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Dawid de Vera MT, Díaz Crespo FJ, Manso R, Penedo Coello A, Morillo-Giles D, Rodríguez-Pinilla SM, Díaz de la Pinta FJ. Intraparenchymal low-grade B-cell lymphomas of the central nervous system: Clinicopathologic and molecular analysis of three cases and a review of the literature. Ann Diagn Pathol 2024; 73:152376. [PMID: 39321755 DOI: 10.1016/j.anndiagpath.2024.152376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 09/13/2024] [Accepted: 09/17/2024] [Indexed: 09/27/2024]
Abstract
Primary central nervous system (CNS) lymphomas represent 1 % of all non-Hodgkin lymphomas, with diffuse large B-cell lymphomas as the prevailing subtype. Low-grade B-cell lymphomas are exceptional with only 24 marginal zone B-cell lymphomas (EMZL) and 1 follicular lymphoma (FL) previously reported so far. While their molecular profiles are studied elsewhere, data on primary intraparenchymal CNS cases remain limited. The objective of the present study is to contribute new cases of primary intraprenchymal low-grade B-cell lymphomas in the CNS and characterize their mutational profile. We conducted a comprehensive review of cases and a literature review to identify similar instances. Clinical, imaging, histological, immunohistochemical, and molecular characteristics were analyzed. Diagnoses were established according to established criteria. We present three novel cases of intraparenchymal CNS low-grade B-cell lymphomas. One case of intraparenchymal EMZL exhibited plasmacytic differentiation, while another lacked a plasma cell component. The third case was diagnosed as FL. The L265P mutation of MYD88 was absent in all cases. Next generation sequencing revealed pathogenic mutations in SPEN (Glu1970ValfsTer64) and ARID1A (Pro1355LeufsTer118) genes in one EMZL case. In conclusion, intraparenchymal CNS low-grade B-cell lymphomas are rare, with few reported cases. Our findings expand knowledge on their clinical and molecular features. We present the first molecular profile of primary CNS intraparenchymal EMZL, underscoring the need for further research to understand their biology and optimize treatment strategies.
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Affiliation(s)
- Maria Teresa Dawid de Vera
- Pathology Department, Institute of Biomedical Research in Malaga (IBIMA-Plataforma BIONAND), Virgen de la Victoria University Hospital, University of Málaga, 29010 Málaga, Spain.
| | | | - Rebeca Manso
- Pathology Department, Institute of Biomedical Research Fundación Jiménez Díaz, University Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Agustín Penedo Coello
- START Madrid-CIOCC Phase I Unit, University Hospital HM Sanchinarro, 28050 Madrid, Spain
| | - Daniel Morillo-Giles
- Hematology Department, University Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Socorro María Rodríguez-Pinilla
- Pathology Department, Institute of Biomedical Research Fundación Jiménez Díaz, University Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain; Medicine Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Francisco Javier Díaz de la Pinta
- Pathology Department, Institute of Biomedical Research Fundación Jiménez Díaz, University Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain
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Hamamoto R, Kawasaki T, Oda M, Sumiyoshi S, Hayashi K, Kobayashi T, Ioroi Y, Uchiyama T, Takayama M, Saiki M. Primary extranodal marginal zone mucosa-associated lymphoid tissue-type B-cell lymphoma involving the dura: A case report. Surg Neurol Int 2024; 15:113. [PMID: 38628522 PMCID: PMC11021089 DOI: 10.25259/sni_792_2023] [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: 09/22/2023] [Accepted: 03/09/2024] [Indexed: 04/19/2024] Open
Abstract
Background Primary extranodal marginal zone mucosa-associated lymphoid tissue-type B-cell lymphoma (EMZMBCL), which presents as a dural mass, is a rare intracranial tumor that mimics a subdural hematoma or meningioma. Case Description A 49-year-old woman presented to our hospital with transient right upper limb paresis, dysarthria for 10 min, and ongoing right upper-limb numbness. Computed tomography (CT) of the head revealed extra-axial lesions in the left frontal and parietal lobes. Based on the initial CT findings in the emergency room, an acute subdural hematoma was suspected. However, meningiomas and other intracranial tumors were also listed as differential diagnoses because there was no history of head trauma or coagulation abnormalities on blood examination, and further imaging studies were performed. Imaging findings suggested a subdural neoplastic lesion. A partial resection was performed for the lesion. Based on histopathological and immunohistochemical examinations, the patient was diagnosed with EMZMBCL. Whole-brain and intensity-modulated radiation therapies were administered as adjuvant therapies. The patient was discharged without neurological deficits. Conclusion EMZMBCL is a rare disease that should be considered in the differential diagnosis of subdural lesions, especially when there is no history of trauma or abnormalities in the coagulation system. The patient had a favorable outcome after selecting radiotherapy as the adjuvant therapy.
