CCL19-Mediated Tumor Cell Retention. Cancer Cell 2019; 36:250-267.e9. [PMID: 31526758 DOI: 10.1016/j.ccell.2019.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 06/05/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
How lymphoma cells (LCs) invade the brain during the development of central nervous system lymphoma (CNSL) is unclear. We found that NF-κB-induced gliosis promotes CNSL in immunocompetent mice. Gliosis elevated cell-adhesion molecules, which increased LCs in the brain but was insufficient to induce CNSL. Astrocyte-derived CCL19 was required for gliosis-induced CNSL. Deleting CCL19 in mice or CCR7 from LCs abrogated CNSL development. Two-photon microscopy revealed LCs transiently entering normal brain parenchyma. Astrocytic CCL19 enhanced parenchymal CNS retention of LCs, thereby promoting CNSL formation. Aged, gliotic wild-type mice were more susceptible to forming CNSL than young wild-type mice, and astrocytic CCL19 was observed in both human gliosis and CNSL. Therefore, CCL19-CCR7 interactions may underlie an increased age-related risk for CNSL.
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Affiliation(s)
- Tracy O'Connor
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany; Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany.
| | - Xiaolan Zhou
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, 81377 Munich, Germany; Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jan Kosla
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - Arlind Adili
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany
| | - Maria Garcia Beccaria
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - Elena Kotsiliti
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - Dominik Pfister
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - Anna-Lena Johlke
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany
| | - Ankit Sinha
- Experimental Systems Immunology, Max Planck Institute of Biochemistry, Munich, Germany
| | - Roman Sankowski
- Institute of Neuropathology, Medical Faculty, University of Freiburg, 79085 Freiburg, Germany
| | - Markus Schick
- III. Medical Department, Technical University of Munich, 81675 Munich, Germany
| | - Richard Lewis
- III. Medical Department, Technical University of Munich, 81675 Munich, Germany
| | - Nikolaos Dokalis
- Institute of Neuropathology, Medical Faculty, University of Freiburg, 79085 Freiburg, Germany
| | - Bastian Seubert
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany
| | - Bastian Höchst
- Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany
| | - Donato Inverso
- Division of Vascular Oncology and Metastasis, German Cancer Research Center Heidelberg (DKFZ-ZMBH Alliance), 69120 Heidelberg, Germany
| | - Danijela Heide
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany
| | - Wenlong Zhang
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, 81377 Munich, Germany
| | - Petra Weihrich
- Institute for Physiological Chemistry, University of Ulm, 89081 Ulm, Germany
| | - Katrin Manske
- Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany
| | - Dirk Wohlleber
- Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany
| | - Martina Anton
- Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany
| | - Alexander Hoellein
- III. Medical Department, Technical University of Munich, 81675 Munich, Germany
| | - Gitta Seleznik
- Institute of Neuropathology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Juliane Bremer
- Institute of Neuropathology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Sabine Bleul
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Albert-Ludwigs University, 79106 Freiburg, Germany
| | - Hellmut G Augustin
- Division of Vascular Oncology and Metastasis, German Cancer Research Center Heidelberg (DKFZ-ZMBH Alliance), 69120 Heidelberg, Germany; European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Florian Scherer
- Department of Hematology, Oncology and Stem Cell Transplantation, Freiburg University Medical Center, Albert-Ludwigs University, 79106 Freiburg, Germany
| | - Uwe Koedel
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, 81377 Munich, Germany
| | - Achim Weber
- Department of Pathology and Molecular Pathology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Ulrike Protzer
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany
| | - Reinhold Förster
- Institute of Immunology, Hannover Medical School, 30625 Hannover, Germany
| | - Thomas Wirth
- Institute for Physiological Chemistry, University of Ulm, 89081 Ulm, Germany
| | - Adriano Aguzzi
- Institute of Neuropathology, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Felix Meissner
- Experimental Systems Immunology, Max Planck Institute of Biochemistry, Munich, Germany
| | - Marco Prinz
- Institute of Neuropathology, Medical Faculty, University of Freiburg, 79085 Freiburg, Germany; Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany; Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bernd Baumann
- Institute for Physiological Chemistry, University of Ulm, 89081 Ulm, Germany
| | - Uta E Höpken
- Max Delbrück Center for Molecular Medicine, 13092 Berlin, Germany
| | - Percy A Knolle
- Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurology, Ludwig-Maximilians-University Hospital Munich, 81377 Munich, Germany
| | - Ulrich Keller
- III. Medical Department, Technical University of Munich, 81675 Munich, Germany; German Cancer Consortium (DKTK), 69120 Heidelberg, Germany; Hematology and Oncology, Charité - Universitätsmedizin Campus Benjamin Franklin, 12200 Berlin, Germany
| | - Mathias Heikenwalder
- Institute of Virology, Technical University of Munich, 81675 Munich, Germany; Helmholtz Center Munich, 85764 Neuherberg, Germany; Institute of Molecular Immunology and Experimental Oncology, Technical University of Munich, Ismaningerstraße 22, 81675 Munich, Germany; Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 242, 69120 Heidelberg, Germany.
