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Yolcu A, Akar E, Aker FV, Emon ST. Retrospective Evaluation of Cases Undergoing Stereotaxic Brain Biopsy. Asian J Neurosurg 2023; 18:602-608. [PMID: 38152506 PMCID: PMC10749858 DOI: 10.1055/s-0043-1774821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Objective: The aim of this study is to evaluate the demographic, radiological and histopathological findings, tumoral biomarkers, and survival rates of patients who underwent a stereotactic brain biopsy and those diagnosed with glioblastoma, metastasis, and lymphoma, and the changes in the diagnosis distribution over the years. Materials and Methods: The patients who underwent stereotactic biopsy in our clinic between 2012 and 2020 were evaluated retrospectively. Metastasis, glioblastoma, and lymphoma cases were evaluated as three main groups and the others were excluded. P53 gene expression, isocitrate dehydrogenase (IDH) mutation, and Ki-67 values in glioblastoma cases and Bcl-2, Bcl-6 proteins, and Ki-67 values in lymphomas and their relationship with survival were evaluated. Results: High p53 expression was observed in 27.5% cases diagnosed with glioblastoma. IDH mutation was negative in all glioblastoma cases. Presence of Bcl-2 and Bcl-6 proteins was not associated with survival in lymphomas. Survival rate was significantly higher in cases diagnosed with lymphoma (26.9%) compared to those diagnosed with glioblastoma. A statistically significant increase was determined in patients diagnosed with lymphoma considering the distribution of diseases and incidence and in the distribution of other diagnoses over the years ( p < 0.05). Conclusion: As per the distribution of the disease in recent times, it has been observed that there is an increase in lymphoma cases. Histopathology and biomarkers have great importance in the diagnosis and treatment of cerebral lesions. We think that our findings will be supported by studies in which larger patient population and detailed biomarkers will be studied.
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Affiliation(s)
- Abdullah Yolcu
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Türkiye
| | - Ezgi Akar
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Türkiye
| | - Fügen Vardar Aker
- Department of Pathology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Türkiye
| | - Selin Tural Emon
- Department of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Türkiye
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2
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Saad T, Tuck A, Golestani F, Smith P, McCulloch R. Primary central nervous system lymphoma: a practical guide for neurologists. Pract Neurol 2023:pn-2022-003656. [PMID: 36823116 DOI: 10.1136/pn-2022-003656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
Primary central nervous system lymphoma is rare, comprising 4% of intracranial neoplasms. Although haematologists or oncologists subsequently manage the condition, it is often neurologists who first make, or at least suspect, the diagnosis. This article reviews the disease, its clinical and radiological features and details the work-up needed to achieve a diagnosis (namely histological or cytological confirmation) and to prepare the patient for treatment. We note the importance of brain biopsy, the role of corticosteroids and the varied treatment options.
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Affiliation(s)
- Toni Saad
- Department of Neurology, Gloucestershire Royal Hospital, Gloucester, UK
| | | | - Farhad Golestani
- Department of Neurology, Gloucestershire Royal Hospital, Gloucester, UK
| | - Paul Smith
- Department of Neurology, Gloucestershire Royal Hospital, Gloucester, UK.,Neuroradiology, North Bristol NHS Trust, Bristol, UK
| | - Rory McCulloch
- Haematology, Gloucestershire Royal Hospital, Gloucester, UK
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3
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Hernandez J, Davidson C, Reilly T, Hanbali S, Abou-Al-Shaar H, Ebrahim G, Nguyen A, Lucke-Wold B. Research on the Damage of the Central Nervous System Lymphoma to the Nervous System. JOURNAL OF MODERN MEDICAL ONCOLOGY 2023; 3:1. [PMID: 36911420 PMCID: PMC10003645 DOI: 10.53964/jmmo.2023001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Management of central nervous system (CNS) lymphoma requires multidisciplinary care. The disease can manifest in the context of immunocompromised states or in the context of chronic infections. Nervous system damage from this lymphoma has highly variable presentation that is dependent on the location of the tumor lesions. Damage from disease progression can lead to lasting neurologic deficits and even death. However, some lesions are a consequence of radiation-induced neurotoxicity. This review discusses the sources of and consequences of brain damage due to tumor damage and the associated effect of clinical therapies. We discuss workup, management, and treatments. These include chemotherapy and radiation techniques. We discuss potential complications and avoidance strategies. The review will serve as a user-friendly resource for clinicians.
