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Wong CE, Liao WA, Chang Y, Lee PH, Huang CC, Chang KC, Lee JS. The role of comorbidity indices and histochemical markers in surgically resected and non-resected primary central nervous system lymphoma. Clin Exp Med 2023; 23:3799-3807. [PMID: 37491648 DOI: 10.1007/s10238-023-01130-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/25/2023] [Indexed: 07/27/2023]
Abstract
The role of surgical resection in primary central nervous system lymphoma (PCNSL) was not recognized until recently. However, prognostic factors for surgically treated PCNSL remain unclear. In the present study, we aimed to identify and compare the prognostic value of comorbidity indices and immunohistochemical markers in patients with surgically and non-surgically treated PCNSL. This retrospective single-center study analyzed patients who underwent either surgical resection or stereotactic biopsy for newly diagnosed PCNSL between January 2012 and December 2021. Clinical demographics, comorbidity indices, and immunohistochemical markers were analyzed. We included 23 and 18 patients who underwent stereotactic biopsy and surgical resection, respectively. The median overall survival (OS) was 11.05 months. Using multivariate Cox regression, we identified pretreatment prognostic nutritional index (PNI) (p = 0.009), positive BCL2 staining (p = 0.026), and infratentorial involvement (p = 0.004) as independent prognostic factors of OS. Predictors of progression-free survival (PFS) included PNI (p = 0.040), infratentorial involvement (p = 0.021), and surgical resection for PCNSL (p = 0.048). Subgroup analyses revealed that positive BCL2 (p = 0.048) and PD-L1 (p = 0.037) staining were associated with worse OS in the biopsy group. PNI and infratentorial involvement could significantly impact both OS and PFS in patients with PCNSL. Surgical resection could predict favorable PFS but not OS. Moreover, BCL2 and PD-L1 expression can be employed as prognostic markers in these patients.
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Affiliation(s)
- Chia-En Wong
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-An Liao
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu Chang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Hsuan Lee
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chen Huang
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kung-Chao Chang
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Shun Lee
- Section of Neurosurgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Intelligent Diagnosis and Analysis of Brain Lymphoma Based on DSC Imaging Features. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4981620. [PMID: 35251152 PMCID: PMC8894066 DOI: 10.1155/2022/4981620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/11/2022] [Accepted: 01/19/2022] [Indexed: 11/23/2022]
Abstract
Currently, DSC has been extensively studied in the diagnosis, differential diagnosis, and prognosis evaluation of brain lymphoma, but it has not obtained a uniform standard. By combining DSC imaging features, this study investigated the imaging features and diagnostic value of several types of tumors such as primary brain lymphoma. At the same time, this study obtained data from brain lymphoma patients by data collection and set up different groups to conduct experimental studies to explore the correlation between IVIMMRI perfusion parameters and DSC perfusion parameters in brain lymphoma. Through experimental research, it can be seen that the combination of two perfusion imaging techniques can more fully reflect the blood flow properties of the lesion, which is beneficial to determine the nature of the lesion.
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Nohira S, Shimato S, Yamanouchi T, Takeuchi K, Yamamoto T, Ito M, Kato K, Nishizawa T. A Case of Primary Leptomeningeal Lymphoma Presenting with Hydrocephalus Characterized by Disproportionately Large Fourth Ventricle. NMC Case Rep J 2022; 8:399-404. [PMID: 35079495 PMCID: PMC8769436 DOI: 10.2176/nmccrj.cr.2020-0215] [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: 06/30/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022] Open
Abstract
Primary leptomeningeal malignant lymphoma (PLML) is a rare variant of primary central nerve system malignant lymphoma (PCNSL) which is restricted to leptomeninges. The lesions of PLML can often be detected as abnormal enhancement on the surface of central nervous system or the ventricular wall on magnetic resonance imaging (MRIs). Cerebrospinal fluid (CSF) evaluation together with such MRI findings provides the definitive diagnosis of PLML. Here, we present a 45-year-old female case of PLML in which hydrocephalus with disproportionately large fourth ventricle was observed at presentation with gait instability. Head MRI revealed no abnormal enhancement and CSF cytology was negative, leaving the cause of hydrocephalus undetermined. Endoscopic third ventriculostomy (ETV) was effectively performed for hydrocephalus and her symptoms disappeared. Nearly 2 years later, she was brought to emergent room due to unconsciousness with the recurrence of hydrocephalus. MRI showed expanded fourth ventricle and abnormal enhancement on the ventricular wall. The endoscopic surgery for improving CSF flow was successful and inflammatory change was endoscopically observed on the ventricular wall involving aqueduct. Pathological diagnosis of the specimen from the ventricular wall proved B-cell lymphoma. Because neither brain parenchymal masses nor systemic tumors were identified, she was diagnosed with PLML and treated by high-dose methotrexate. She was in a stable state 2 years after the diagnosis of PLML. We report and discuss the characteristics of this case.
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Affiliation(s)
- Shota Nohira
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Shinji Shimato
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Takashi Yamanouchi
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Kazuhito Takeuchi
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Taiki Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Makoto Ito
- Department of Pathology, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Kyozo Kato
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Toshihisa Nishizawa
- Department of Neurosurgery, Kariya Toyota General Hospital, Kariya, Aichi, Japan
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Perez-Roman RJ, Hubbard ZS, Brusko GD, Starke RM. A case of primary central nervous system lymphoma presenting as a shunt complication. Br J Neurosurg 2020:1-4. [PMID: 32164443 DOI: 10.1080/02688697.2020.1735300] [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] [Indexed: 10/24/2022]
Abstract
The authors describe an 82-year-old female with a right frontal ventriculoperitoneal (VP) shunt for long-standing normal pressure hydrocephalus (NPH) who presented with worsening incontinence and gait instability. She was found to have right lateral ventricle collapse around the shunt catheter and subsequently underwent shunt revision, which failed to improve her symptoms. Magnetic resonance imaging (MRI) was obtained on postoperative day two, which demonstrated a ventricular lesion. Endoscopic brain biopsy was performed and a diagnosis of primary central nervous system lymphoma (PCNSL) was made. The authors believe this is the first published case of PCNSL presenting as a VP shunt complication in a patient with NPH.
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Affiliation(s)
- Roberto J Perez-Roman
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
| | - Zachary S Hubbard
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
| | - G Damian Brusko
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL, USA
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