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Ribas GA, de Mori LH, Freddi TDAL, Oliveira LDS, de Souza SR, Corrêa DG. Primary central nervous system lymphoma: Imaging features and differential diagnosis. Neuroradiol J 2024:19714009241252625. [PMID: 38703015 DOI: 10.1177/19714009241252625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024] Open
Abstract
Primary central nervous system lymphoma (PCNSL) represents 5% of malignant primary brain tumors. The clinical presentation typically includes focal neurological symptoms, increased intracranial pressure, seizures, and psychiatric symptoms. Although histological examination remains the gold standard for diagnostic confirmation, non-invasive imaging plays a crucial role for the diagnosis. In immunocompetent individuals, PCNSL usually appears as a single, well-defined, supratentorial lesion with a predilection for periventricular areas, iso- or hypointense on T1- and T2-weighted magnetic resonance imaging, with restricted diffusion, slightly increased perfusion, and homogenous gadolinium-enhancement. Differential diagnoses include high-grade glioma and pseudotumoral demyelinating disease. In immunocompromised patients, PCNSL may present as multiple lesions, with a higher likelihood of hemorrhage and necrosis and less restricted diffusion than immunocompetent individuals. Differential diagnoses include neurotoxoplasmosis, progressive multifocal leukoencephalopathy, and cerebral abscess. Atypical forms of lymphoma are characterized by extra-axial lymphoma, lymphomatosis cerebri, and intravascular lymphoma. Extra-axial lymphoma presents as single or multiple extra-axial dural lesions with diffuse leptomeningeal contrast-enhancement. Lymphomatosis cerebri appears as an infiltrative and symmetric lesion, primarily affecting deep white matter and basal ganglia, appearing hyperintense on T2-weighted imaging, without significant contrast-enhancement or perfusion changes. Intravascular lymphoma presents as multiple rounded or oval-shaped "infarct-like" lesions, located cortically or subcortically. This study aims to highlight the imaging characteristics of PCNSL, focusing on magnetic resonance imaging and its differential diagnosis.
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Affiliation(s)
| | | | | | | | | | - Diogo Goulart Corrêa
- Department of Diagnostic Imaging, Rio de Janeiro State University, Brazil
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Brazil
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2
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Matejka M, Moreno Beredjiklian C, Rezai A, Kraus TFJ, Pizem D, Klausner F, Pöppe JP, Griessenauer CJ, Schwartz C. Extra- and Intracranial Diffuse Large B-Cell Lymphoma (DLBCL) Mimicking Meningioma: A Case Report and Literature Review. Cureus 2023; 15:e42500. [PMID: 37637562 PMCID: PMC10456976 DOI: 10.7759/cureus.42500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Primary central nervous system lymphomas (PCNLSs) are malignant non-Hodgkin lymphomas solely affecting the central nervous system (CNS). Here, we present a rare case of extra- and intracranial manifestation without adjacent calvarial infiltration. We report a 67-year-old woman who presented with right leg paresis and hypoesthesia, facial hypoesthesia, focal epileptic seizures, and an indolent tumor on the left parietal scalp. MRI showed a left paramedian extra- and intracranial contrast-enhancing tumor with infiltration of the superior sagittal sinus, but without osseous infiltration on CT. The tumor was radiologically suspected to be a meningioma and resection was performed. Histological examination, however, revealed a diffuse large B-cell lymphoma (DLBCL). Thus, the patient received adjuvant treatment according to the MATRix protocol. We provide a detailed analysis of this rare case with a focus on preoperative radiological findings and differential diagnoses. To the best of our knowledge, this is one of only four published cases of DLBCL with extra- and intracranial manifestation without bone affection.
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Affiliation(s)
| | | | - Arwin Rezai
- Neurosurgery, University Hospital Salzburg, Salzburg, AUT
| | - Theo F J Kraus
- Pathology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, AUT
| | - Dominik Pizem
- Neuroradiology, University Hospital Salzburg, Salzburg, AUT
| | - Fritz Klausner
- Neuroradiology, University Hospital Salzburg, Salzburg, AUT
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3
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Capasso R, Negro A, Russo C, Zeccolini F, Muto G, Caranci F, Pinto A. Conventional and advanced MRI techniques in the evaluation of primary CNS lymphoma. Semin Ultrasound CT MR 2023; 44:126-135. [DOI: 10.1053/j.sult.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Yokogami K, Azuma M, Takeshima H, Hirai T. Lymphomas of Central Nervous System. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:527-543. [PMID: 37452952 DOI: 10.1007/978-3-031-23705-8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Central nervous system (CNS) lymphoma consists of primary central nervous system lymphoma (PCNSL) and secondary CNS involvement by systemic lymphoma. This chapter focuses on the former. PCNSL is a relative rare disease, accounting for approximately 2.4-4.9% of all primary CNS tumors. It is an extra-nodal variant of non-Hodgkin's lymphoma (NHL), confined to the brain, leptomeninges, spinal cord, and eyes, with no systemic involvement. Recently, elderly patients (≥ 60 years) are increasing. Histologically, B cell blasts, which originate from late germinal center exit B cell, are growing and homing in CNS. Immunohistochemically, these cells are positive for PAX5, CD19, CD20, CD22, and CD79a. PCNSL shows relatively characteristic appearances on CT, MR imaging, and PET. Treatment first line of PCNSL is HD-MTX-based chemotherapy with or without rituximab and irradiation. Severe side-effect of this treatment is delayed onset neurotoxicity, which cause of cognitive impairment. Therefore, combined chemotherapy alone or chemotherapy with reduced-dose irradiation is more recommended for elderly patients. There is no established standard care for relapse of the PCNSLs. Temsirolimus, lenalidomide, temozolomide, and Bruton's tyrosine kinase (BTK) inhibitor ibrutinib are candidates for refractory patients. The prognosis of PCNSL has significantly improved over the last decades (median OS: 26 months, 5-year survival: 31%). Younger than 60 age and WHO performance status less than < or = 1 are associated with a significantly better overall survival.
