P03.04 Primary CNS lymphoma of the corpus callosum: presentation and neurocognitive prognosis. Study of a monocentric cohort of 27 patients

BACKGROUND

The corpus callosum (CC) is frequently involved in primary central nervous system lymphomas (PCNSL). The aim of our study was to describe the impact of these lesions on neurocognition of patients presenting with PCNSL of the CC (PCNSL-CC) and their post-therapeutic evolution.

MATERIAL AND METHODS

This is a retrospective single-center study. Patients newly diagnosed at Pitié Salpêtrière Hospital from (1999–2018) were included in this study according to the following criteria: age >18, immunocompetent patient, pathological confirmation (Diffuse Large B cell lymphoma) and CC as main location of the tumor on MRI. Clinical, neuroradiological and neuropsychological data of the patients were collected. In addition, prognostic factors for the neurocognitive outcome of the patients were investigated.

RESULTS

27 patients were included (median age: 67 years, median KPS: 70). At the time of diagnosis, 74% of patients had cognitive impairment and 59% of patients had balance disorders. The cognitive functions most frequently affected were memory and executive functions. Tumor lesions in the CC had a median maximum diameter of 5 cm with a so called “butterfly pattern” in 92% of cases. All patients received a high dose methotrexate based polychemotherapy, including one with radiation therapy, and 67% of patients achieved a complete remission (CR). Median PFS and OS were 33.3 months and 177.9 months respectively. With a median follow-up of 48 months (range 6–156), despite CR, there were still abnormal values in 17% of patients on overall efficiency, 17–55% of patients on executive function tests, 45–55% of patients on memory tests. No significant impaired values were found for visuo-spatial and language tests. Splenial location and age ≥ 60 years were significantly associated with worse episodic memory scores throughout the follow-up.

CONCLUSION

PCNSL-CC are associated with frequent cognitive dysfunctions, especially memory impairment, which may recover only partially despite CR, that warrant specific rehabilitation. Older age (≥ 60) and splenial location have worse neurocognition outcome.

Merkel cell tumor: report of two cases and review of the literature

The "Merkel cell carcinoma" is a rare tumor usually occuring in the sun-exposed skin. Its poor prognosis is explained by a high rate of metastasis (one third of the patients at the initial presentation) and a high post-operative recurrence rate. Descriptions of the imaging features of this type of tumor are rare. We present two cases of Merkel cell carcinoma localized to the head region. In the first patient, the lesion involved the soft tissues of the scalp with secondary invasion of the skull and meninges. The second patient had a metastasis to the parietal lobe.

Dilatation of deep medullary veins in cortical venous occlusion due to focal tuberculous leptomeningitis

We report a case of surgically proven, focal left parietal tuberculous leptomeningitis. Occlusion of superficial cerebral veins in the affected area led to dilatation of medullary veins to drain the left parietal lobe. Deep medullary veins were clearly demonstrated on MRI and angiography.