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Affiliation(s)
- Ryo Hamamoto
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Toshinari Kawasaki
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masashi Oda
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Sosuke Sumiyoshi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Kosuke Hayashi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Tamaki Kobayashi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Yoshihiko Ioroi
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Tatsuki Uchiyama
- Department of Hematology Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Motohiro Takayama
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Masaaki Saiki
- Department of Neurosurgery Japanese Red Cross Otsu Hospital, Otsu, Japan
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3
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Flospergher E, Marino F, Calimeri T, Cangi MG, Ferreri AJM, Ponzoni M, Bongiovanni L. Primary central nervous system marginal zone lymphoma. Br J Haematol 2024; 204:31-44. [PMID: 38054330 DOI: 10.1111/bjh.19238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
Marginal zone lymphoma (MZL) is the most common indolent lymphoma primarily arising in the central nervous system (CNS). To date, 207 cases of primary CNS MZL (PCNSMZL) were published, mostly as single case reports or small case series. It most commonly presents as extra-axial dural-based masses, more frequently in middle-aged women, displaying an insidious onset, with a long history of symptoms preceding the diagnosis. PCNSMZL can be radiographically mistaken for meningioma. PCNSMZL consists of CD20+ , CD3- small B lymphocytes with varying degrees of plasmacytic differentiation and low proliferation index. Trisomy 3, but not MALT1 or IgH translocation, is a common genetic abnormality. Other recurrent genetic abnormalities involve TNFAIP3 and NOTCH2. Ethiopathogenesis was poorly investigated. Due to its rarity, standard of care remains to be defined; it exhibits an excellent prognosis after varied treatments, such as surgery, radiotherapy, chemotherapy or their combinations. Nevertheless, each treatment should be considered after an accurate analysis of overtreatment risk. Short follow-up is a major limitation in reported PCNSMZL cases, which restrains our knowledge on long-term results and iatrogenic sequels. This review was focussed on presentation, differential diagnoses, pathological findings, treatment options and clinical outcomes of PCNSMZL; recommendations for best clinical practice are provided.
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Affiliation(s)
- Elena Flospergher
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Marino
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Teresa Calimeri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Andrés José María Ferreri
- Lymphoma Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
| | - Maurilio Ponzoni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
| | - Lucia Bongiovanni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Ateneo Vita-Salute San Raffaele University, Milan, Italy
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Ren J, Cai L, Ren J, Li S, Ding L. Mucosa‑associated lymphoid tissue in the central nervous system presenting as meningioma: A case report. Oncol Lett 2023; 26:277. [PMID: 37274477 PMCID: PMC10236133 DOI: 10.3892/ol.2023.13863] [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: 10/05/2022] [Accepted: 04/11/2023] [Indexed: 06/06/2023] Open
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma involving meningeal tissue is rare condition, easily mistaken for meningiomas upon imaging. In this report, a case of primary left temporal lobe MALT lymphoma that was initially misdiagnosed as temporal meningioma is presented, with subsequent investigation into the mechanism and treatments. Clinically, MALT lymphomas can be easily confused with meningiomas based solely on imaging and clinical manifestations. MALT lymphomas are indolent, localized lesions that can be cured through surgical resection and radiotherapy. Currently, radiotherapy is the most commonly used treatment; however, the patient in the present report did not receive any chemotherapy or radiotherapy after surgery, and recent related examinations revealed a recurrence of lymphomas that had metastasized throughout the body. As a result, future patients may benefit from chemotherapy or radiotherapy, and clinicians should be more meticulous regarding patient follow-up.
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Affiliation(s)
- Jiangbin Ren
- Department of Neurosurgery, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Nanjing Medical University, Huai'an, Jiangsu 223000, P.R. China
| | - Lingyu Cai
- Department of Neurosurgery, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Nanjing Medical University, Huai'an, Jiangsu 223000, P.R. China
| | - Jianghao Ren
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, P.R. China
| | - Shaoxun Li
- Department of Neurosurgery, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Nanjing Medical University, Huai'an, Jiangsu 223000, P.R. China
| | - Lianshu Ding
- Department of Neurosurgery, The Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, Nanjing Medical University, Huai'an, Jiangsu 223000, P.R. China
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Laghaei Farimani P, Karthikeyan V, Fatehi M, Levine A, Slack GW, Mackenzie IR, Haw C. Intraparenchymal Mucosa-Associated Lymphoid Tissue Lymphoma: A Case Report. Cureus 2022; 14:e28301. [PMID: 36158354 PMCID: PMC9496647 DOI: 10.7759/cureus.28301] [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] [Accepted: 08/23/2022] [Indexed: 12/04/2022] Open
Abstract
Marginal zone B-cell lymphoma (MZBCL) of mucosa-associated lymphoid tissue (MALT) type, which is primary to the central nervous system (CNS), is a rare lesion, with those originating within the parenchyma even more so. We present the case of a 64-year-old male with weakness in the left hand and focal motor seizures of his arm, who was found to have a right frontal intraparenchymal lesion. Following resection, histopathological and immunohistochemical evaluations were completed, leading to a diagnosis of a primary CNS MZBCL of MALT type in the context of a negative workup of systemic disease. Neuroimaging, histopathological, and immunohistochemical findings, as well as a comprehensive literature review of similar cases, are discussed.
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Sugita Y, Hashimoto G, Fukuda K, Takahashi K, Shioga T, Furuta T, Arakawa F, Ohshima K, Nakamura H, Miyata H, Watanabe M, Kakita A. Primary Nondural Central Nervous System Marginal ZoneB-Cell Lymphoma of the Mucosa-Associated Lymphoid Tissue Type Mimicking CNS Inflammatory Diseases. J Neuropathol Exp Neurol 2021; 80:789-799. [PMID: 34383910 DOI: 10.1093/jnen/nlab058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Marginal zone B-cell lymphomas (MZBCLs) are non-Hodgkin lymphomas arising from postgerminal center marginal zone B cells. MZBCLs are subclassified into extranodal, nodal, and splenic MZBCLs. Primary nondural central nervous system (CNS) MZBCLs of the mucosa-associated lymphoid tissue (MALT) type are among the extranodal examples. Their clinicopathological features are not well characterized. Therefore, the clinicopathological features of 8 primary nondural CNS MZBCLs of the MALT type were assessed to establish their pathological diagnostic criteria. Histologically, all cases of primary nondural CNS MZBCLs of the MALT type showed perivascular expansive monotonous proliferation of small atypical B lymphoid cells with plasma cell differentiation, low Ki-67 labeling index, and minimal invasion from the perivascular space. In addition, no vascular changes such as glomeruloid changes, obliterative fibrointimal proliferation, and intramural lymphocytic infiltration were seen. These key histological characteristics should be considered when diagnosing cases that are suspected to be primary nondural CNS MZBCLs of the MALT type. Additionally, regarding PCR for the detection of immunoglobulin heavy variable gene and T-cell receptor γ gene rearrangements, the former is detected, but the latter is not detected in all cases. Therefore, PCR detection including sequence analysis should be added when diagnosing difficult cases based on the key histological characteristics.