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Affiliation(s)
- Kiyotaka Yokogami
- Departments of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
| | - Minako Azuma
- Departments of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hideo Takeshima
- Departments of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Toshinori Hirai
- Departments of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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5
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Efficacy of endoscopic management of primary central nervous system lymphoma: a multicentric study and literature review. J Neurooncol 2022; 159:457-468. [PMID: 35829848 DOI: 10.1007/s11060-022-04081-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION To date, confined intra-ventricular localization of primary central nervous system lymphoma (PCNSL) has been usually managed with open surgical resection and/or stereotactic biopsy; nonetheless, the endoscopic approach to such localization can provide many advantages over standard microsurgery and/or stereotactic biopsy. Here we present our experience in managing such a rare pathology through the endoscopic approach. METHOD In order to gather more information about such a rare pathology, a retrospective multicentric study on a prospectively built database has been performed during a 5 year period. Ten different European centers have been involved. RESULTS A total of 60 patients, 25 women and 35 men, have been enrolled in the study. The mean age was 65.3 years. The mean lesion size was 40.3 mm. Among all selected patients, 40 (66.6%) had superficial lesions within the ventricle, whereas the remaining 20 (33.4%) had lesions involving/extending to deeper structures. All surgical procedures were uneventful and ETV was deemed necessary only in 20/60 cases. CONCLUSION In our experience, endoscopic management of intraventricular PCNSL is an effective option. It should be considered after a careful examination of neurological and immunological status, alternative options for diagnostic sampling, location of the lesion, and presence or absence of hydrocephalus. Endoscopic management could be considered as a safe and minimally invasive option to obtain: (a) a biopsy sample of the lesion for further diagnostic workup, (b) CSF diversion through third ventriculostomy or VP shunt for the management of hydrocephalus, and (c) insertion of ventricular access devices for long term medical management and whenever necessary as a rescue option for ventricular tap.
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Scheichel F, Pinggera D, Popadic B, Sherif C, Marhold F, Freyschlag CF. An Update on Neurosurgical Management of Primary CNS Lymphoma in Immunocompetent Patients. Front Oncol 2022; 12:884724. [PMID: 35515113 PMCID: PMC9065338 DOI: 10.3389/fonc.2022.884724] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Primary central nervous system lymphomas (PCNSL) are rare CNS tumors that harbor a conspicuously longer diagnostic delay compared to other malignant brain tumors. The gold standard for diagnosis is stereotactic biopsy to acquire tissue for histopathological analysis and therefore neurosurgery plays a central role when reducing the diagnostic period is mandated. However, histopathological diagnosis could be complicated if the patient was preoperatively exposed to corticosteroids. Besides the histopathological result, diagnosis of a PCNSL also requires full diagnostic workup to exclude cerebral metastatic disease of a systemic lymphoma. Most reviews of PCNSL discuss recent advancements in systemic treatment options from an (neuro-)oncologic viewpoint, whereas our intention was to discuss the optimization of the diagnostic period and therefore describe current standards of imaging, summarizing the diagnostic workup, discussing the surgical workup and future diagnostic prospects as well as the influence of preoperative corticosteroid therapy to reduce the diagnostic delay of PCNSL patients.
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Affiliation(s)
- Florian Scheichel
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Branko Popadic
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Camillo Sherif
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
| | - Franz Marhold
- Karl Landsteiner University of Health Sciences, Krems, Austria.,Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria
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Talybov R, Beylerli O, Mochalov V, Prokopenko A, Ilyasova T, Trofimova T, Sufianov A, Guang Y. Multiparametric MR Imaging Features of Primary CNS Lymphomas. Front Surg 2022; 9:887249. [PMID: 35510125 PMCID: PMC9058099 DOI: 10.3389/fsurg.2022.887249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Primary central nervous system lymphomas (PCNS) are relatively rare tumors, accounting for about 4% of all brain tumors. On neuroimaging, they are characterized by a low MR signal in T1, isointense in T2, bright uniform contrast enhancement, and diffusion restriction. The aim of this study is to note the lack of effectiveness of the MR/CT perfusion technique in complex multiparametric imaging in the differential diagnosis of primary lymphomas of the central nervous system in comparison with highly malignant gliomas and brain metastases. Materials and Methods This prospective study included 80 patients with CNS tumors examined/operated at the Federal Center for Neurosurgery (Tyumen, Russia) from 2018 to 2021. The patients were divided into 4 groups: group 1 consisted of 33 cases with primary CNS lymphomas (10 cases with atypical manifestations according to perfusion parameters and 23 cases of classic CNS lymphomas), group 2 with anaplastic astrocytomas—14 cases, group 3—23 cases with glioblastomas and group 4—10 cases with solitary metastatic lesions. The study was carried out on a General Electric Discovery W750 3T magnetic resonance tomograph, a Canon Aquilion One multispiral X-ray computed tomograph (Gadovist 7.5 ml, Yomeron 400 mg−50 ml). Additionally, immunohistochemical analysis was carried out with the following markers: CD3, CD20, CD34, Ki-67, VEGF. Results It has been established that MR/CT perfusion is not a highly sensitive method for visualizing primary CNS lymphomas, as previously thought, but at the same time, the method has a number of undeniable advantages that make it indispensable in the algorithm of a complex multiparametric diagnostic approach for this type of tumor. Nevertheless, PLCNS is characterized by an atypical manifestation, which is an exception to the rule. Conclusions The possibilities of neuroimaging of primary lymphomas, even with the use of improved techniques for collecting MR/CT data, are limited and do not always allow reliable differentiation from other neoplasms.
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Affiliation(s)
| | | | | | | | | | - Tatiana Trofimova
- V.M. Bekhterev Psychoneurological Research Institute, St. Petersburg, Russia
| | - Albert Sufianov
- Federal Center of Neurosurgery, Tyumen, Russia
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Albert Sufianov
| | - Yang Guang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Institute of Brain Science, Harbin Medical University, Harbin, China
- *Correspondence: Yang Guang
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8
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Salem AE, Zaki YH, El-Hussieny G, ElNoueam KI, Shaaban AM, Koppula BR, Bustoros M, Salama M, Elsayes KM, Morton K, Covington MF. An Overview of Selected Rare B-Cell Lymphoproliferative Disorders: Imaging, Histopathologic, and Clinical Features. Cancers (Basel) 2021; 13:cancers13225853. [PMID: 34831006 PMCID: PMC8616256 DOI: 10.3390/cancers13225853] [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: 10/28/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Lymphoproliferative disorders (LPD) are conditions characterized by the uncontrolled proliferation of B or T-cell lines. They encompass a wide spectrum of abnormalities, which may be broadly classified as reactive processes or malignant diseases, such as lymphoma, based on their cellular clonality and clinical behavior. While some of these disorders are rare, they may be encountered sporadically in clinical practice, causing diagnostic dilemmas owing to overlap in their clinical and imaging features with more common disorders. The updated 4th edition WHO classification of lymphoid neoplasms was released in 2016 to incorporate the rapid clinical, pathological, molecular biology and cytogenetic advances of some of these disorders. Despite these updates, very little information is presented in the literature from the radiology perspective. The aim of this article is to familiarize radiologists and other physicians with certain rare variants of B-cell lymphoproliferative disorders with a focus on imaging features of these disorders, as well as to provide an overview of some important updates contained within the new WHO classification of lymphoid neoplasms.
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Affiliation(s)
- Ahmed Ebada Salem
- Department of Radiology and Imaging Sciences, Utah University School of Medicine, Salt Lake City, UT 84123, USA; (A.E.S.); (A.M.S.); (B.R.K.); (K.M.); (M.F.C.)