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Affiliation(s)
- Jairo Hernandez
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | | | - Thomas Reilly
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Seif Hanbali
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Ghaidaa Ebrahim
- Department of Neurosurgery, University of Florida, Gainesville, USA
| | - Andrew Nguyen
- Department of Neurosurgery, University of Florida, Gainesville, USA
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Sahin U, Gokmen A, Soydan E, Urlu SM, Merter M, Gokgoz Z, Arslan O, Ozcan M. Outcomes of Autologous Stem Cell Transplantation as a Consolidative Strategy for the Treatment of Primary and Isolated Secondary Central Nervous System Diffuse Large B Cell Lymphomas. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e1-e13. [PMID: 36344419 DOI: 10.1016/j.clml.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/17/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Standard consolidation for primary diffuse large B cell lymphoma (DLBCL) of the central nervous system (CNS) (PCNSL) is not established. This single center, retrospective observational study aims to define the outcomes of consolidative high dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) in patients with PCNSL and isolated secondary CNS DLBCL (SCNSL) and evaluate the prognostic factors. PATIENTS AND METHODS All consecutive patients performed an HDC/ASCT for PCNSL or isolated SCNSLs between October 2012 and February 2022 were identified. Primary endpoints were progression-free survival (PFS) and overall survival (OS). RESULTS Among 35 patients included, 28 had PCNSL and 7 had isolated SCNSL. Median age was 51 (16-78). Males constituted 48.6%. Median follow-up after HDC/ASCT was 42.0 months. MATRIX (51.4%) and TEAM (80.0%) were the most frequent regimens of induction and conditioning, respectively. OS and PFS 1- and 2-year after HDC/ASCT were 68.0%, 57.0%, 58.0%, 48.0%, respectively. Increasing age, poor performance and comorbidities were associated with lower OS and PFS and higher non-relapse mortality (NRM). Complete response (CR) 1 at HDC/ACST was independently associated with higher OS and PFS [hazard ratio (HR): 4.67 and 6.99, respectively]. CONCLUSION In patients < 60 years consolidative HDC/ASCT yields promising OS and PFS. Patients ≥ 60 years may less likely benefit from consolidative HDC/ASCT and should be studied further in trials of novel agents, lower doses of consolidative radiotherapy and dose-adjusted conditioning regimens. Not only age, but also comorbidities, clinical performance and response to induction correlate with outcomes. Patients with isolated SCNSL may achieve similar outcomes.
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Affiliation(s)
- Ugur Sahin
- Hematology and Bone Marrow Transplantation Unit, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ayla Gokmen
- Hematology and Bone Marrow Transplantation Unit, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ender Soydan
- Hematology and Bone Marrow Transplantation Unit, Medicana International Ankara Hospital, Ankara, Turkey
| | - Selin M Urlu
- Hematology and Bone Marrow Transplantation Unit, Medicana International Ankara Hospital, Ankara, Turkey
| | - Mustafa Merter
- Department of Hematology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Zafer Gokgoz
- Hematology and Bone Marrow Transplantation Unit, Medicana International Ankara Hospital, Ankara, Turkey
| | - Onder Arslan
- Department of Hematology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Muhit Ozcan
- Department of Hematology, Faculty of Medicine, Ankara University, Ankara, Turkey.
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5
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He M, Zhong J, Li X, Chen Y, Li F. Cerebellar primary central nervous system lymphoma: Case series report. Int J Surg Case Rep 2022; 97:107440. [PMID: 35901552 PMCID: PMC9403198 DOI: 10.1016/j.ijscr.2022.107440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary central nervous system lymphoma (PCNSL) is a rare cranial malignant haematological tumour. PCNSL in the cerebellar region is less common than PCNSL in other encephalic regions. A diagnosis of cerebellar PCNSL is relatively difficult to make due to its diverse imaging manifestations. The aim of this case series report is to determine whether surgery could be used to confirm the diagnosis of cerebellar PCNSL and the effect of surgical treatment. METHODS We report 3 cases of cerebellar PCNSL that underwent neuronavigation microsurgery under general anaesthesia. The operation was performed by author 3 and author 5. One patient underwent left lateral ventricular drainage on the fourth and tenth days after the operation due to postoperative obstructive hydrocephalus. All patients received chemotherapy or radiotherapy after histological confirmation. OUTCOMES All patients' tumours were completely removed. One patient developed obstructive hydrocephalus twice during the perioperative period after the operation, was given drainage, and then recovered from the hospital. The other two patients recovered and were discharged smoothly without complications. One patient died 9 months after the operation, and the other two patients survived. The prognosis of 3 patients was related to tumour size and timely follow-up chemo-radiation therapy. CONCLUSION The histology of all patients showed diffuse large B-cell lymphoma (GCB phenotype). Suspicious cerebellar PCNSL patients should undergo surgery to confirm the diagnosis, followed by radiotherapy and chemotherapy.