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Secondary Diffuse Choroid Plexus B-Cell Lymphoma: Case Report and Review of Literature. World Neurosurg 2019; 128:18-22. [DOI: 10.1016/j.wneu.2019.04.203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/20/2022]
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20
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Quantitative and Visual Characteristics of Primary Central Nervous System Lymphoma on 18F-FDG-PET. Interdiscip Sci 2019; 11:300-306. [DOI: 10.1007/s12539-019-00333-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/14/2019] [Accepted: 04/30/2019] [Indexed: 11/26/2022]
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21
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Kim H, Nam TS, Levy M, Lee KH, Kim J, Lee SJ. Primary central nervous system lymphoma with intramedullary spinal cord involvement mimicking inflammatory demyelinating disease. JOURNAL OF NEUROCRITICAL CARE 2019. [DOI: 10.18700/jnc.190083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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22
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Go JA, Mandujano-Sanchez JI, Vickers A, Sadaka A, Ortiz J, Berry S, Yalamanchili S, Lee AG. Primary central nervous system lymphoma of the optic chiasm. Can J Ophthalmol 2019; 54:e134-e140. [DOI: 10.1016/j.jcjo.2018.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/14/2018] [Indexed: 12/14/2022]
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23
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Chen YH, Hueng DY, Tsai WC. Proteolipid Protein 2 Overexpression Indicates Aggressive Tumor Behavior and Adverse Prognosis in Human Gliomas. Int J Mol Sci 2018; 19:ijms19113353. [PMID: 30373180 PMCID: PMC6274732 DOI: 10.3390/ijms19113353] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 01/12/2023] Open
Abstract
Proteolipid protein 2 (PLP2), a membrane protein of the endoplasmic reticulum, is related to tumor proliferation and metastasis in some human cancers, but not in gliomas. First, we performed western-blot analysis, real-time quantitative PCR and immunohistochemical stains to detect PLP2 expression in 4 glioma cell lines and human glioma tissues. In addition, we used small interfering RNA (SiPLP2) and short hairpin RNA (shPLP2) to knockdown PLP2 expression in GBM8401 and LN229 glioma cell lines. After then, the alteration of PLP2 suppressed glioma cells behavior were examined by cell proliferation, wound healing, cell invasion, and colonies formation assays. Finally, the possible mechanism of PLP2 was analyzed by detecting the expression of the proteins related to cell-cycle checkpoints, cell-proliferative signaling factors, and cell-matrix interaction. Compared with normal brain cell lysates and mRNA, all glioma cell lines displayed PLP2 protein and mRNA overexpression. Besides, higher PLP2 IHC staining significantly correlated with more advanced tumor grades and poorer prognosis in human gliomas. Both siPLP2 transfected gliomas showed a clear inhibition of glioma cell proliferation, migration, and invasion as well as down-regulating p-p38, p-ERK, MMP-2, and MMP-9 expression. In conclusion, we successfully demonstrated that PLP2 overexpression played an oncogenic role in glioma development and aggressive tumor behavior.
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Affiliation(s)
- Yi-Hsuan Chen
- Graduate Institute of Pathology and Parasitology, National Defense Medical Center, Taipei 11490, Taiwan.
| | - Dueng-Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan.
| | - Wen-Chiuan Tsai
- Graduate Institute of Pathology and Parasitology, National Defense Medical Center, Taipei 11490, Taiwan.
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei 11490, Taiwan.
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Geng M, Xiao H, Liu J, Song Y, Fu P, Cheng X, Zhang J, Wang G. The diagnostic role and dynamic changes in cerebrospinal fluid neopterin during treatment of patients with primary central nervous system lymphoma. Cancer Med 2018; 7:3889-3898. [PMID: 29982995 PMCID: PMC6089159 DOI: 10.1002/cam4.1581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/03/2018] [Accepted: 05/06/2018] [Indexed: 12/28/2022] Open
Abstract
This study aimed at evaluating the diagnostic and prognostic role of neopterin (Npt) concentration in the cerebrospinal fluid (CSF) of patients with primary central nervous system lymphoma (PCNSL). Ninety‐nine patients were enrolled in this retrospective study; these included patients with PCNSL (n = 21), other brain tumors (n = 44), and inflammatory diseases (n = 34). CSF Npt concentration was measured using ELISA. Receiver operating characteristic (ROC) curve analysis was performed to assess the discriminative ability of CSF Npt concentration for the diagnosis of PCNSL. CSF Npt concentration in patients with PCNSL was significantly higher than that in patients with other brain tumors and inflammatory diseases (P < .001). On ROC curve analysis, the optimal cutoff CSF Npt level of 10.77 ng/mL for the diagnosis of PCNSL and the diagnostic yield of MRI were increased when used in conjunction with CSF Npt concentration. The CSF Npt concentrations in PCNSL patients with multiple lesions were significantly higher than those in patients with a single lesion. Changes in CSF Npt concentration were consistent with post‐treatment changes in tumor sizes. The CSF Npt concentration may be a good biomarker for the diagnosis, for monitoring of disease course, and for prognostic evaluation of patients with PCNSL.