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Affiliation(s)
- Yasuo Sugita
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Go Hashimoto
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Kenji Fukuda
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Kenji Takahashi
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Taro Shioga
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Takuya Furuta
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Fumiko Arakawa
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Koichi Ohshima
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Hideo Nakamura
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Hajime Miyata
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Masashi Watanabe
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
| | - Akiyoshi Kakita
- From the Department of Neuropathology, St. Mary's Hospital, Kurume, Japan (YS); Department of Cerebrovascular Medicine, St. Mary's Hospital, Kurume, Japan (GH, KF); Department of Neurosurgery, St. Mary's Hospital, Kurume, Japan (KT); Department of Pathology, St. Mary's Hospital, Kurume, Japan (TS); Department of Pathology, Kurume University School of Medicine, Kurume, Japan (TF, FA, KO); Department of Neurosurgery, Kurume University School of Medicine, Kurume, Japan (HN); Department of Neuropathology, Research Institute for Brain and Blood Vessels, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan (HM); Department of Neurology, Ehime Prefectural Central Hospital, Ehime, Japan (MW); and Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan (AK)
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Zhao YR, Hu RH, Wu R, Xu JK. Primary mucosa-associated lymphoid tissue lymphoma in the midbrain: A case report. World J Clin Cases 2021; 9:6566-6574. [PMID: 34435027 PMCID: PMC8362552 DOI: 10.12998/wjcc.v9.i22.6566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/01/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary non-dural central nervous system mucosa-associated lymphoid tissue (MALT) lymphoma is a rare indolent B-cell lymphoma, with only a few reported cases worldwide.
CASE SUMMARY A 33-year-old man presented with a 5-mo history of left blepharoptosis and a 4-mo history of right limb numbness and weakness. Magnetic resonance imaging showed a significantly enhanced mass in the left midbrain. Subsequent positron emission tomography revealed that the lesion had increased glucose uptake. A stereotactic robotic biopsy supported a diagnosis of MALT lymphoma. Then he was treated with radiation therapy (30Gy/15F), which resulted in complete remission. We also review the literature on brain parenchymal-based MALT lymphoma, including the clinical presentation, treatment options, and outcomes.
CONCLUSION Although there is no consensus on the optimal treatment for this rare disease, patients can respond well when treated with radiotherapy alone.
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Affiliation(s)
- Yong-Rui Zhao
- Department of Radiation Oncology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Rong-Hua Hu
- Department of Hematology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Rui Wu
- Department of Pathology, Peking University Third Hospital, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Jian-Kun Xu
- Department of Radiation Oncology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
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Bureta C, Higa N, Makino R, Takajo T, Yonezawa H, Uchida H, Yoshimoto K. Diffuse Large B-Cell Lymphoma of the Central Nervous System Manifesting with Intratumoral Hemorrhage: A Case Report and Literature Review. World Neurosurg 2020; 143:490-494. [PMID: 32763371 DOI: 10.1016/j.wneu.2020.07.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cases of primary central nervous system lymphoma manifesting with hemorrhage are very rare, with only a few previous studies available. CASE DESCRIPTION A 49-year-old man presented with occipital headache and visual disturbance for the past 4 months. Computed tomography showed a high-density area involving the left basal ganglia, with surrounding vasogenic edema. Head T2∗-weighted imaging showed a hypointense signaling area. Edematous changes and a midline shift were observed on fluid attenuated inversion recovery magnetic resonance imaging. Radiologic features were highly suggestive of intracerebral hemorrhage. Methylprednisolone pulse therapy improved his symptoms transiently and reduced the size of the lesion. Nonetheless, there was recurrence 1 month later. The patient was referred to our institution; a biopsy was performed, and a diffuse large B-cell lymphoma was diagnosed. After 3 cycles of high-dose methotrexate and whole-brain radiation therapy, his symptoms improved, and there were no signs of recurrence. CONCLUSIONS We report a very rare case of diffuse large B-cell lymphoma manifested with intratumoral hemorrhage. This case indicates the importance of regular clinical and radiologic follow-up, histopathologic examination, and combined treatment with high-dose methotrexate and whole-brain radiation therapy.