- Department of Radiodiagnosis and Intervention, Faculty of Medicine, Alexandria University, Alexandria 21566, Egypt; (Y.H.Z.); (K.I.E.)
| | - Yehia H. Zaki
- Department of Radiodiagnosis and Intervention, Faculty of Medicine, Alexandria University, Alexandria 21566, Egypt; (Y.H.Z.); (K.I.E.)
| | - Gamal El-Hussieny
- Department of Medical Oncology and Nuclear Medicine, Faculty of Medicine, Alexandria University, Alexandria 21566, Egypt;
| | - Khaled I. ElNoueam
- Department of Radiodiagnosis and Intervention, Faculty of Medicine, Alexandria University, Alexandria 21566, Egypt; (Y.H.Z.); (K.I.E.)
| | - Akram M. Shaaban
- Department of Radiology and Imaging Sciences, Utah University School of Medicine, Salt Lake City, UT 84123, USA; (A.E.S.); (A.M.S.); (B.R.K.); (K.M.); (M.F.C.)
| | - Bhasker Rao Koppula
- Department of Radiology and Imaging Sciences, Utah University School of Medicine, Salt Lake City, UT 84123, USA; (A.E.S.); (A.M.S.); (B.R.K.); (K.M.); (M.F.C.)
| | - Mark Bustoros
- Division of Hematology and Medical Oncology, Weil Cornell Medicine, Cornell University, New York, NY 10021, USA;
| | - Mohamed Salama
- Department of Pathology, Mayo Clinic, Rochester, MN 55901, USA;
| | - Khaled M. Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-713-745-3025
| | - Kathryn Morton
- Department of Radiology and Imaging Sciences, Utah University School of Medicine, Salt Lake City, UT 84123, USA; (A.E.S.); (A.M.S.); (B.R.K.); (K.M.); (M.F.C.)
| | - Matthew F. Covington
- Department of Radiology and Imaging Sciences, Utah University School of Medicine, Salt Lake City, UT 84123, USA; (A.E.S.); (A.M.S.); (B.R.K.); (K.M.); (M.F.C.)
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9
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Kumaria A. Insights in primary central nervous system lymphoma: a role for glymphatics? Brain Tumor Pathol 2021; 38:290-291. [PMID: 34532755 DOI: 10.1007/s10014-021-00414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Ashwin Kumaria
- Department of Neurosurgery, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
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10
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Khan B, Chong I, Ostrom Q, Ahmed S, Dandachi D, Kotrotsou A, Colen R, Morón F. Diffusion-weighted MR imaging histogram analysis in HIV positive and negative patients with primary central nervous system lymphoma as a predictor of outcome and tumor proliferation. Oncotarget 2020; 11:4093-4103. [PMID: 33227089 PMCID: PMC7665236 DOI: 10.18632/oncotarget.27800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ki-67 expression, a marker of tumor proliferation, is considered a prognostic factor in primary CNS lymphoma (PCNSL). Apparent diffusion coefficient (ADC) parameters have also been proposed as imaging biomarkers for tumor progression and proliferative activity in various malignancies. The aim of this study is to investigate the correlation between ADC parameters, Ki-67 expression, overall survival (OS) and progression free survival (PFS) in PCNSL. MATERIALS AND METHODS Patients diagnosed with PCNSL at MD Anderson Cancer Center between Mar 2000 and Jul 2016 and at Ben Taub Hospital between Jan 2012 and Dec 2016 were retrospectively studied. Co-registered ADC maps and post-contrast images underwent whole tumor segmentation. Normalized ADC parameters (nADC) were calculated as the ratio to normal white matter. Percentiles of nADC were calculated and were correlated with Ki-67 using Pearson's correlation coefficient and clinical outcomes (OS and PFS) using Cox proportional hazards models. RESULTS Selection criteria yielded 90 patients, 23 patients living with HIV (PLWH) and 67 immunocompetent patients. Above median values for nADCmean, nADC15, nADC75 and nADC95 were associated with improved OS in all patients (p < 0.05). Above median values for nADCmin, nADCmean, nADC1, nADC5 and kurtosis were associated with improved PFS in all patients (p < 0.05). In patients with available Ki-67 expression data (n = 22), nADCmean, nADC15 and nADC75 inversely correlated with Ki-67 expression (p < 0.05). For PLWH, there was no correlation between ADC parameters and Ki-67 expression or clinical outcomes. CONCLUSIONS ADC histogram analysis can predict tumor proliferation and survival in immunocompetent patients with PCNSL, but with limited utility in PLWH.
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Affiliation(s)
- Bilal Khan
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Insun Chong
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Quinn Ostrom
- Department of Medicine, Section of Epidemiology and Population Sciences, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Sara Ahmed
- Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Dima Dandachi
- Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, MO, USA
| | - Aikaterini Kotrotsou
- Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA.,Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Rivka Colen
- Department of Radiology, Neuroradiology Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Fanny Morón
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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Tateishi K, Miyake Y, Kawazu M, Sasaki N, Nakamura T, Sasame J, Yoshii Y, Ueno T, Miyake A, Watanabe J, Matsushita Y, Shiba N, Udaka N, Ohki K, Fink AL, Tummala SS, Natsumeda M, Ikegaya N, Nishi M, Ohtake M, Miyazaki R, Suenaga J, Murata H, Aoki I, Miller JJ, Fujii Y, Ryo A, Yamanaka S, Mano H, Cahill DP, Wakimoto H, Chi AS, Batchelor TT, Nagane M, Ichimura K, Yamamoto T. A Hyperactive RelA/p65-Hexokinase 2 Signaling Axis Drives Primary Central Nervous System Lymphoma. Cancer Res 2020; 80:5330-5343. [PMID: 33067267 DOI: 10.1158/0008-5472.can-20-2425] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/08/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is an isolated type of lymphoma of the central nervous system and has a dismal prognosis despite intensive chemotherapy. Recent genomic analyses have identified highly recurrent mutations of MYD88 and CD79B in immunocompetent PCNSL, whereas LMP1 activation is commonly observed in Epstein-Barr virus (EBV)-positive PCNSL. However, a lack of clinically representative preclinical models has hampered our understanding of the pathogenic mechanisms by which genetic aberrations drive PCNSL disease phenotypes. Here, we establish a panel of 12 orthotopic, patient-derived xenograft (PDX) models from both immunocompetent and EBV-positive PCNSL and secondary CNSL biopsy specimens. PDXs faithfully retained their phenotypic, metabolic, and genetic features, with 100% concordance of MYD88 and CD79B mutations present in PCNSL in immunocompetent patients. These models revealed a convergent functional dependency upon a deregulated RelA/p65-hexokinase 2 signaling axis, codriven by either mutated MYD88/CD79B or LMP1 with Pin1 overactivation in immunocompetent PCNSL and EBV-positive PCNSL, respectively. Notably, distinct molecular alterations used by immunocompetent and EBV-positive PCNSL converged to deregulate RelA/p65 expression and to drive glycolysis, which is critical for intracerebral tumor progression and FDG-PET imaging characteristics. Genetic and pharmacologic inhibition of this key signaling axis potently suppressed PCNSL growth in vitro and in vivo. These patient-derived models offer a platform for predicting clinical chemotherapeutics efficacy and provide critical insights into PCNSL pathogenic mechanisms, accelerating therapeutic discovery for this aggressive disease. SIGNIFICANCE: A set of clinically relevant CNSL xenografts identifies a hyperactive RelA/p65-hexokinase 2 signaling axis as a driver of progression and potential therapeutic target for treatment and provides a foundational preclinical platform. GRAPHICAL ABSTRACT: http://cancerres.aacrjournals.org/content/canres/80/23/5330/F1.large.jpg.