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Affiliation(s)
| | | | | | | | - Fei Li
- Corresponding author at: Institute of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
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Diversity of genetic alterations of primary central nervous system lymphoma in Hispanic versus non-Hispanic patients. Cancer Treat Res Commun 2021; 27:100310. [PMID: 33581493 DOI: 10.1016/j.ctarc.2021.100310] [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: 09/19/2020] [Revised: 01/02/2021] [Accepted: 01/08/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) is a rare type of non-Hodgkin lymphoma. Previous studies have identified MYD88, CD79b and PIM1 as the most common genetic mutations in PCNSL. The extent to which mutations vary by ethnicity is unknown. The purpose of this study was to describe differences in genetic mutations and survival by Hispanic ethnicity in PCNSL. METHODS 30 patients with PCNSL were examined for mutations in 275 genes by DNA analysis and 1408 genes by RNA analysis utilizing next generation sequencing. RESULTS 60% of patients were Hispanic. 125 different mutated genes were detected. The most commonly affected genes were: MYD88 (44%), CARD11 (21%), CD79b (17%), PIM1 (17%) and KMT2D (17%) . MYD88 mutation was less frequent in Hispanic patients (27% vs 66%, P=.02). More Hispanic patients had >3 mutated genes (89% vs 55 %. P=.03). Two-year progression-free survival (PFS) and overall survival (OS) in Hispanic vs. non-Hispanic patients (PFS 60% vs 27%, P=.09), (OS 60% vs 36%, P=.23). MYD88, CARD11, PIM1, and KMT2D were not associated with significant differences in OS or PFS. CD79b mutation correlated with superior 2-yr PFS (P=.04). CONCLUSIONS We identified highly recurrent genetic alterations in PCNSL. Our data suggest that heterogeneity in some mutations may be related to ethnicity. There was no statistically significant difference in 2-yr PFS and OS in our Hispanic patients. Studies on larger population may further help to describe differences in tumor biology, and outcomes in Hispanic patients.
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Nalivaeva NN, Zhuravin IA, Turner AJ. Neprilysin expression and functions in development, ageing and disease. Mech Ageing Dev 2020; 192:111363. [PMID: 32987038 PMCID: PMC7519013 DOI: 10.1016/j.mad.2020.111363] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 12/21/2022]
Abstract
Neprilysin (NEP) is an integral membrane-bound metallopeptidase with a wide spectrum of substrates and physiological functions. It plays an important role in proteolytic processes in the kidney, cardiovascular regulation, immune response, cell proliferation, foetal development etc. It is an important neuropeptidase and amyloid-degrading enzyme which makes NEP a therapeutic target in Alzheimer's disease (AD). Moreover, it plays a preventive role in development of cancer, obesity and type-2 diabetes. Recently a role of NEP in COVID-19 pathogenesis has also been suggested. Despite intensive research into NEP structure and functions in different organisms, changes in its expression and regulation during brain development and ageing, especially in age-related pathologies, is still not fully understood. This prevents development of pharmacological treatments from various diseases in which NEP is implicated although recently a dual-acting drug sacubitril-valsartan (LCZ696) combining a NEP inhibitor and angiotensin receptor blocker has been approved for treatment of heart failure. Also, various natural compounds capable of upregulating NEP expression, including green tea (EGCG), have been proposed as a preventive medicine in prostate cancer and AD. This review summarizes the existing literature and our own research on the expression and activity of NEP in normal brain development, ageing and under pathological conditions.