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Affiliation(s)
- Costansia Bureta
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Nayuta Higa
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Ryutaro Makino
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Tomoko Takajo
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hajime Yonezawa
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hiroyuki Uchida
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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9
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Nomani L, Cotta CV, Hsi ED, Ferry JA, Cook JR. Extranodal Marginal Zone Lymphoma of the Central Nervous System Includes Parenchymal-Based Cases With Characteristic Features. Am J Clin Pathol 2020; 154:124-132. [PMID: 32318699 DOI: 10.1093/ajcp/aqaa032] [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] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To define the clinicopathologic features of extranodal marginal zone lymphoma (EMZL) of the central nervous system (CNS), including cases arising in CNS parenchyma, which have been reported only rarely. METHODS Twelve cases of CNS EMZL were identified, including 5 based in CNS parenchyma and 7 nonparenchymal cases arising in dura or choroid plexus. RESULTS Histologically, parenchymal cases were perivascular infiltrates without a dominant lymphoid mass, whereas nonparenchymal cases were masses of small lymphocytes. Plasma cells were a larger component of the infiltrate in parenchymal cases (median, 30%; range, 20%-50%) than nonparenchymal cases (median, 0%; range, 0%-5%; P < .001), and plasma cells were clonal by immunohistochemistry in 4 of 5 parenchymal vs 1 of 7 nonparenchymal cases (P = .07). Fluorescence in situ hybridization for MALT1 rearrangement was positive in 1 of 3 parenchymal and none of 3 nonparenchymal cases. Chromosomal microarray was abnormal in 5 of 7 cases (71%), with chromosome 6/6q alterations identified in 3 cases. No patients with parenchymal disease but all 6 (100%) with nonparenchymal disease achieved complete remission. CONCLUSIONS This case series, the first to include multiple parenchymal cases, clarifies the spectrum of clinical, pathologic, and genetic findings in CNS EMZL and suggests that parenchymal-based lesions may show less favorable prognosis than dural-based disease.
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Affiliation(s)
- Laila Nomani
- Department of Laboratory Medicine, Robert J. Tomisch Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Claudiu V Cotta
- Department of Laboratory Medicine, Robert J. Tomisch Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Eric D Hsi
- Department of Laboratory Medicine, Robert J. Tomisch Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital, Boston
| | - James R Cook
- Department of Laboratory Medicine, Robert J. Tomisch Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
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10
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Lopetegui‐Lia N, Delasos L, Asad SD, Kumar M, Harrison JS. Primary central nervous system marginal zone B-cell lymphoma arising from the dural meninges: A case report and review of literature. Clin Case Rep 2020; 8:491-497. [PMID: 32185043 PMCID: PMC7069868 DOI: 10.1002/ccr3.2680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/26/2019] [Accepted: 12/16/2019] [Indexed: 12/26/2022] Open
Abstract
Primary central nervous system (CNS) marginal zone B-cell lymphoma (MZBCL) arising from the dural meninges is a rare but indolent disease. This malignancy can present in various ways, hence making it difficult to diagnose. Biopsy results dictate an appropriate treatment plan, which commonly consists of a combination of surgical resection, whole brain radiotherapy and systemic therapy.
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Affiliation(s)
| | - Lukas Delasos
- Department of MedicineUniversity of Connecticut SystemFarmingtonCTUSA
| | - Syed Daniyal Asad
- Department of MedicineUniversity of Connecticut SystemFarmingtonCTUSA
| | - Manish Kumar
- Department of MedicineUniversity of Connecticut SystemFarmingtonCTUSA
| | - Jonathan S. Harrison
- Department of Hematology/Oncology, Carole and Ray Neag Comprehensive Cancer CenterUniversity of Connecticut SystemFarmingtonCTUSA
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11
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Sunderland AJ, Steiner RE, Al Zahrani M, Pinnix CC, Dabaja BS, Gunther JR, Nastoupil LJ, Jerkeman M, Joske D, Cull G, El‐Galaly T, Villa D, Cheah CY. An international multicenter retrospective analysis of patients with extranodal marginal zone lymphoma and histologically confirmed central nervous system and dural involvement. Cancer Med 2020; 9:663-670. [PMID: 31808316 PMCID: PMC6970027 DOI: 10.1002/cam4.2732] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022] Open
Abstract
Marginal zone lymphoma of the central nervous system (CNS MZL) is rare. The clinical features, treatment, and prognosis are not well characterized. We performed a multicenter retrospective study of CNS MZL. Twenty-six patients were identified: half with primary and half with secondary CNS involvement. The median age was 59 years (range 26-78), 62% female and 79% with ECOG performance status ≤ 1. The most common disease site was the dura (50%). Treatment was determined by the treating physician and varied substantially. After a median follow up of 1.9 years, the estimated 2-year progression-free (PFS) and overall survival (OS) rates were 59% and 80%, respectively. Secondary CNS MZL was associated with 2-year OS of 58%. CNS MZL is rare, but relative to other forms of CNS lymphoma, outcomes appear favorable, particularly among the subset of patients with dural presentation and primary CNS presentation.
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Affiliation(s)
| | | | - Musa Al Zahrani
- University of British Columbia and BC Cancer Centre for Lymphoid CancerVancouverBritish ColumbiaCanada
- Department of MedicineKing Saud University HospitalRiyadhSaudi Arabia
| | - Chelsea C. Pinnix
- Department of Radiation OncologyMD Anderson Cancer CenterHoustonTXUSA
| | | | | | | | | | - David Joske
- Department of HaematologySir Charles Gairdner HospitalNedlandsWAAustralia
- Department of HaematologyPathwest Laboratory Medicine WANedlandsWAAustralia
- Medical SchoolUniversity of Western AustraliaCrawleyWAAustralia
| | - Gavin Cull
- Department of HaematologySir Charles Gairdner HospitalNedlandsWAAustralia
- Department of HaematologyPathwest Laboratory Medicine WANedlandsWAAustralia
- Medical SchoolUniversity of Western AustraliaCrawleyWAAustralia
| | - Tarec El‐Galaly
- Department of HematologyAalborg University HospitalAalborgDenmark
| | - Diego Villa
- University of British Columbia and BC Cancer Centre for Lymphoid CancerVancouverBritish ColumbiaCanada
| | - Chan Yoon Cheah
- Department of HaematologySir Charles Gairdner HospitalNedlandsWAAustralia
- Department of HaematologyPathwest Laboratory Medicine WANedlandsWAAustralia
- Medical SchoolUniversity of Western AustraliaCrawleyWAAustralia
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12
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Javier R, Shaikh N, Lesniak MS, Sonabend A, Stupp R, Behdad A, Horbinski C. B cell-rich non-neoplastic sentinel lesion preceding primary central nervous system lymphoma. Diagn Pathol 2018; 13:37. [PMID: 29871654 PMCID: PMC5989478 DOI: 10.1186/s13000-018-0717-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/25/2018] [Indexed: 11/10/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is an uncommon tumor in the brain. Although most PCNSL are readily diagnosed as diffuse large B cell lymphoma (DLBCL) on the first biopsy, very rare cases have been described in which the first detected intracerebral lesions are non-neoplastic, and are composed mostly of perivascular T cells, not B cells. This phenomenon is known as “sentinel lesions.”