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Affiliation(s)
- Kensuke Tateishi
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan. .,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Yohei Miyake
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Masahito Kawazu
- Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan
| | - Nobuyoshi Sasaki
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan.,Department of Neurosurgery, Kyorin University Graduate School of Medicine, Mitaka, Tokyo, Japan
| | - Taishi Nakamura
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Jo Sasame
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.,Neurosurgical-Oncology Laboratory, Yokohama City University, Yokohama, Japan
| | - Yukie Yoshii
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Toshihide Ueno
- Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan
| | - Akio Miyake
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Jun Watanabe
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yuko Matsushita
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Norio Shiba
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Naoko Udaka
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Kentaro Ohki
- Department of Pediatric Hematology and Oncology Research, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Alexandria L Fink
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Translational-Neurooncology Laboratory, Brain Tumor Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Shilpa S Tummala
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Translational-Neurooncology Laboratory, Brain Tumor Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Naoki Ikegaya
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Mayuko Nishi
- Department of Microbiology, Graduate School of Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Makoto Ohtake
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Ryohei Miyazaki
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Jun Suenaga
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hidetoshi Murata
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Ichio Aoki
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - Julie J Miller
- Translational-Neurooncology Laboratory, Brain Tumor Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.,Stephen E. and Catherine Papas Center for Neuro-Oncology, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akihide Ryo
- Department of Microbiology, Graduate School of Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Shoji Yamanaka
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan
| | - Hiroyuki Mano
- Division of Cellular Signaling, National Cancer Center Research Institute, Tokyo, Japan
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Translational-Neurooncology Laboratory, Brain Tumor Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.,Translational-Neurooncology Laboratory, Brain Tumor Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | | | - Tracy T Batchelor
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Mitaka, Tokyo, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Tokyo, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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12
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Miyakita Y, Ohno M, Takahashi M, Kurihara H, Katai H, Narita Y. Usefulness of carbon-11-labeled methionine positron-emission tomography for assessing the treatment response of primary central nervous system lymphoma. Jpn J Clin Oncol 2020; 50:512-518. [PMID: 32129443 DOI: 10.1093/jjco/hyaa010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/16/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) responds relatively quickly to chemotherapy or radiotherapy. However, determination of a complete response after treatment is often difficult because of extremely light residual contrast enhancement on magnetic resonance images due to the effects of microhemorrhages and scar tissue formation. These small enhancing lesions define an unconfirmed complete response. The aim of this study was to investigate the usefulness of carbon-11-labeled methionine (11C-Met) positron-emission tomography (PET) for determining the treatment response of PCNSL. METHODS Data for 36 patients who were treated for PCNSL between 2011 and 2015 and underwent magnetic resonance imaging and 11C-Met PET were reviewed. Magnetic resonance imaging findings were classified as complete response, unconfirmed complete response, and tumor mass (a composite of partial response, stable disease and progressive disease). PET images were evaluated, standardized uptake values were quantified, and the tumor-to-normal tissue count ratio (TNR) was calculated. Receiver operating characteristic curves were generated to determine the optimal cutoff TNRs. RESULTS The optimal TNRs for differentiating complete response and unconfirmed complete response from tumor mass were 1.83 (area under the curve, 0.951) and 1.80 (area under the curve, 0.932), respectively. The corresponding sensitivity and specificity values for the diagnosis of tumor mass were 82.4 and 100%, respectively, in the complete response group and 85.3 and 85%, respectively, in the unconfirmed complete response group. CONCLUSIONS A TNR of ≥1.80 can aid in the detection of active PCNSL using 11C-Met PET. Thus, 11C-Met-PET may be a useful tool for accurate evaluation of the treatment efficacy in PCNSL.
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Affiliation(s)
- Yasuji Miyakita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Chuo-ku, Japan.,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Makoto Ohno
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Chuo-ku, Japan
| | - Masamichi Takahashi
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Chuo-ku, Japan
| | - Hiroaki Kurihara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo-ku, Japan
| | - Hitoshi Katai
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Bunkyo-ku, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Chuo-ku, Japan
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13
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Whole Tumor Histogram Analysis Using DW MRI in Primary Central Nervous System Lymphoma Correlates with Tumor Biomarkers and Outcome. Cancers (Basel) 2019; 11:cancers11101506. [PMID: 31597366 PMCID: PMC6827036 DOI: 10.3390/cancers11101506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 11/16/2022] Open
Abstract
The ability to non-invasively predict outcomes and monitor treatment response in primary central nervous system lymphoma (PCNSL) is important as treatment regimens are constantly being trialed. The aim of this study was to assess the validity of using apparent diffusion coefficient (ADC) histogram values to predict Ki-67 expression, a tumor proliferation marker, and patient outcomes in PCNSL in both immunocompetent patients and patients living with HIV (PLWH). Qualitative PCNSL magnetic resonance imaging (MRI) characteristics from 93 patients (23 PLWH and 70 immunocompetent) were analyzed, and whole tumor segmentation was performed on the ADC maps. Quantitative histogram analyses of the segmentations were calculated. These measures were compared to PCNSL Ki-67 expression. Progression-free survival (PFS) and overall survival (OS) were analyzed via comparison to the International Primary Central Nervous System Lymphoma Collaboration Group Response Criteria. Associations between ADC measures and clinical outcomes were assessed using univariate and multivariate Cox proportional hazards models. Normalized ADC (nADC)Min, nADCMean, nADC1, nADC5, and nADC15 values were significantly associated with a poorer OS. nADCMax, nADCMean, nADC5, nADC15, nADC75, nADC95, nADC99 inversely correlated with Ki-67 expression. OS was also significantly associated with lesion hemorrhage. PFS was not significantly associated with ADC values but with lesion hemorrhage. ADC histogram values and related parameters can predict the degree of tumor proliferation and patient outcomes for primary central nervous system lymphoma patients and in both immunocompetent patients and patients living with HIV.