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Affiliation(s)
- Mingying Geng
- Cancer Center, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - He Xiao
- Cancer Center, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiaqi Liu
- Department of Clinical Laboratory, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yang Song
- Cancer Center, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ping Fu
- Department of Pathology, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqin, China
| | - Xing Cheng
- Department of Neurosurgery, Chongqing Cancer Hospital, Chongqing, China
| | - Jinwei Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Ge Wang
- Cancer Center, Institute of Surgery Research, Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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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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Treatment with methotrexate, rituximab, and cytosine arabinoside followed by autologous stem cell transplantation in primary central nervous system lymphoma: A single-center experience. Hematol Oncol Stem Cell Ther 2018. [DOI: 10.1016/j.hemonc.2017.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Case of Primary Central Nervous System Lymphoma Arising at Site of Remote Herpes Encephalitis. World Neurosurg 2018; 113:217-222. [PMID: 29382621 DOI: 10.1016/j.wneu.2018.01.143] [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: 12/01/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare malignancy that usually arises in the context of severe immunosuppression but has incompletely understood etiology, limiting effective treatments. CASE DESCRIPTION We present the case of an 81-year-old immunocompetent man who developed a PCNSL in the right temporal lobe, at the site of a remote episode of herpes simplex virus (HSV) encephalitis 8 years prior. There are numerous viruses with known oncogenic associations; however, to our knowledge, this is the first reported case of PCNSL with an antecedent HSV infection. CONCLUSIONS We discuss this case in the context of our current understandings of the pathogenesis of HSV encephalitis and PCNSL and postulate mechanisms through which the 2 could be associated.
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Geschwind MD, Murray K. Differential diagnosis with other rapid progressive dementias in human prion diseases. HANDBOOK OF CLINICAL NEUROLOGY 2018; 153:371-397. [PMID: 29887146 DOI: 10.1016/b978-0-444-63945-5.00020-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Prion diseases are unique in medicine as in humans they occur in sporadic, genetic, and acquired forms. The most common human prion disease is sporadic Creutzfeldt-Jakob disease (CJD), which commonly presents as a rapidly progressive dementia (RPD) with behavioral, cerebellar, extrapyramidal, and some pyramidal features, with the median survival from symptom onset to death of just a few months. Because human prion diseases, as well as other RPDs, are relatively rare, they can be difficult to diagnose, as most clinicians have seen few, if any, cases. Not only can prion diseases mimic many other conditions that present as RPD, but some of those conditions can present similarly to prion disease. In this article, the authors discuss the different etiologic categories of conditions that often present as RPD and also present RPDs that had been misdiagnosed clinically as CJD. Etiologic categories of conditions are presented in order of the mnemonic used for remembering the various categories of RPDs: VITAMINS-D, for vascular, infectious, toxic-metabolic, autoimmune, mitochondrial/metastases, iatrogenic, neurodegenerative, system/seizures/sarcoid, and demyelinating. When relevant, clinical, imaging, or other features of an RPD that overlap with those of CJD are presented.
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Affiliation(s)
- Michael D Geschwind
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, United States.
| | - Katy Murray
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
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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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30
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Primary central nervous system lymphoma as a neurosurgical problem. Neurol Neurochir Pol 2017; 51:319-323. [DOI: 10.1016/j.pjnns.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/10/2017] [Indexed: 11/21/2022]
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Tavares Bello C, Sousa Santos F, Sequeira Duarte J, Vasconcelos C. Diabetes insipidus and hypopituitarism in HIV: an unexpected cause. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170024. [PMID: 28620498 PMCID: PMC5467654 DOI: 10.1530/edm-17-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/07/2017] [Indexed: 11/13/2022] Open
Abstract
Central diabetes insipidus (DI) is a rare clinical entity characterized by low circulating levels of antidiuretic hormone (ADH) presenting with polyuria and volume depletion. Pituitary surgery is the most common cause of central DI in adults. Pituitary and hypothalamic disease, particularly invasive neoplasms, rarely cause DI, being idiopathic cases responsible for the majority of non-surgical cases. HIV patients, especially those with poor virulogical control, are prone to the development of CNS neoplasms, particularly lymphomas. These neoplasms usually become manifest with mass effects and seizures. Central DI and hypopituitarism are uncommon initial manifestations of primary CNS lymphomas. The authors describe the case of 29-year-old female, HIV-positive patient whose CNS lymphoma presented with DI.