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Affiliation(s)
- Rodrigo Javier
- Departments of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA
| | - Nawal Shaikh
- Departments of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Maciej S Lesniak
- Departments of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA
| | - Adam Sonabend
- Departments of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA
| | - Roger Stupp
- Departments of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA
| | - Amir Behdad
- Departments of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Craig Horbinski
- Departments of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Tarry 2-705, 300 East Superior Street, Chicago, IL, 60611, USA. .,Departments of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA.
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13
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Bustoros M, Liechty B, Zagzag D, Liu C, Shepherd T, Gruber D, Raphael B, Placantonakis DG. A Rare Case of Composite Dural Extranodal Marginal Zone Lymphoma and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Front Neurol 2018; 9:267. [PMID: 29740389 PMCID: PMC5928293 DOI: 10.3389/fneur.2018.00267] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 04/06/2018] [Indexed: 12/27/2022] Open
Abstract
Background Primary extranodal marginal zone lymphoma (MZL) of the dura is a rare neoplastic entity in the central nervous system (CNS). Methods We used literature searches to identify previously reported cases of primary dural MZL. We also reviewed clinical, pathologic, and radiographic data of an adult patient with concurrent dural MZL and chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). Results We identified 104 cases of dural MZL in the literature. None of them presented concurrently with another type of non-Hodgkin lymphoma. This is the first report of composite lymphoma consisting of dural MZL and CLL/SLL in the bone marrow and lymph nodes. Conclusion Primary dural MZL is a rare, indolent low-grade CNS lymphoma, with a relatively good prognosis. Its treatment is multidisciplinary and often requires surgical intervention due to brain compression, along with low to moderate doses of radiotherapy and/or systemic chemotherapy.
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Affiliation(s)
- Mark Bustoros
- Department of Neurosurgery, NYU School of Medicine, New York, NY, United States
| | - Benjamin Liechty
- Department of Pathology, NYU School of Medicine, New York, NY, United States
| | - David Zagzag
- Department of Neurosurgery, NYU School of Medicine, New York, NY, United States.,Department of Pathology, NYU School of Medicine, New York, NY, United States.,Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY, United States.,Brain Tumor Center, NYU Langone Medical Center, New York, NY, United States
| | - Cynthia Liu
- Department of Pathology, NYU School of Medicine, New York, NY, United States
| | - Timothy Shepherd
- Department of Radiology, NYU School of Medicine, New York, NY, United States
| | - Deborah Gruber
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY, United States.,Brain Tumor Center, NYU Langone Medical Center, New York, NY, United States.,Department of Neurology, NYU School of Medicine, New York, NY, United States
| | - Bruce Raphael
- Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY, United States.,Department of Medicine, NYU School of Medicine, New York, NY, United States
| | - Dimitris G Placantonakis
- Department of Neurosurgery, NYU School of Medicine, New York, NY, United States.,Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY, United States.,Brain Tumor Center, NYU Langone Medical Center, New York, NY, United States.,Kimmel Center for Stem Cell Biology, NYU School of Medicine, New York, NY, United States.,Neuroscience Institute, NYU School of Medicine, New York, NY, United States
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14
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Li J, Lei C, Richard SA, Liu Y. Giant solitary primary intracranial lymphoma masquerading as meningioma: a case and review of literature. Pan Afr Med J 2018; 28:196. [PMID: 29610634 PMCID: PMC5878841 DOI: 10.11604/pamj.2017.28.196.13996] [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: 09/28/2017] [Accepted: 10/21/2017] [Indexed: 02/05/2023] Open
Abstract
Non-Hodgkin's lymphomas (NHL) with intracranial origin are very rare and constitutes about 1-2% of primary central nervous system lymphomas (PCNSL). Diffuse large B cell lymphoma (DLBCL) is the most common subtype of NHL and mostly seen in immunocompromised patients. Therefore, the occurrence of giant solitary DLBCL in an immunocompetent patient is puzzling. We present a case of 68-year-old man who was admitted at our facility with a history of “hypomnesia of two (2) months” duration. Magnetic resonance imaging (MRI) revealed a space occupying lesion in the bilateral frontal lobe and corpus callosum measuring about 5.4cm * 4.6cm * 3.8cm with mixed signal intensities and vasogenic edema around the mass. Radiological, this mass was mistaken for meningioma until histopathological studies revealed DLBCL. Giant solitary primary intracranial lymphomas are very rare and can be mistake for meningioma even with very experience radiologist or neurosurgeon since the radiological features of PCNSL can be very unspecific. We achieved to total resection because of the giant and solitary nature of our case. The prognosis of PCNSL is general very poor when the patient is immunocompromised. In immunocompetent patients, who are well managed with surgery and chemotherapy, the overall survival and quality of life can very encouraging.