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14
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Kayed MH, Saleh TR, Reda IS, Elsirafy MN, Farhoud AH, Abdelzaher E. The added value of advanced neuro-imaging (MR diffusion, perfusion and proton spectroscopy) in diagnosis of primary CNS lymphoma. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2013.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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15
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Yun J, Park JE, Lee H, Ham S, Kim N, Kim HS. Radiomic features and multilayer perceptron network classifier: a robust MRI classification strategy for distinguishing glioblastoma from primary central nervous system lymphoma. Sci Rep 2019; 9:5746. [PMID: 30952930 PMCID: PMC6451024 DOI: 10.1038/s41598-019-42276-w] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 03/25/2019] [Indexed: 12/14/2022] Open
Abstract
We aimed to establish a high-performing and robust classification strategy, using magnetic resonance imaging (MRI), along with combinations of feature extraction and selection in human and machine learning using radiomics or deep features by employing a small dataset. Using diffusion and contrast-enhanced T1-weighted MR images obtained from patients with glioblastomas and primary central nervous system lymphomas, classification task was assigned to a combination of radiomic features and (1) supervised machine learning after feature selection or (2) multilayer perceptron (MLP) network; or MR image input without radiomic feature extraction to (3) two neuro-radiologists or (4) an end-to-end convolutional neural network (CNN). The results showed similar high performance in generalized linear model (GLM) classifier and MLP using radiomics features in the internal validation set, but MLP network remained robust in the external validation set obtained using different MRI protocols. CNN showed the lowest performance in both validation sets. Our results reveal that a combination of radiomic features and MLP network classifier serves a high-performing and generalizable model for classification task for a small dataset with heterogeneous MRI protocols.
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Affiliation(s)
- Jihye Yun
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, Korea.
| | - Hyunna Lee
- Health Innovation Big Data Center, Asan Institute for Life Science, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, Korea
| | - Sungwon Ham
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, Korea
| | - Namkug Kim
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, Korea
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul, 05505, Korea
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16
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Primary central nervous system lymphoma in patients with and without HIV infection: a multicenter study and comparison with U.S national data. Cancer Causes Control 2019; 30:477-488. [PMID: 30888569 DOI: 10.1007/s10552-019-01144-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/11/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) in patients living with HIV (PLWH) is a distinct entity; however, the management is adopted from patients without HIV. The study aims to examine the differences in presentation, treatment, and outcomes of PCNSL patients with or without HIV. METHODS We retrospectively compared the characteristics of 144 patients with PCNSL with and without HIV, and analyzed factors associated with overall and progression-free survival. Results were compared to the Central Brain Tumor Registry of the United States (CBTRUS) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) system. RESULTS Among all patients with PCNSL, 19% had HIV. PLWH were younger (38 vs. 63 years; p < 0.01) and more likely to be African American (59% vs. 7%; p < 0.01) and male (74% vs. 49%; p = 0.02) than patients without HIV. PLWH were more likely to have multiple lesions (67% vs. 43%; p = 0.02), hemorrhage (59 vs. 37%; p = 0.03), and peripheral rim enhancement (57% vs. 7%; p < 0.01) on imaging; to receive palliative care (15% vs. 2%) or whole brain radiation (63% vs. 3%); and less likely to receive chemotherapy (22% vs. 95%) (p < 0.01). Twenty-four patients, none PLWH, underwent stem cell transplant. Not receiving transplant was an independent factor in mortality and disease progression. Our cohort of patients, compared to the national database, were younger (60 vs. 65 years), 58% were white vs. 75%, and had longer median overall survival 43 vs. 25 months. CONCLUSION Epidemiology, imaging, and treatment options for patients with PCNSL with and without HIV differ, but HIV was not an independent factor of mortality or disease progression. More efforts are needed to improve access to research and treatment options for PLWH with PCNSL.
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Gómez Roselló E, Quiles Granado A, Laguillo Sala G, Pedraza Gutiérrez S. Primary central nervous system lymphoma in immunocompetent patients: Spectrum of findings and differential characteristics. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Goldwirt L, Beccaria K, Ple A, Sauvageon H, Mourah S. Ibrutinib brain distribution: a preclinical study. Cancer Chemother Pharmacol 2018; 81:783-789. [DOI: 10.1007/s00280-018-3546-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/17/2018] [Indexed: 10/18/2022]
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19
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Gómez Roselló E, Quiles Granado AM, Laguillo Sala G, Pedraza Gutiérrez S. Primary central nervous system lymphoma in immunocompetent patients: spectrum of findings and differential characteristics. RADIOLOGIA 2018; 60:280-289. [PMID: 29482953 DOI: 10.1016/j.rx.2017.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
Primary central nervous system (CNS) lymphomas are uncommon and their management differs significantly from that of other malignant tumors involving the CNS. This article explains how the imaging findings often suggest the diagnosis early. The typical findings in immunocompetent patients consist of a supratentorial intraaxial mass that enhances homogeneously. Other findings to evaluate include multifocality and incomplete ring enhancement. The differential diagnosis of primary CNS lymphomas should consider mainly other malignant tumors of the CNS such as glioblastomas or metastases. Primary CNS lymphomas tend to have less edema and less mass effect; they also tend to spare the adjacent cortex. Necrosis, hemorrhage, and calcification are uncommon in primary CNS lymphomas. Although the findings in morphologic sequences are characteristic, they are not completely specific and atypical types are sometimes encountered. Advanced imaging techniques such as diffusion or especially perfusion provide qualitative and quantitative data that play an important role in differentiating primary CNS lymphomas from other brain tumors.
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Affiliation(s)
- E Gómez Roselló
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España.
| | - A M Quiles Granado
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España
| | - G Laguillo Sala
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España
| | - S Pedraza Gutiérrez
- Sección de Neurorradiología, Servicio de Radiología (IDI), Hospital Universitario Dr. Josep Trueta, Girona, España
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20
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Suzuki Y, Tanaka H, Suyama K, Mochida H, Suzuki Y. Secondary Central Nerve System Lymphoma With Intratumoral Hemorrhage Suggested as Intravascular Lymphoma by Autopsy: A Case Report. J Clin Med Res 2017; 9:953-957. [PMID: 29038675 PMCID: PMC5633098 DOI: 10.14740/jocmr3177w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 09/14/2017] [Indexed: 11/22/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVL) is a rare type of extranodal diffuse large B-cell lymphoma (DLBCL), which often infiltrates the central nervous system (CNS) during the clinical course. Cerebral hemorrhage in patients with CNS lymphoma at presentation is rare. Herein, we describe a case of secondary CNS lymphoma with intratumoral hemorrhage, which was suggested as IVL from autopsy findings. A 76-year-old Japanese man with a history of treatment for B-cell non-Hodgkin’s lymphoma was transferred to our hospital in an ambulance for generalized convulsions. Brain CT scan revealed a high-density tumor with edema and intratumoral hemorrhage in the left temporal lobes. He died in a rapid course, and autopsy revealed a focal hemorrhage with diffuse infiltration of lymphoma cells in the left temporal lobe and findings suggestive of IVL. Furthermore, the autopsy revealed a discrepancy in the CD20 immunostaining of lymphoma cells between the brain and other organs. Clinicians should not eliminate CNS lymphoma from the differential diagnosis of intracranial tumor with hemorrhage. Although many patients with IVL have rapidly progressive courses, it is very important to diagnose IVL at the initial onset, even in serious situations, to consider CNS prophylaxis.
