Diagnosis and treatment of primary central nervous system lymphoma

Object White matter diseases, including demyelinating or inflammatory disorders, may be indistinguishable clinically and radiologically from some central nervous system (CNS) tumors. In such situations, determination of the final diagnosis is difficult. An example is the differential diagnosis of non-acquired immunodeficiency syndrome–related primary central nervous system lymphoma (PCNSL) and multiple sclerosis (MS), a demyelinating disease. Unfortunately, delayed diagnosis and treatment of PCNSL can negatively affect prognosis. Methods The authors reviewed the cases of eight patients with PCNSL or MS. In each case, the initial diagnosis (PCNSL or MS) was equivocal. In these cases, conventional diagnostic approaches were not definitive, thus further delaying diagnosis. The initial symptoms, the selected diagnostic tests, and the presumptive as well as final diagnosis for each case are discussed. The final diagnosis was PCNSL in six cases and MS in two. The uncertainty about the clinical or initial pathological presentation required further diagnostic evaluation in all cases. Two important neurosurgical guidelines are the avoidance of corticosteroid agents and performance of biopsy sampling rather than volumetric tumor resection. High-volume lumbar puncture, slit-lamp examination/vitrectomy, new CNS imaging techniques, and repeated biopsy procedures also proved helpful. Conclusions In PCNSL, early definitive diagnosis and treatment are the keys to successful outcomes. Knowledge of strategies essential to early diagnosis lessens the need for brain biopsy sampling, but this procedure is still usually necessary. In such selected cases, biopsy sampling is appropriate even when pathological investigation shows MS rather than PCNSL. Complete resection is not indicated in PCNSL and can lead to additional sequelae.

Download Full-text

Ocular presentation of primary central nervous system lymphoma: diagnosis and treatment

British Journal of Haematology ◽

10.1111/j.1365-2141.2004.05028.x ◽

2004 ◽

Vol 126 (2) ◽

pp. 202-208 ◽

Cited By ~ 87

Author(s):

Adília Hormigo ◽

Lauren Abrey ◽

Murk-Hein Heinemann ◽

Lisa M. DeAngelis

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Central Nervous System Lymphoma ◽

Diagnosis And Treatment

Download Full-text

Prognostic factors in the diagnosis and treatment of primary central nervous system lymphoma

Cancer ◽

10.1002/1097-0142(19890301)63:5<939::aid-cncr2820630526>3.0.co;2-v ◽

1989 ◽

Vol 63 (5) ◽

pp. 939-947 ◽

Cited By ~ 96

Author(s):

Ian F. Pollack ◽

L. Dade Lunsford ◽

John C. Flickinger ◽

H. Lee Dameshek

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Prognostic Factors ◽

Central Nervous System Lymphoma ◽

Diagnosis And Treatment

Download Full-text

18F-FDG PET in the Diagnosis and Treatment of Primary Central Nervous System Lymphoma

BioMed Research International ◽

10.1155/2013/247152 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 37

Author(s):