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Affiliation(s)
- Junhong Li
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Road, Chengdu, 610041, PR, China
| | - Chuanfen Lei
- Department of Pathology, West China Hospital, Sichuan University, 37 Guo Xue Xiang Road, Chengdu, 610041, PR, China
| | - Seidu A Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Road, Chengdu, 610041, PR, China.,Department of Immunology, Jiangsu University, 301 Xuefu Road, Zhenjiang, Jiangsu, 212013 PR, China.,Department of Surgery, Volta Regional Hospital, PO, Box MA-374, Ho, Ghana, West Africa
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Road, Chengdu, 610041, PR, China
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15
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Liu X, Zhang Y, Zhang S, Tao C, Ju Y. Intraparenchymal Atypical Meningioma in Basal Ganglia Region in a Child: Case Report and Literature Review. J Korean Neurosurg Soc 2017; 61:120-126. [PMID: 29354244 PMCID: PMC5769854 DOI: 10.3340/jkns.2015.0609.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 10/24/2015] [Accepted: 10/25/2015] [Indexed: 02/05/2023] Open
Abstract
Intraparenchymal meningiomas without dural attachment are extremely rare, especially when they occur in basal ganglia region in child. An 8-year-old boy was admitted at our hospital, complaining of recurrent headache and vomiting for 3 months. Neurological examination showed impaired vision and mild paresis of the left extremities. Magnetic resonance imaging demonstrated a lesion located in the right basal ganglia region extending to superasellar cistern with solid, multiple cystic and necrotic components. Computed tomography revealed calcification within the mass. Due to the anterior cerebral artery involvement, a subtotal resection was achieved and postoperative radiotherapy was recommended. Histopathological examination indicated that the lesion was an atypical meningioma. The postoperative rehabilitation was uneventful. Mildly impaired vision and motor weakness of left extremities improved significantly and the patient returned to normal life after surgery. To our knowledge, intraparenchymal atypical meningioma in basal ganglia extending to superasellar cistern was never reported. The significance in differential diagnosis of lesions in basal ganglia should be emphasized.
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Affiliation(s)
- Xiaowei Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Yuekang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Si Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Chuanyuan Tao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Yan Ju
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
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16
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Ayanambakkam A, Ibrahimi S, Bilal K, Cherry MA. Extranodal Marginal Zone Lymphoma of the Central Nervous System. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017; 18:34-37.e8. [PMID: 29103980 DOI: 10.1016/j.clml.2017.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022]
Abstract
Extranodal marginal zone lymphoma of the central nervous system (CNS EMZBL) is a rare disease. We present a review of the literature and describe its presentation, differential diagnosis, treatment options, and outcomes. Systematic search of PubMed, Medline, and Embase databases via the Ovid engine for primary articles and case reports yielded 37 unduplicated peer-reviewed articles of CNS EMZBL. We identified 69 cases in these articles and 1 unreported case at our institution, which were included for this review's analysis. Median age at diagnosis was 55 years (range, 18-78 years), with a female preponderance of 77% (n = 54). Most common presenting symptoms were headache in 43% (n = 30), seizures in 31% (n = 22), and visual defects in 27% (n = 19). The most common treatment modalities were localized therapies, which were provided to 67% (n = 47) of cases. These included radiotherapy in 27% (n = 19), radiotherapy with surgery in 24% (n = 17), and surgery alone in 16% (n = 11). Ninety percent (n = 63) of patients had a median follow-up of 23 months. Complete remission was experienced by 77% (n = 49) patients, and 22% (n = 14) were alive with disease. Three patients had evidence of relapse, and one patient died. CNS EMZBL is an indolent, low-grade, radiosensitive lymphoma with good treatment outcomes and prognosis. It is an important differential to consider in extra-axial dural-based masses. Individualized management plans, with preference given to localized treatment options, should be considered after factoring in the site and extent of disease, its resectability, and the expected adverse effects of systemic therapy.
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Affiliation(s)
- Adanma Ayanambakkam
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Sami Ibrahimi
- Department of Hematology and Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Khalid Bilal
- Department of Hematology and Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Mohamad A Cherry
- Department of Hematology and Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
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17
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Gazzola DM, Arbini AA, Haglof K, Pacia SV. Primary marginal zone lymphoma of the cns presenting as a diffuse leptomeningeal process. Neurology 2016; 87:1180-2. [PMID: 27521434 DOI: 10.1212/wnl.0000000000003097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/01/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Deana M Gazzola
- From the Departments of Neurology (D.M.G., S.V.P.) and Pathology (A.A.A.), and Department of Medicine (Hematology), Division of Oncology (K.H.), New York University Langone Medical Center, NY.
| | - Arnaldo A Arbini
- From the Departments of Neurology (D.M.G., S.V.P.) and Pathology (A.A.A.), and Department of Medicine (Hematology), Division of Oncology (K.H.), New York University Langone Medical Center, NY
| | - Karen Haglof
- From the Departments of Neurology (D.M.G., S.V.P.) and Pathology (A.A.A.), and Department of Medicine (Hematology), Division of Oncology (K.H.), New York University Langone Medical Center, NY
| | - Steven V Pacia
- From the Departments of Neurology (D.M.G., S.V.P.) and Pathology (A.A.A.), and Department of Medicine (Hematology), Division of Oncology (K.H.), New York University Langone Medical Center, NY
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18
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Terada T. Primary extranodal marginal zone B-cell lymphoma with AL amyloidosis in cerebral parenchyma in an immunocompetent patient. HUMAN PATHOLOGY: CASE REPORTS 2015. [DOI: 10.1016/j.ehpc.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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19
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Choi JY, Chung JH, Park YJ, Jung GY, Yoon TW, Kim YJ, Lim TK, Kim BS, Nam SH. Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Tissue Type Involving the Dura. Cancer Res Treat 2015; 48:859-63. [PMID: 26194368 PMCID: PMC4843722 DOI: 10.4143/crt.2014.334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/29/2015] [Indexed: 02/07/2023] Open
Abstract
Primary central nervous system marginal zone B-cell lymphoma (MZBCL) is very rare, with only a few reported cases worldwide. It has an indolent disease course with high cure potential. We experienced a rare case of dural MZBCL of mucosa-associated lymphoid tissue (MALT) in a 69-year-old man who presented with headache. A magnetic resonance imaging scan of brain showed a 1.9×3.6-cm-sized extra-axial mass with a broad based dural attachment to the anterosuperior aspect of the falx cerebri, radiographically consistent with meningioma. Surgical resection yielded a MZBCL of the MALT type. Histopathology revealed a lymphoplasmacytic infiltration of the dura, and immunohistochemical study showed a B-cell phenotype with CD20, bcl-2, MUM-1, Ki-67 positive. He was treated with chemotherapy after complete surgical resection and remained free of disease at 30 months after chemotherapy. MALT lymphoma must be considered in the differential diagnosis in patients presenting radiographically with meningioma.