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Affiliation(s)
- Yutaro Suzuki
- Department of Internal Medicine, Asahi General Hospital, Chiba, Japan
| | - Hiroaki Tanaka
- Department of Hematology, Asahi General Hospital, Chiba, Japan
| | | | | | - Yoshio Suzuki
- Department of Diagnostic Pathology, Asahi General Hospital, Chiba, Japan
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21
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Ambady P, Fu R, Netto JP, Kersch C, Firkins J, Doolittle ND, Neuwelt EA. Patterns of relapse in primary central nervous system lymphoma: inferences regarding the role of the neuro-vascular unit and monoclonal antibodies in treating occult CNS disease. Fluids Barriers CNS 2017; 14:16. [PMID: 28577579 PMCID: PMC5457655 DOI: 10.1186/s12987-017-0064-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/22/2017] [Indexed: 12/22/2022] Open
Abstract
Background and purpose The radiologic features and patterns of primary central nervous system lymphoma (PCNSL) at initial presentation are well described. High response rates can be achieved with first-line high-dose methotrexate (HD-MTX) based regimens, yet many relapse within 2 years of diagnosis. We describe the pattern of relapse and review the potential mechanisms involved in relapse. Methods We identified 78 consecutive patients who attained complete radiographic response (CR) during or after first-line treatment for newly diagnosed PCNSL (CD20+, diffuse large B cell type). Patients were treated with HD-MTX based regimen in conjunction with blood–brain barrier disruption (HD-MTX/BBBD); 44 subsequently relapsed. Images and medical records of these 44 consecutive patients were retrospectively reviewed. The anatomical location of enhancing lesions at initial diagnosis and at the time of relapse were identified and compared. Results 37/44 patients fulfilled inclusion criteria and had new measureable enhancing lesions at relapse; the pattern and location of relapse of these 37 patients were identified. At relapse, the new enhancement was at a spatially distinct site in 30 of 37 patients. Local relapse was found only in seven patients. Discussion Unlike gliomas, the majority of PCNSL had radiographic relapse at spatially distinct anatomical locations within the brain behind a previously intact neurovascular unit (NVU), and in few cases outside, the central nervous system (CNS). This may suggest either (1) reactivation of occult reservoirs behind an intact NVU in the CNS (or ocular) or (2) seeding from bone marrow or other extra CNS sites. Conclusion Recognizing patterns of relapse is key for early detection and may provide insight into potential mechanisms of relapse as well as help develop strategies to extend duration of complete response.
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Affiliation(s)
- Prakash Ambady
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA.,Portland Veterans Affairs Medical Center, Portland, OR, USA
| | - Rongwei Fu
- School of Public Health, Oregon Health & Science University, Portland, OR, USA.,Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Joao Prola Netto
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA.,Department of Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Cymon Kersch
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA
| | - Jenny Firkins
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA
| | - Nancy D Doolittle
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L603, Portland, OR, 97239, USA. .,Portland Veterans Affairs Medical Center, Portland, OR, USA. .,Department of Neurosurgery, Oregon Health & Science University, Portland, OR, USA.
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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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Kim J, Kim YZ. A Case of Primary Central Nervous System Lymphoma Located at Brain Stem in a Child. Brain Tumor Res Treat 2016; 4:155-159. [PMID: 27867930 PMCID: PMC5114190 DOI: 10.14791/btrt.2016.4.2.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 11/20/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is an extranodal Non-Hodgkin's lymphoma that is confined to the brain, eyes, and/or leptomeninges without evidence of a systemic primary tumor. Although the tumor can affect all age groups, it is rare in childhood; thus, its incidence and prognosis in children have not been well defined and the best treatment strategy remains unclear. A nine-year old presented at our department with complaints of diplopia, dizziness, dysarthria, and right side hemiparesis. Magnetic resonance image suggested a diffuse brain stem glioma with infiltration into the right cerebellar peduncle. The patient was surgically treated by craniotomy and frameless stereotactic-guided biopsy, and unexpectedly, the histopathology of the mass was consistent with diffuse large B cell lymphoma, and immunohistochemical staining revealed positivity for CD20 and CD79a. Accordingly, we performed a staging work-up for systemic lymphoma, but no evidence of lymphoma elsewhere in the body was obtained. In addition, she had a negative serologic finding for human immunodeficient virus, which confirmed the histopathological diagnosis of PCNSL. She was treated by radiosurgery at 12 Gy and subsequent adjuvant combination chemotherapy based on high dose methotrexate. Unfortunately, 10 months after the tissue-based diagnosis, she succumbed due to an acute hydrocephalic crisis.
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Affiliation(s)
- Jinho Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Zoon Kim
- Division of Neurooncology and Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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25
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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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Molecular MRI differentiation between primary central nervous system lymphomas and high-grade gliomas using endogenous protein-based amide proton transfer MR imaging at 3 Tesla. Eur Radiol 2015; 26:64-71. [PMID: 25925361 DOI: 10.1007/s00330-015-3805-1] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/18/2015] [Accepted: 04/14/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To show the ability of using the amide proton transfer-weighted (APTW) MRI signals as imaging biomarkers to differentiate primary central nervous system lymphomas (PCNSLs) from high-grade gliomas (HGGs). METHODS Eleven patients with lymphomas and 21 patients with HGGs were examined. Magnetization-transfer (MT) spectra over an offset range of ± 6 ppm and the conventional MT ratio (MTR) at 15.6 ppm were acquired. The APTW signals, total chemical-exchange-saturation-transfer signal (integral between 0 and 5 ppm, CEST total), and MTR signal were obtained and compared between PCNSLs and HGGs. The diagnostic performance was assessed with the receiver operating characteristic (ROC) curve analysis. RESULTS The PCNSLs usually showed more homogeneous APTW hyperintensity (spatially compared to normal brain tissue) than the HGGs. The APTW max, APTW max-min and CEST total signal intensities were significantly lower (P < 0.05, 0.001 and 0.05, respectively), while the APTW min and MTR were significantly higher (both P < 0.01) in PCNSL lesions than in HGG lesions. The APTW values in peritumoral oedema were significantly lower for PCNSLs than for HGGs (P < 0.01). APTW max-min had the highest area under the ROC curve (0.963) and accuracy (94.1 %) in differentiating PCNSLs from HGGs. CONCLUSIONS The protein-based APTW signal would be a valuable MRI biomarker by which to identify PCNSLs and HGGs presurgically. KEY POINTS PCNSLs overall showed more homogeneous APTW hyperintensity than HGGs. Maximum APTW signals were lower in PCNSL lesions than in HGG lesions. MTR signals were higher in PCNSLs than in HGGs. APTW heterogeneity had the highest accuracy in differentiating PCNSLs from HGGs.