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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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High-dose thiotepa-based chemotherapy with autologous stem cell support in elderly patients with primary central nervous system lymphoma: a European retrospective study. Bone Marrow Transplant 2017; 52:1113-1119. [DOI: 10.1038/bmt.2017.23] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/21/2016] [Accepted: 01/10/2017] [Indexed: 11/09/2022]
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High-dose methotrexate-based immuno-chemotherapy for elderly primary CNS lymphoma patients (PRIMAIN study). Leukemia 2016; 31:846-852. [PMID: 27843136 PMCID: PMC5383936 DOI: 10.1038/leu.2016.334] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/10/2016] [Accepted: 10/21/2016] [Indexed: 01/12/2023]
Abstract
To investigate immuno-chemotherapy for elderly immuno-competent patients (⩾65 years) with newly diagnosed primary central nervous system lymphoma, we conducted a multicentre single-arm trial. One cycle consisted of rituximab (375 mg/m2, days 1, 15, 29), high-dose methotrexate (3 g/m2 days 2, 16, 30), procarbazine (60 mg/m2 days 2–11) and lomustine (110 mg/m2, day 2)—R-MPL protocol. Owing to infectious complications, we omitted lomustine during the study and consecutive patients were treated with the R-MP protocol. Three cycles were scheduled and repeated on day 43. Subsequently, patients commenced 4 weekly maintenance treatment with procarbazine (100 mg for 5 days). Primary end point was complete remission (CR) after 3 cycles. We included 107 patients (69 treated with R-MPL and 38 with R-MP). In all, 38/107 patients achieved CR (35.5%) and 15 (14.0%) achieved partial remission. R-MP was associated with a lower CR rate (31.6%) compared with R-MPL (37.7%), but respective 2-year progression-free survival (All 37.3% R-MP 34.9% R-MPL 38.8%) and overall survival (All 47.0% R-MP 47.7% R-MPL 46.0%) rates were similar. R-MP was associated with less ⩾grade 3 toxicities compared with R-MPL (71.1% vs 87.0%). R-MP is more feasible while still associated with similar efficacy compared with R-MPL and warrants further improvement in future studies.
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Abstract
BACKGROUND Primary CNS lymphoma (PCNSL), a rare form of aggressive extranodal non-Hodgkin's lymphoma (NHL), has increased in incidence during the last three decades and occurs in both immune compromised and immune competent hosts. It has an overall poor prognosis. OBJECTIVE This study attempts to further delineate the clinico-pathological, immunohistochemical and radiological profile of PCNSL at Jeddah to King Faisal Hospital and Research Center. METHODS Computerized search through the archives of King Faisal Hospital and Research Centre between July 2000- December 2012 identified 15 patients with pathologically confirmed PCNSL. These were analyzed retrospectively. Their clinico-pathological, immunohistochemical and radiological data were analyzed. RESULTS Of the 15 PCNSL patients, 8 (53.3%) were females and 7 (46.6%) were males. There was female predilection especially in the age group of 40-59 years. Mean age at diagnosis for all patients was 50.4 years. There was no patient in the pediatric age group. The most common location in the brain was the frontal region in 7 patients (46.6%), 7 (46.6%) had multiple intracranial masses; all 15 (100%) were Non Hodgkin B-cell lymphomas, among which 13 (86.6%) were diffuse large B-cell lymphomas. All 15 (100%) cases showed diffuse and strong positivity for CD 45, and CD 20. Fourteen patients were immune competent while one was immune compromised. CONCLUSIONS PCNSL often occurs in middle-aged and aged patients. There is female predilection especially in the middle age. Frontal region is the most common location with diffuse large B-cell lymphoma being the predominant subtype.