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Affiliation(s)
- N N Nalivaeva
- I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia; School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom.
| | - I A Zhuravin
- I.M. Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - A J Turner
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, United Kingdom
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Sopittapan T, Tunthanathip T, Kaewborisutsakul A. Outcome and Prognostic Factors of Primary Central Nervous System Lymphoma in Southern Thailand. Asian J Neurosurg 2020; 15:560-565. [PMID: 33145207 PMCID: PMC7591185 DOI: 10.4103/ajns.ajns_208_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/27/2020] [Accepted: 07/09/2020] [Indexed: 11/04/2022] Open
Abstract
Context: Primary central nervous system lymphoma (PCNSL) is an uncommon type of brain tumor that has an aggressive disease course. Its outcomes, including factor-related outcomes, are therefore not well established in our country. Aims: This study aims to investigate the outcome and prognostic factors in PCNSL patients at our institute. Settings and Design: Retrospective study in a single university hospital. Subjects and Methods: We reviewed consecutive cases of newly diagnosed PCNSL at Prince of Songkla University from 2005 to 2018. The data were collected to evaluate the treatment outcomes and prognostic factors. Statistical Analysis Used: The Kaplan–Meier method for survival analysis, and Cox regression for variable analysis. Results: Eighty-seven patients met the inclusion criteria. Patients were predominantly male, and their mean age was 58.8 ± 11.2 years. Only four patients were infected with HIV. Motor weakness was the most common presentation, and neuroimaging revealed multiple lesions in 56.3% of patients. The patients were divided into four groups according to treatment modality: palliative treatment, whole-brain radiotherapy (WBRT) alone, chemotherapy (CMT) alone, and combined WBRT and CMT groups. The median overall survival was 7 months. The 1-, 2-, and 5-year survival rates were 29%, 21.5%, and 4.6%, respectively. The age of >60 years was a significant poor prognostic factor. In addition, patients who received combined treatment exhibited the highest survival rate. Conclusions: PCNSL has a low survival rate, even in the present era. Older age is the most substantial factor associated with unfavorable outcomes. The most effective treatment is combined with WBRT and CMT.
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Affiliation(s)
- Thanya Sopittapan
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Thara Tunthanathip
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Anukoon Kaewborisutsakul
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
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9
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Monabati A, Nematollahi P, Dehghanian A, Safaei A, Sadeghipour A, Movahedinia S, Mokhtari M. Immune Checkpoint Molecules in Primary Diffuse Large B-Cell Lymphoma of the Central Nervous System. Basic Clin Neurosci 2020; 11:491-498. [PMID: 33613887 PMCID: PMC7878047 DOI: 10.32598/bcn.11.4.2542.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/08/2020] [Accepted: 05/17/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Primary Diffuse Large B Cell Lymphoma of CNS (PCNSL) is a rare variant of Diffuse Large B Cell Lymphoma (DLBCL) and presents with an aggressive clinical course and usually resistant to commonly used therapy regimens. Recently, role of immune checkpoint molecules including PD-1 and PD-L1 confirmed in some solid tumors and lymphoma resulting tumor cells escape the immune system and help to survive and to spread. Inhibitors of PD-1 and PD-L1 have shown lasting responses in several solid and some hematological tumors, while limited studies evaluate checkpoint molecules on PCNSL. Method: In this study, we investigated PD-1 and PD-L1 expression by immunostaining on 71 patients with PCNSL and correlation with demographic data, location of the tumor, proliferation rate, cell of origin, and CD8 positive T cell infiltration in tumor microenvironment. Results: 16 from71 showed PD-1 expression, while PD-L1 expression were 42/71. No association was determined between PD-1/PD-L1 expression and gender, cell of origin, and proliferation rate, but a highly significant difference was determined between the infiltration of CD8 positive T cells in two groups of PD-1/PD-L1 positive and negative. Conclusion: This study revealed expression of check point molecules in remarkable number of PCNSL which may open new therapeutic recommendations in this aggressive lymphoma type.
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Affiliation(s)
- Ahmad Monabati
- Department of Pathology, Hematology Research Center, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Pardis Nematollahi
- Department of Pathology, Cancer Prevention Research Center, Isfahan University of Medical Science, Isfahan, Iran
| | - Amirreza Dehghanian
- Department of Pathology, Molecular Pathology and Cytogenetics Division, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Akbar Safaei
- Department of Pathology, Hematology Research Center, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Alireza Sadeghipour
- Department of Pathology, Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sajjadeh Movahedinia
- Department of Pathology, Faculty of Medicine, Kerman University of Medical Science, Kerman, Iran
| | - Maral Mokhtari
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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