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Abstract
This article provides an overview of the intra-axial tumors that affect the cerebellum, which can be categorized by location and age. For each tumor, we review conventional neuroimaging findings and discuss the value of more advanced neuroimaging techniques. Current management strategies are also briefly discussed. Finally, cerebellar paraneoplastic disorders and medication-induced cerebellar disorders are discussed.
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Affiliation(s)
- Thomas J Pfiffner
- DENT Neurologic Institute, 3980 Sheridan Drive, Amherst, NY 14226, USA
| | - Ronak Jani
- DENT Neurologic Institute, 3980 Sheridan Drive, Amherst, NY 14226, USA
| | - Laszlo Mechtler
- DENT Neurologic Institute, Roswell Park Cancer Institute, 3980 Sheridan Drive, Buffalo, NY 14226, USA.
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28
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"Brain on fire": a new imaging sign. J Clin Neurosci 2014; 21:2015-7. [PMID: 25043167 DOI: 10.1016/j.jocn.2014.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 03/16/2014] [Accepted: 04/06/2014] [Indexed: 11/21/2022]
Abstract
Primary central nervous system (CNS) marginal zone B cell lymphoma is a rare condition. It has an indolent disease course and usually presents as a dural-based lesion. We present a patient with non-dural-based, primary CNS marginal zone B cell lymphoma with an unusual imaging appearance, not previously described to our knowledge.
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DeRosa P, Cappuzzo JM, Sherman JH. Isolated recurrence of secondary CNS lymphoma: case report and literature review. J Neurol Surg Rep 2014; 75:e154-9. [PMID: 25083377 PMCID: PMC4110153 DOI: 10.1055/s-0034-1378152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 04/04/2014] [Indexed: 01/20/2023] Open
Abstract
Isolated secondary central nervous system lymphoma (SCNSL) relapse is a rare disease. Consequently, standardized treatment regimens have yet to be developed. We present an interesting case of isolated SCNSL presenting with altered mental status and panhypopituitarism in a patient at low risk of developing the disease. We also review the related literature and discuss newer, more aggressive treatments for primary CNS lymphoma and SCNSL.
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Affiliation(s)
- Peter DeRosa
- Department of Neurological Surgery, The George Washington University, Washington, District of Columbia, United States
| | - Justin M Cappuzzo
- School of Medical and Health Sciences, The George Washington University, Washington, District of Columbia, United States
| | - Jonathan H Sherman
- Department of Neurological Surgery, The George Washington University, Washington, District of Columbia, United States
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30
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Mansour A, Qandeel M, Abdel-Razeq H, Abu Ali HA. MR imaging features of intracranial primary CNS lymphoma in immune competent patients. Cancer Imaging 2014; 14:22. [PMID: 25608570 PMCID: PMC4331827 DOI: 10.1186/1470-7330-14-22] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 11/18/2022] Open
Abstract
We aimed to characterize specific MRI findings seen in immune competent patients with intracranial primary CNS lymphoma (PCNSL) and to determine their value in the management of such patients. Pre-treatment MRI examinations of 21 immunocompetent patients with biopsy-proven PCNSL were retrospectively evaluated. T1 and T2 signal characteristics as well as contrast enhancement features are described in all patients. Diffusion, perfusion and proton-MR-spectroscopy features are described in a subset of these patients. In the proper clinical and radiologic setting, suggesting the diagnosis of PCNSL can help institute proper treatment in a timely fashion and avoid unnecessary attempts at surgical resection and the associated morbidity.
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31
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Svolos P, Kousi E, Kapsalaki E, Theodorou K, Fezoulidis I, Kappas C, Tsougos I. The role of diffusion and perfusion weighted imaging in the differential diagnosis of cerebral tumors: a review and future perspectives. Cancer Imaging 2014; 14:20. [PMID: 25609475 PMCID: PMC4331825 DOI: 10.1186/1470-7330-14-20] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 12/31/2022] Open
Abstract
The role of conventional Magnetic Resonance Imaging (MRI) in the detection of cerebral tumors has been well established. However its excellent soft tissue visualization and variety of imaging sequences are in many cases non-specific for the assessment of brain tumor grading. Hence, advanced MRI techniques, like Diffusion-Weighted Imaging (DWI), Diffusion Tensor Imaging (DTI) and Dynamic-Susceptibility Contrast Imaging (DSCI), which are based on different contrast principles, have been used in the clinical routine to improve diagnostic accuracy. The variety of quantitative information derived from these techniques provides significant structural and functional information in a cellular level, highlighting aspects of the underlying brain pathophysiology. The present work, reviews physical principles and recent results obtained using DWI/DTI and DSCI, in tumor characterization and grading of the most common cerebral neoplasms, and discusses how the available MR quantitative data can be utilized through advanced methods of analysis, in order to optimize clinical decision making.
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Adachi K, Yamaguchi F, Node Y, Kobayashi S, Takagi R, Teramoto A. Neuroimaging of primary central nervous system lymphoma in immunocompetent patients: comparison of recent and previous findings. J NIPPON MED SCH 2013; 80:174-83. [PMID: 23832401 DOI: 10.1272/jnms.80.174] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The typical neuroimaging features of primary central nervous system lymphoma (PCNSL) have been described as single or multiple intra-axial, homogenous, contrast-enhancing lesions with marked perilesional edema and restricted diffusion, usually contacting the cerebrospinal fluid surface. Necrosis, peripheral enhancement, hemorrhages, and calcifications are unusual. Recently, some of our patients with PCNSL have had atypical neuroimaging features even before treatment. In this article, we review the neuroimaging characteristics of PCNSL in immunocompetent patients and analyzed how imaging findings over the last 10 years differ from those from more than 10 years ago. Neuroimaging findings suggest that PCNSL is a disease that affects the entire brain. Although some imaging findings are characteristic of PCNSL, the frequency of atypical findings on conventional neuroimaging is increasing. Atypical neuroimaging findings do not rule out PCNSL, even in immunocompetent patients.
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Affiliation(s)
- Koji Adachi
- Department of Neurosurgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan.
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Westwood TD, Hogan C, Julyan PJ, Coutts G, Bonington S, Carrington B, Taylor B, Khoo S, Bonington A. Utility of FDG-PETCT and magnetic resonance spectroscopy in differentiating between cerebral lymphoma and non-malignant CNS lesions in HIV-infected patients. Eur J Radiol 2013; 82:e374-9. [PMID: 23578921 DOI: 10.1016/j.ejrad.2013.03.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/12/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE In HIV infected patients, MRI cannot reliably differentiate between central nervous system (CNS) lymphoma and non-malignant CNS lesions, particularly cerebral toxoplasmosis (CTOX). This study prospectively investigates the utility of FDG PET-CT and magnetic resonance spectroscopy (MRS) in discriminating CNS lymphoma from non-malignant CNS lesions in HIV infected patients, and assesses the ability of FDG PET-CT to guide the use of early brain biopsy. METHODS 10 HIV patients with neurological symptoms and contrast enhancing lesions on MRI were commenced on anti-toxoplasmosis therapy before undergoing FDG PET-CT and MRS. Brain biopsies were sought in those with FDG PET-CT suggestive of CNS lymphoma, and in those with a negative FDG PET-CT scan who failed to respond to therapy. Final diagnosis was based on histology or treatment response. RESULTS Two patients were confirmed to have CNS lymphoma and FDG PET-CT was consistent with this diagnosis in both. Six patients had cerebral toxoplasmosis in all of whom FDG PET-CT was consistent with non-malignant disease. One patient had progressive multifocal leukoencephalopathy (PML), FDG PET-CT was equivocal. One patient had a haemorrhagic brain metastasis and FDG PET-CT wrongly suggested non-malignant disease. MRS was performed successfully in eight subjects: three results were suggestive of CNS lymphoma (one true positive, two false positive), four suggested CTOX (two false negative, two true negative), one scan was equivocal. CONCLUSION FDG PET-CT correctly identified all cases of CNS lymphoma and CTOX, supporting its use in this situation. MRS was unhelpful in our cohort.