Nobuyuki Kawai ◽

Keisuke Miyake ◽

Yuka Yamamoto ◽

Yoshihiro Nishiyama ◽

Takashi Tamiya

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Brain Tumors ◽

Fdg Pet ◽

Early Stage ◽

Central Nervous System Lymphoma ◽

Diagnosis And Treatment ◽

Fdg Uptake ◽

Malignant Brain Tumors ◽

Positron Emission

This paper summarizes the usefulness and limitation of positron emission tomography (PET) with18F-fluorodeoxyglucose (18F-FDG) in the diagnosis and treatment of primary central nervous system lymphoma (PCNSL). The18F-FDG uptake in typical PCNSL is about 2.5 times higher than that in the normal gray matter, and the tumor can usually be identified visually. The18F-FDG uptake pattern and value provide useful information for differentiating PCNSL from other enhancing malignant brain tumors especially glioblastoma (GB). The18F-FDG uptake in typical PCNSL is usually homogenous, and the uptake value is significantly higher than that in GB. However,18F-FDG PET often fails to show the presence of tumor in the brain as18F-FDG uptake is faint in atypical PCNSL such as disseminated or nonenhancing lesions.18F-FDG PET is also useful for evaluating the treatment response at a very early stage after the initial treatment. Pretreatment and posttreatment18F-FDG uptake values may have a prognostic value in patients with PCNSL. In conclusion,18F-FDG PET is very useful in the diagnosis of typical PCNSL and can differentiate PCNSL from other malignant brain tumors. However, the usefulness of18F-FDG PET is limited in the diagnosis of atypical PCNSL.

Download Full-text

P308 – 2060 Primary central nervous system lymphoma: radiology based diagnosis and treatment when tissue diagnosis is not possible

European Journal of Paediatric Neurology ◽

10.1016/s1090-3798(13)70487-2 ◽

2013 ◽

Vol 17 ◽

pp. S138

Author(s):

H Maras ◽

EU Yalcin ◽

Y Anik ◽

B Kara

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Central Nervous System Lymphoma ◽

Diagnosis And Treatment ◽

Tissue Diagnosis

Download Full-text

ML-09 DIAGNOSIS AND TREATMENT OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA IN HIV POSITIVE PATIENTS

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz039.151 ◽

2019 ◽

Vol 1 (Supplement_2) ◽

pp. ii33-ii34

Author(s):

Koji Takano ◽

Keisuke Nishimoto ◽

Hiroki Yamazaki ◽

Koki Murakami ◽

Tetsuro Tachi ◽

...

Keyword(s):

Central Nervous System ◽

Cerebrospinal Fluid ◽

Nervous System ◽

Malignant Lymphoma ◽

Central Nervous System Lymphoma ◽

Brain Biopsy ◽

Final Diagnosis ◽

Diagnosis And Treatment ◽

Hiv Positive ◽

Whole Brain Irradiation

Abstract INTRODUCTION HIV infection is known to cause a variety of central nervous system complications, such as malignant lymphoma (ML), toxoplasma encephalopathy, cryptococcal encephalopathy, progressive multifocal leukoencephalopathy (PML), brain tuberculosis and HIV encephalopathy. In our hospital, we performed brain biopsy for HIV-positive patients with central nervous system lesions suspected malignant lymphoma, or cases difficult to diagnose with blood, cerebrospinal fluid, and imaging alone. In this study, we retrospectively examined HIV-positive patients who underwent brain biopsy at our hospital, and analyzed diagnosis and treatment of patients with ML. Methods HIV-positive patients who underwent brain biopsy in our hospital from January 2010 to April 2019 were examined in this study. We analyzed background factors, preoperative examination results, pathological diagnosis, treatment and prognosis. RESULTS There were 1,894 HIV-positive patients who were treated at our hospital during the period, of which 16 cases underwent a total of 18 brain biopsies. The final diagnosis was 7 ML (6 PCNSL, 1 brain metastasis), 3 toxoplasma encephalopathy, 1 PML, 1 brain tuberculosis, 1 immune reconstitution syndrome, 1 Penicillium marneffei infection, 1 hematoma and one case that could not be diagnosed. In patients with ML, preoperative sIL-2 receptor was higher and EBV positive cases in cerebrospinal fluid tended to be more common (p=0.051, p=0.086, respectively). Five of the six patients with PCNSL were treated at our hospital, four of which were treated with highly active antiretroviral treatment (HAART) and whole-brain irradiation and one with HAARA alone, resulting four with CR and one with SD. Four patients, except one who had sudden death of unknown cause, were still alive without recurrence (median observation period 44.5 months). CONCLUSION At the moment, it is difficult to diagnose ML without brain biopsy. HIV-positive status has been regarded as a poor prognosis factor in PCNSL patients, but the prognosis seems to have improved with HAART.

Download Full-text