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Affiliation(s)
- Shagufta T Mufti
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Saleh S Baeesa
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Jaudah A Al-Maghrabi
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; Department of Pathology, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia
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Nguyen-Them L, Costopoulos M, Tanguy ML, Houillier C, Choquet S, Benanni H, Elias-Shamieh R, Armand M, Faivre G, Glaisner S, Malak S, Vargaftig J, Hoang-Xuan K, Ahle G, Touitou V, Cassoux N, Davi F, Merle-Béral H, Le Garff-Tavernier M, Soussain C. The CSF IL-10 concentration is an effective diagnostic marker in immunocompetent primary CNS lymphoma and a potential prognostic biomarker in treatment-responsive patients. Eur J Cancer 2016; 61:69-76. [DOI: 10.1016/j.ejca.2016.03.080] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/17/2016] [Accepted: 03/26/2016] [Indexed: 10/21/2022]
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Zhang Y, Zhang Q, Wang XX, Deng XF, Zhu YZ. Value of pretherapeutic DWI in evaluating prognosis and therapeutic effect in immunocompetent patients with primary central nervous system lymphoma given high-dose methotrexate-based chemotherapy: ADC-based assessment. Clin Radiol 2016; 71:1018-1029. [PMID: 27341986 DOI: 10.1016/j.crad.2016.05.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/30/2016] [Accepted: 05/24/2016] [Indexed: 01/18/2023]
Abstract
AIM To investigate apparent diffusion coefficient (ADC) as a prognostic indicator in primary central nervous system lymphoma (PCNSL) by analysing patient clinical characteristics and pretherapeutic diffusion-weighted imaging (DWI). MATERIALS AND METHODS Clinical characteristics and pretherapeutic DWI were studied retrospectively in 28 patients receiving high-dose methotrexate (HD-MTX)-based chemotherapy. Mean (ADCmean), 95th percentile (ADC95%), and 5th percentile (ADC5%) ADC values of the enhancing tumour volume were measured. The influence of prognostic parameters on progression-free survival (PFS) was investigated by log-rank test and Cox regression analysis. Correlations between the variables and PFS or the level of Ki-67 expression were analysed. ADC and clinical features were analysed using an independent sample t-test between the complete response (CRi) and partial response (PRi) groups after initial four cycles of chemotherapy. Receiver operating characteristic (ROC) curves were constructed using ADC parameters. RESULTS Patients with CRi, lower Ki-67 level, higher Karnofsky performance status (KPS), ADC5%, or ADCmean showed better PFS. The level of Ki-67 expression and ADC5% were independent risk factors. There was a positive correlation between KPS, ADC5%, and PFS, and negative correlation between ADC5%, PFS, and the level of Ki-67 expression. There was a significant difference for PFS, KPS, ADCmean, and ADC5% between CRi and non-CRi; however, ADC5% outperformed ADCmean because the area under the ROC curve (AUC) using ADC5% (0.983) was higher than the AUC using ADCmean (0.822). CONCLUSION ADC measurements, especially ADC5%, are useful predictors for PFS and response to HD-MTX in PCNSL.
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Affiliation(s)
- Y Zhang
- Department of Radiology, The 105th Hospital of Chinese PLA, Hefei 230031, People's Republic of China
| | - Q Zhang
- Department of Radiology, The 105th Hospital of Chinese PLA, Hefei 230031, People's Republic of China
| | - X-X Wang
- Department of Pathology, The 105th Hospital of Chinese PLA, Hefei 230031, People's Republic of China
| | - X-F Deng
- Basic Medicine College, Anhui Medical University, Hefei 230032, People's Republic of China
| | - Y-Z Zhu
- Department of Radiology, The 105th Hospital of Chinese PLA, Hefei 230031, People's Republic of China.
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Chen D, Gu W, Li W, Liu X, Yang X. Primary diffuse large B-cell lymphoma of the central nervous system: A case report and literature review. Oncol Lett 2016; 11:3085-3090. [PMID: 27123068 DOI: 10.3892/ol.2016.4365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 12/14/2015] [Indexed: 12/13/2022] Open
Abstract
The present study reports the clinical diagnosis and management of a patient with primary diffuse large B-cell lymphoma (Bcl) of the central nervous system (CNS). Making an early diagnosis of primary diffuse large Bcl is challenging due to the variable and complicated clinical manifestations of the disease. The relevant literature was reviewed, and high-dose methotrexate, whole brain radiotherapy and highly active antiretroviral therapy was recommended for the patient. The present study elucidates the role of positron emission tomography-computed tomography scans for the diagnosis and management of primary diffuse large Bcl of the CNS, and demonstrates the importance of resection surgery in the management of the disease. Specifically, the present study proposes that resection surgery may be applied in the early stages of disease for patients with a single occupied lesion and increased intracranial pressure.
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Affiliation(s)
- Dawei Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Weihong Gu
- Department of Surgery, The Second Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Wenzhong Li
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaoliang Liu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaoyu Yang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Igala M. Unusual relapse of primary central nervous system lymphoma. SPRINGERPLUS 2016; 5:301. [PMID: 27066337 PMCID: PMC4783311 DOI: 10.1186/s40064-016-1926-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/23/2016] [Indexed: 11/10/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare disease which accounts for 1-2 % of non-Hodgkin lymphoma and 3-5 % of primary brain tumor lesions. PCNSL of an immunocompetent patient is an uncommon disease, it is estimated at 4 % of new diagnoses of CNS tumors. The prognosis of PCNSL is poor compared to other extranodal lymphomas, with a 5-year survival estimated between 20 and 40 %. PCNSL relapse occurs either in the original site but still confined to the CNS or exceptionally outside it. Brain magnetic resonance imaging, although not allowing a clear distinction between primary lesions and secondary brain lymphoma is of paramount importance not only for diagnosis but also for monitoring the patient. This manuscript report the case of a patient in whom the PCNSL has relapsed in the cervical spinal cord and also in the liver.