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Affiliation(s)
- Joon Young Choi
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Ji Hwan Chung
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Young Jun Park
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Geun Yong Jung
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Tae Wook Yoon
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Yoon Jung Kim
- Department of Pathology, Veterans Health Service Medical Center, Seoul, Korea
| | - Tae kyu Lim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Bong Seog Kim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung-Hyun Nam
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
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20
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Tomio R, Sasaki H, Hirose S, Shimizu T, Koda Y, Ohno M, Narita Y, Shibao S, Yoshida K. Intraparenchymal, primary central nervous system lymphoma of low-grade B cell malignancy: a case report with review of the literature on therapeutic consideration. Int Cancer Conf J 2015. [DOI: 10.1007/s13691-014-0173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Milgrom SA, Yahalom J. The role of radiation therapy in the management of primary central nervous system lymphoma. Leuk Lymphoma 2014; 56:1197-204. [PMID: 25219590 DOI: 10.3109/10428194.2014.961014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is an aggressive neoplasm with a poor prognosis. Early studies of whole brain radiation therapy (WBRT) alone revealed a robust initial response but high rates of local recurrence with long-term follow-up. The addition of high-dose methotrexate (HDMTX)-based chemotherapy improved the durability of disease control. However, delayed neurotoxicity emerged as an important complication, mainly in elderly patients. Therefore, researchers have investigated eliminating WBRT or reducing its dose. Multiple studies of chemotherapy alone have demonstrated inferior disease control. On the other hand, a phase III trial reported that WBRT may be deferred until relapse without compromising survival; however, this trial is fraught with flaws. A recent study of immunochemotherapy and dose-reduced WBRT demonstrated excellent outcomes. Currently, this regimen is being studied in a multi-institutional trial by the Radiation Therapy Oncology Group. WBRT maintains an important position in the armamentarium against PCNSL. This article aims to describe its evolving role.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center , New York, NY , USA
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22
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Sebastián C, Vela AC, Figueroa R, Marín MÁ, Alfaro J. Primary intracranial mucosa-associated lymphoid tissue lymphoma. A report of two cases and literature review. Neuroradiol J 2014; 27:425-30. [PMID: 25196615 DOI: 10.15274/nrj-2014-10074] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/04/2014] [Indexed: 12/13/2022] Open
Abstract
Low-grade B cell non-Hodgkin lymphomas typically arise from the marginal zone of the secondary lymphatic follicles. Their intracranial expression is very rare, most frequently affecting the dura mater and the choroid plexus glomi in the lateral ventricles. Their initial evaluation requires the exclusion of more common extra-axial lesions, such as meningiomas, dural metastasis, granulomatous lesions or secondary lymphoproliferative dural extension from body lymphomas. Whenever a ventricular lesion is present, the patient's age and lesion location help narrow the differential diagnosis. Dural-based lymphomas and ventricular/choroid plexus lymphomas are slow-growing lesions with imaging features similar to meningiomas, which is typically their main differential consideration. Diffusion-weighted images frequently show restricted diffusion behaviour on lymphomas, helping to differentiate them from the typical meningiomas.
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Affiliation(s)
- Cristina Sebastián
- Department of Radiology, Regional Hospital; Kemerovo, Russia; Department of Radiology, University Hospital Miguel Servet; Zaragoza, Spain -
| | - Ana Carmen Vela
- Department of Radiology, Regional Hospital; Kemerovo, Russia; Department of Radiology, University Hospital Miguel Servet; Zaragoza, Spain
| | | | - Miguel Ángel Marín
- Department of Radiology, Regional Hospital; Kemerovo, Russia; Department of Radiology, University Hospital Miguel Servet; Zaragoza, Spain
| | - Jorge Alfaro
- Department of Radiology, Regional Hospital; Kemerovo, Russia; Department of Radiology, University Hospital Miguel Servet; Zaragoza, Spain
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23
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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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24
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Citterio G, María Ferreri AJ, Reni M. Current uses of radiation therapy in patients with primary CNS lymphoma. Expert Rev Anticancer Ther 2014; 13:1327-37. [DOI: 10.1586/14737140.2013.851007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Giovanni Citterio
- Department of Onco-Hematology, San Raffaele Scientific Institute,
Milano, Italy
| | | | - Michele Reni
- Medical Oncology Unit, Department of Oncology,
San Raffaele Scientific Institute, via Olgettina 60, Milano 20132, Italy
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Wei D, Rich P, Bridges L, Martin AJ, Chau I, Bodi I, MacDonald BK. Rare case of cerebral MALToma presenting with stroke-like symptoms and seizures. BMJ Case Rep 2013; 2013:bcr-2012-008494. [PMID: 23608841 DOI: 10.1136/bcr-2012-008494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Mucosa-associated lymphoid tissue (MALT) cells are present in gastrointestinal mucosa but rarely found in the central nervous system (CNS). We describe an unusual and rare case of CNS MALT lymphoma in a patient presenting with stroke-like symptoms.