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Affiliation(s)
- Thomas D Westwood
- Department of Radiology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, United Kingdom.
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34
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Lee SC, Moon WJ, Choi JW, Roh HG, Bak SH, Yi JG, Yim YJ, Chung EC. Differentitation between Primary Central Nervous System Lymphoma and Glioblastoma: Added Value of Quantitative Analysis of CT Attenuation and Apparent Diffusion Coefficient. ACTA ACUST UNITED AC 2012. [DOI: 10.13104/jksmrm.2012.16.3.226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Seung Choul Lee
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Jin Woo Choi
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - So hyeon Bak
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Geun Yi
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Yoo Jeong Yim
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - En Chul Chung
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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35
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Analysis of perfusion weighted image of CNS lymphoma. Eur J Radiol 2010; 76:48-51. [DOI: 10.1016/j.ejrad.2009.05.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 05/07/2009] [Indexed: 11/21/2022]
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Haldorsen IS, Espeland A, Larsson EM. Central nervous system lymphoma: characteristic findings on traditional and advanced imaging. AJNR Am J Neuroradiol 2010; 32:984-92. [PMID: 20616176 DOI: 10.3174/ajnr.a2171] [Citation(s) in RCA: 286] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CNS lymphoma consists of 2 major subtypes: secondary CNS involvement by systemic lymphoma and PCNSL. Contrast-enhanced MR imaging is the method of choice for detecting CNS lymphoma. In leptomeningeal CNS lymphoma, representing two-thirds of secondary CNS lymphomas, imaging typically shows leptomeningeal, subependymal, dural, or cranial nerve enhancement. Single or multiple periventricular and/or superficial contrast-enhancing lesions are characteristic of parenchymal CNS lymphoma, representing one-third of secondary CNS lymphomas and almost 100% of PCNSLs. New CT and MR imaging techniques and metabolic imaging have demonstrated characteristic findings in CNS lymphoma, aiding in its differentiation from other CNS lesions. Advanced imaging techniques may, in the future, substantially improve the diagnostic accuracy of imaging, ultimately facilitating a noninvasive method of diagnosis. Furthermore, these imaging techniques may play a pivotal role in planning targeted therapies, prognostication, and monitoring treatment response.
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Affiliation(s)
- I S Haldorsen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.
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Clark AJ, Lee K, Broaddus WC, Martin MJ, Ghatak NR, Grossman CE, Baker S, Baykal A. Primary brain T-cell lymphoma of the lymphoblastic type presenting as altered mental status. Acta Neurochir (Wien) 2010; 152:163-8. [PMID: 19578806 PMCID: PMC2801848 DOI: 10.1007/s00701-009-0433-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 06/01/2009] [Indexed: 11/28/2022]
Abstract
The authors present a case of a 56-year-old man with altered mental status. Magnetic resonance imaging (MRI) of the brain revealed non-enhancing abnormalities on T2 and FLAIR imaging in the brainstem, cerebellum, and cerebrum. Immunohistochemisty demonstrated precursor T-cell lymphoblastic lymphoma. After treatment with methotrexate, he improved clinically without focal sensorimotor deficits and with improving orientation. MRI showed almost complete resolution of brainstem and cerebral lesions. To the authors’ knowledge, there are only five previous reports of primary central nervous system T-cell lymphoblastic lymphoma. Since treatable, it deserves consideration in patients with altered mental status and imaging abnormalities that include diffuse, non-enhancing changes with increased signal on T2-weighted images.
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Affiliation(s)
- Aaron J Clark
- Deparment of Neurosurgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
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38
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Haldorsen IS, Kråkenes J, Krossnes BK, Mella O, Espeland A. CT and MR imaging features of primary central nervous system lymphoma in Norway, 1989-2003. AJNR Am J Neuroradiol 2009; 30:744-51. [PMID: 19164442 DOI: 10.3174/ajnr.a1447] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Studying imaging findings of non-acquired immunodeficiency syndrome (AIDS) primary central nervous system lymphoma (PCNSL), we hypothesized that the imaging presentation has changed with the increasing incidence of PCNSL and is related to clinical factors (eg, time to diagnosis and the patient's being diagnosed alive or at postmortem examination). MATERIALS AND METHODS Chart and histologic reviews of patients recorded as having PCNSL during 1989-2003 in the Norwegian Cancer Registry identified 98 patients with non-AIDS PCNSL; 75 had available imaging. CT and MR images from the first diagnostic work-up after onset of symptoms but before histologic diagnosis were reviewed. RESULTS CT and/or MR imaging in the 75 patients revealed no lesion in 10 (13%), a single focal lesion in 34 (45%), multiple focal lesions in 26 (35%), and disseminated lesions in 5 (7%) patients. All together, we identified 103 focal lesions (single/multiple): 63% in white matter, 56% abutting the ventricular surface, and 43% in the frontal lobes); 100% (102/102 lesions evaluated with contrast) showed contrast enhancement. The median time from imaging to diagnosis for patients with no, single, multiple, or disseminated lesions was 32, 3, 5, and 3 weeks, respectively (P = .01). Patients with no or disseminated lesions were more often diagnosed at postmortem examination (P = .06). Imaging findings were practically unchanged during the consecutive 5-year periods. CONCLUSIONS White matter periventricular contrast-enhancing single or multiple focal lesions were typical of non-AIDS PCNSL. No or disseminated lesions heightened the risk of delayed or postmortem diagnosis. Although the incidence of non-AIDS PCNSL has increased, its presentation at imaging remains unchanged.
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Affiliation(s)
- I S Haldorsen
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.
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39
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Cecchi PC, Billio A, Colombetti V, Rizzo P, Ricci UM, Schwarz A. Primary high-grade B-cell lymphoma of the choroid plexus. Clin Neurol Neurosurg 2008; 110:75-9. [DOI: 10.1016/j.clineuro.2007.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Revised: 07/26/2007] [Accepted: 08/23/2007] [Indexed: 10/22/2022]
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