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Affiliation(s)
- Marielle Igala
- Hematology Department, Hôpital du 20 Aôut, Centre hospitalier universitaire de Casablanca, Casablanca, Morocco
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40
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Ungur R, Tempescul A, Berthou C, Bagacean C, Radeanu D, Muresan A, Zdrenghea M. ESHAP chemotherapy is efficient in refractory/relapsed primary central nervous system lymphoma: report of four cases. Onco Targets Ther 2015; 8:2771-3. [PMID: 26491351 PMCID: PMC4599053 DOI: 10.2147/ott.s89358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Primary central nervous system non-Hodgkin’s lymphoma is a rare presentation, almost always of diffuse large B-cell type. Although there is no consensus regarding therapy for this condition, induction regimens are based on high-dose methotrexate and consolidation whole-brain radiotherapy, or, more preferred recently, blood–brain barrier penetrating drugs such as etoposide, cytarabine, and alkylating agents like temozolomide, ifosfamide, and lomustine. We present here four cases of relapsed/refractory primary central nervous system lymphoma treated with ESHAP (etoposide, solumedrol, high-dose cytarabine, and platinum) chemotherapy to complete remission, with the eligible patients proceeding to autologous transplantation. We want to draw attention to this interesting, relatively well tolerated, underused therapeutic option, in a setting where treatment options are scarce and evidence-based recommendations are lacking.
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Affiliation(s)
- Rodica Ungur
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj, Cluj-Napoca, Romania ; Department of Hematology, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Adrian Tempescul
- Department of Clinical Hematology, Institute of Cancerology and Hematology, Brest Teaching Hospital, Brest, France
| | - Christian Berthou
- Department of Clinical Hematology, Institute of Cancerology and Hematology, Brest Teaching Hospital, Brest, France
| | - Cristina Bagacean
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj, Cluj-Napoca, Romania ; Department of Hematology, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
| | - Doinel Radeanu
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj, Cluj-Napoca, Romania
| | - Adriana Muresan
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj, Cluj-Napoca, Romania
| | - Mihnea Zdrenghea
- Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj, Cluj-Napoca, Romania ; Department of Hematology, Ion Chiricuta Oncology Institute, Cluj-Napoca, Romania
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Zhu YL, Song XF, Wang B. Isolated lymphoma of the optic nerve, chiasm and tract: A case report. Oncol Lett 2015; 10:3013-3017. [PMID: 26722281 DOI: 10.3892/ol.2015.3675] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 07/17/2015] [Indexed: 11/06/2022] Open
Abstract
The current study reports the case of a 68-year-old, previously healthy female who presented with progressive visual impairment leading to blindness bilaterally. Brain imaging features were suggestive of malignant glioma of the anterior visual pathway. Postoperative examination indicated a diagnosis of diffuse malignant lymphoma type B. As no evidence of extracranial lymphoma was observed, the final diagnosis was primary central nervous system lymphoma (PCNSL). Following treatment with surgery and radiotherapy, the patient's symptoms went into remission. At a follow-up examination 12 months after diagnosis, the patient demonstrated no evidence of recurrence. To the best of our knowledge, PCNSL isolated to the optic chiasm has been reported only three times in immunocompetent patients. Therefore, the present case of the lymphoma involving the optic nerve, optic chiasm and optic tract in an immunocompetent patient is unusual. The present case emphasizes the importance of considering the diagnosis of lymphoma in this setting.