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Affiliation(s)
- D Wei
- Department of Neurology, Frenchay Hospital, Bristol, UK
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26
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Aqil B, Rouah E, Verstovsek G. Primary CNS Marginal Zone Lymphoma: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojpathology.2013.32010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Dey M, Daniel S, Wong RH, Smith SM, Yamini B. Marginal zone lymphoma of the thoracic dura causing spinal cord compression. J Clin Neurosci 2012; 20:171-3. [PMID: 22989787 DOI: 10.1016/j.jocn.2012.01.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 01/19/2012] [Indexed: 10/27/2022]
Abstract
Primary extra-nodal marginal zone B cell lymphoma (Ex-MZBCL) or mucosa-associated lymphoid tissue (MALT) lymphoma of the cranial dura is a rare but well-known entity. We describe a 58-year-old woman with primary MALT lymphoma of the spinal dura causing extreme thickening of the dura and spinal cord compression who initially presented with acute spinal cord compression from a chronic epidural lesion. She was treated with surgery and radiotherapy and diagnosed with a mature B-cell lymphoma based on gene rearrangement studies. Two years following the completion of radiotherapy, she presented with an increase in the size of the residual mass that was suggestive of an epidural lesion. On re-exploration, no epidural lesion was found; however, the dura was extremely thickened causing spinal cord compression. Clinical course, histological evaluation, immunostaining and gene rearrangement studies resulted in a final diagnosis of primary Ex-MZBCL of the spinal dura. To our knowledge, this is the first report of Ex-MZBCL in the spinal dura. This diagnosis should be considered when evaluating spinal cord lesions in patients with primary central nervous system (CNS) lymphoma, especially recurrent lesions, since this group of tumors carries a favorable outcome compared to other primary CNS lymphomas.
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Affiliation(s)
- Mahua Dey
- Section of Neurosurgery, Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA
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Lim T, Kim SJ, Kim K, Lee JI, Lim DH, Lee DJ, Baek KK, Lee HY, Han B, Uhm JE, Ko YH, Kim WS. Primary CNS lymphoma other than DLBCL: a descriptive analysis of clinical features and treatment outcomes. Ann Hematol 2011; 90:1391-8. [PMID: 21479535 PMCID: PMC3210363 DOI: 10.1007/s00277-011-1225-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Accepted: 03/22/2011] [Indexed: 12/01/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) constitutes most primary central nervous system (CNS) lymphoma (PCNSL), whereas T-cell, low-grade and Burkitt’s lymphomas (BL) are rarely encountered. Due to the paucity of cases, little is known about the clinical features and treatment outcomes of PCNSL other than DLBCL. The objective of this study was to describe the clinical characteristics and outcomes for patients with PCNSL other than DLBCL. Fifteen patients, newly diagnosed with PCNSLs other than DLBCL between 2000 and 2010, were included. The male to female ratio was 0.67:1 with a median age of diagnosis of 31 years (range 18–59). Pathologic distributions were as follows: peripheral T-cell lymphoma (PTCL; n = 7), marginal zone B-cell lymphoma (MZBCL; n = 1), lymphoplasmacytic lymphoma (LPL; n = 2), Burkitt’s lymphoma (n = 1), other unspecified (T-cell lineage, n = 2; B-cell lineage, n = 2). Thirteen patients (87%) showed Eastern Cooperative Oncology Group performance score (ECOG PS) 1–2. The remaining two were one PTCL patient and one Burkitt’s lymphoma patient. Of the nine patients with T-cell lymphoma, five (56%) had multifocal lesions, and one (20%) with LPL of the five patients with B-cell lymphoma showed a single lesion. Leptomeningeal lymphomatosis was identified in two patients (one with Burkitt’s lymphoma and one with unspecified B-cell lymphoma). Two patients (22%) with T-cell lymphoma died 7.7 and 23.3 months later, respectively, due to disease progression, despite HD-MTX-based therapy. Six patients with T-cell lymphoma (6/9, 66.7%) and four patients with low-grade B-cell lymphoma (4/5, 80%) achieved complete response and have survived without relapse (Table 3). One patient with Burkitt’s lymphoma showed poor clinical features with ECOG PS 3, deep structure, multifocal, and leptomeningeal lymphomatosis, and died 7.6 months after the initiation of treatment. In comparison with previously reported DLBCLs (median OS 6.4 years, 95% CI 3.7–9.1 years), T-cell lymphoma showed equivocal or favorable clinical outcomes and low-grade B-cell lymphomas, such as MZBCL and LPL, had a good prognosis. However, primary CNS Burkitt’s lymphoma presented poor clinical outcomes and showed a comparatively aggressive clinical course. In conclusion, primary CNS lymphoma other than DLBCL occurred more in younger patients and showed a generally good prognosis, except for Burkitt’s lymphoma. Further research on treatment strategies for Burkitt’s lymphoma is needed.
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Affiliation(s)
- Taekyu Lim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea
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29
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Primary central nervous system large B-cell lymphoma with prolific, mixed T-cell and macrophage infiltrates, mimicking multiple sclerosis. Brain Tumor Pathol 2010; 27:59-63. [DOI: 10.1007/s10014-010-0264-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2009] [Accepted: 01/07/2010] [Indexed: 10/19/2022]
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