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Affiliation(s)
- Yue-Li Zhu
- Shandong Medical Imaging Research Institution, Shandong University, Jinan, Shandong 250021, P.R. China ; Department of Radiology, Qingdao Municipal Hospital, Qingdao, Shandong 266071, P.R. China
| | - Xiu-Feng Song
- Department of Radiology, Qingdao University Affiliated Hospital, Qingdao, Shandong 266003, P.R. China
| | - Bin Wang
- Shandong Medical Imaging Research Institution, Shandong University, Jinan, Shandong 250021, P.R. China ; Medical Imaging Research Institute, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
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Kontogeorgi E, Papadopoulos D, Zafeiropoulou E, Karagkounis G, Argyrakos T, Stranjalis G, Rontogianni D, Karakalos D. A 24 year-old woman with relapsing brainstem manifestations and multiple focal brain lesions. Natural killer cell lymphoblastic lymphoma/leukemia. Brain Pathol 2015; 25:115-6. [PMID: 25521184 DOI: 10.1111/bpa.12235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Elli Kontogeorgi
- Department of Neurology, Evangelismos General Hospital, 4th floor AHEPA building, GREECE
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43
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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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Abstract
PURPOSE OF REVIEW Brain tumors differ in histology, biology, prognosis and treatment options. Although structural magnetic resonance is still the gold standard for morphological tumor characterization, molecular imaging has gained an increasing importance in assessment of tumor activity and malignancy. RECENT FINDINGS Amino acid PET is frequently used for surgery and biopsy planning as well as therapy monitoring in suspected primary brain tumors as well as metastatic lesions, whereas 18F-fluorodeoxyglucose (18F-FDG) remains the tracer of choice for evaluation of patients with primary central nervous system lymphoma. Application of somatostatin receptor ligands has improved tumor delineation in skull base meningioma and concurrently opened up new treatment possibilities in recurrent or surgically not assessable tumors.Recent development focuses on the implementation of hybrid PET/MRI as well as on the development of new tracers targeting tumor hypoxia, enzymes involved in neoplastic metabolic pathways and the combination of PET tracers with therapeutic agents. SUMMARY Implementation of molecular imaging in the clinical routine continues to improve management in patients with brain tumors. However, more prospective large sample studies are needed to validate the additional informative value of PET.
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45
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Avancées dans les tumeurs cérébrales primitives malignes de l’adulte : quels patients transférer en réanimation médicale? ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13546-015-1073-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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46
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Primary intramedullary non-Hodgkin's lymphoma in an immunocompetent child. Spinal Cord 2015; 52 Suppl 2:S21-3. [PMID: 25082378 DOI: 10.1038/sc.2014.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 05/07/2014] [Accepted: 05/11/2014] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Case report. OBJECTIVES Primary intramedullary spinal cord lymphoma is a rare entity. Studies have shown that there is a recent increase in the number of patients regardless of the status of the immunity. High index of suspicion should be kept in all patients with intramedullary tumors. Multidisciplinary approach at the earliest is required for best outcomes. SETTING Department of Neurosurgery, Medical Oncology, Pathology and Radiation oncology. Nizam's Institute of Medical Sciences, Hyderabad, India. METHODS We describe the case of an 11-year-old boy who presented with paraparesis and sensory loss below T10 level. On imaging, the dorsal spine showed intramedullary lesion mimicking an astrocytoma. RESULTS Surgical decompression of the tumor was done and histopathology showed non-Hodgkin's lymphoma, diffuse large B-cell type. There were no findings suggestive of congenital or acquired immunodeficiency. After complete staging evaluation, we instituted chemotherapy with modified DeAngelis protocol. At 2 years post treatment, he is in complete remission with near normal neurological status. CONCLUSIONS Intramedullary spinal cord diffuse B-cell lymphoma in a pediatric age group is very rare and hence requires a high index of suspicion in patients presented with myelopathy. The outcomes are encouraging with current multidisciplinary approach.
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Khadilkar SV, Bhutada AG, Chaudhari CR, Velho V, Domkundwar S, Muzumdar G. Hypertrophic multiple cranial neuropathies: An unusual presentation of primary CNS lymphoma. Ann Indian Acad Neurol 2015; 18:74-6. [PMID: 25745316 PMCID: PMC4350220 DOI: 10.4103/0972-2327.144305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 07/18/2014] [Accepted: 07/30/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Satish V Khadilkar
- Department of Neurology, Jamsetjee Jeejebhoy Hospital and Grant Government Medical College, Mumbai, India
| | - Ashish G Bhutada
- Department of Neurology, Jamsetjee Jeejebhoy Hospital and Grant Government Medical College, Mumbai, India
| | - Chetan R Chaudhari
- Department of Neurology, Jamsetjee Jeejebhoy Hospital and Grant Government Medical College, Mumbai, India
| | - Vernon Velho
- Department of Neurosurgery, Jamsetjee Jeejebhoy Hospital and Grant Government Medical College, Mumbai, India
| | - Shilpa Domkundwar
- Department of Radiology, Jamsetjee Jeejebhoy Hospital and Grant Government Medical College, Mumbai, India
| | - Girish Muzumdar
- Department of Pathology, Bombay Hospital, Mumbai, Maharashtra, India
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Kasenda B, Ferreri AJM, Marturano E, Forst D, Bromberg J, Ghesquieres H, Ferlay C, Blay JY, Hoang-Xuan K, Pulczynski EJ, Fosså A, Okoshi Y, Chiba S, Fritsch K, Omuro A, O'Neill BP, Bairey O, Schandelmaier S, Gloy V, Bhatnagar N, Haug S, Rahner S, Batchelor TT, Illerhaus G, Briel M. First-line treatment and outcome of elderly patients with primary central nervous system lymphoma (PCNSL)--a systematic review and individual patient data meta-analysis. Ann Oncol 2015; 26:1305-13. [PMID: 25701456 DOI: 10.1093/annonc/mdv076] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 02/10/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To investigate prognosis and effects of first-line therapy in elderly primary central nervous system lymphoma (PCNSL) patients. PATIENTS AND METHODS A systematic review of studies about first-line therapy in immunocompetent patients ≥60 years with PCNSL until 2014 and a meta-analysis of individual patient data from eligible studies and international collaborators were carried out. RESULTS We identified 20 eligible studies; from 13 studies, we obtained individual data of 405 patients, which were pooled with data of 378 additional patients (N = 783). Median age and Karnofsky Performance Score (KPS) was 68 years (range: 60-90 years) and 60% (range: 10%-100%), respectively. Treatments varied greatly, 573 (73%) patients received high-dose methotrexate (HD-MTX)-based therapy. A total of 276 patients received whole-brain radiotherapy (median 36 Gy, range 28.5-70 Gy). KPS ≥ 70% was the strongest prognostic factor for mortality [hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.41-0.62]. After a median follow-up of 40 months, HD-MTX-based therapy was associated with improved survival (HR 0.70, 95% CI 0.53-0.93). There was no difference between HD-MTX plus oral chemotherapy and more aggressive HD-MTX-based therapies (HR 1.39, 95% CI 0.90-2.15). Radiotherapy was associated with an improved survival, but correlated with an increased risk for neurological side-effects (odds ratio 5.23, 95% CI 2.33-11.74). CONCLUSIONS Elderly PCNSL patients benefit from HD-MTX-based therapy, especially if combined with oral alkylating agents. More aggressive HD-MTX protocols do not seem to improve outcome. WBRT may improve outcome, but is associated with increased risk for neurological side-effects. Prospective trials for elderly PCNSL patients are warranted.
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Affiliation(s)
- B Kasenda
- Department of Oncology, University Hospital of Basel, Basel Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - A J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy
| | - E Marturano
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy
| | - D Forst
- Partners Neurology Residency Program, Harvard Medical School, Boston, USA
| | - J Bromberg
- Department of Neuro-Oncology, Daniel den Hoed Cancer Center, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - H Ghesquieres
- Department of Hematology, Centre Léon Bérard, University of Lyon, Lyon
| | - C Ferlay
- Department of Hematology, Centre Léon Bérard, University of Lyon, Lyon
| | - J Y Blay
- Department of Hematology, Centre Léon Bérard, University of Lyon, Lyon
| | - K Hoang-Xuan
- Department of Neurology Mazarin, LOC National Expert Center, APHP, IHU, UPMC, CRICM, GH Pitié-Salpêtrière, Paris, France
| | - E J Pulczynski
- Department of Haematology, Nordic Lymphoma Group, University Hospital Aarhus, Aarhus, Denmark
| | - A Fosså
- Norwegian Department of Oncology, Nordic Lymphoma Group, Radium Hospital, Oslo, Norway
| | - Y Okoshi
- Faculty of Medicine, Department of Hematology, University of Tsukuba, Tsukuba, Japan
| | - S Chiba
- Faculty of Medicine, Department of Hematology, University of Tsukuba, Tsukuba, Japan
| | - K Fritsch
- Department of Hematology/Oncology, University Hospital Freiburg, Freiburg, Germany
| | - A Omuro
- Department of Neurology Mazarin, LOC National Expert Center, APHP, IHU, UPMC, CRICM, GH Pitié-Salpêtrière, Paris, France
| | - B P O'Neill
- Department of Neurology, Mayo Medical School, Rochester, USA
| | - O Bairey
- Institute of Hematology, Rabin Medical Center, Beilinson Hospital, Tel Aviv Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Schandelmaier
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - V Gloy
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - N Bhatnagar
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - S Haug
- Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg
| | - S Rahner
- Medical Faculty, University of Freiburg, Freiburg, Germany
| | - T T Batchelor
- Partners Neurology Residency Program, Harvard Medical School, Boston, USA Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, USA
| | - G Illerhaus
- Stuttgart Cancer Center, Eva-Mayr-Stihl Tumor Center, Stuttgart, Germany
| | - M Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Cytomegalovirus Meningoencephalitis After Rituximab Treatment for Primary Central Nervous System Lymphoma. Neurologist 2015; 19:35-7. [DOI: 10.1097/nrl.0b013e318287fde0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Livermore LJ, Ma R, Bojanic S, Pereira EAC. Yield and complications of frame-based and frameless stereotactic brain biopsy – The value of intra-operative histological analysis. Br J Neurosurg 2014; 28:637-44. [DOI: 10.3109/02688697.2014.887657] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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