scholarly journals The Influence of Corticosteroids on Diagnostic Accuracy of Biopsy for Primary Central Nervous System Lymphoma

2016 ◽  
Vol 43 (5) ◽  
pp. 721-725 ◽  
Author(s):  
Mashary Binnahil ◽  
Karolyn Au ◽  
Jian-Qiang Lu ◽  
Blaise Matthew Wheatley ◽  
Tejas Sankar
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Diagnostic Yield ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
Lymphoproliferative Disease ◽  
Stereotactic Brain Biopsy ◽  
Corticosteroid Administration ◽  
Initial Biopsy ◽  
Polymerase Chain

AbstractClassical neurosurgical teaching suggests that corticosteroid administration reduces the diagnostic yield of stereotactic brain biopsy for primary central nervous system lymphoma (PCNSL). In a single-center series spanning 6 years, we reviewed 155 consecutive biopsy patients, 135 treated with prebiopsy corticosteroids. PCNSL was correctly diagnosed on initial biopsy in 15 of 16 steroid-treated patients; in the single nondiagnostic specimen, polymerase chain reaction reanalysis by an outside institution showed evidence of lymphoproliferative disease consistent with PCNSL. Our data challenge the notion that it is necessary to withhold corticosteroid therapy for cerebral edema in patients awaiting stereotactic biopsy for suspected PCNSL.

scholarly journals Diagnosis of primary central nervous system lymphoma: a systematic review of the utility of CSF screening and the role of early brain biopsy

2019 ◽  
Vol 6 (6) ◽  
pp. 415-423 ◽  
Author(s):  
Alexis A Morell ◽  
Ashish H Shah ◽  
Claudio Cavallo ◽  
Daniel G Eichberg ◽  
Christopher A Sarkiss ◽  
...  
Keyword(s):  
Systematic Review ◽  
Central Nervous System ◽  
Nervous System ◽  
Diagnostic Yield ◽  
Diagnostic Delay ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
Suspected Case ◽  
Stereotactic Brain Biopsy

Abstract Background Because less-invasive techniques can obviate the need for brain biopsy in the diagnosis of primary central nervous system lymphoma (PCNSL), it is common practice to wait for a thorough initial work-up, which may delay treatment. We conducted a systematic review and reviewed our own series of patients to define the role of LP and early brain biopsy in the diagnosis of PCNSL. Methods Our study was divided into 2 main sections: 1) systematic review assessing the sensitivity of cerebrospinal fluid (CSF) analysis on the diagnosis of PCNSL, and 2) a retrospective, single-center patient series assessing the diagnostic accuracy and safety of early biopsy in immunocompetent PCNSL patients treated at our institution from 2012 to 2018. Results Our systematic review identified 1481 patients with PCNSL. A preoperative LP obviated surgery in 7.4% of cases. Brain biopsy was the preferred method of diagnosis in 95% of patients followed by CSF (3.1%). In our institutional series, brain biopsy was diagnostic in 92.3% of cases (24/26) with 2 cases that required a second procedure for diagnosis. Perioperative morbidity was noted in 7.6% of cases (n = 2) due to hemorrhages after stereotactic brain biopsy that improved at follow-up. Conclusions The diagnostic yield of CSF analyses for PCNSL in immunocompetent patients remains exceedingly low. Our institutional series demonstrates that early biopsy for PCNSL is safe and accurate, and may avert protracted work-ups. We conclude that performing an early brain biopsy in a suspected case of PCNSL is a valid, safe option to minimize diagnostic delay.

scholarly journals Case report of an elderly woman with atypical imaging for primary central nervous system lymphoma who needed a brain biopsy for diagnosis

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110351
Author(s):  
Kosuke Matsuzono ◽  
Tomoya Yagisawa ◽  
Keisuke Ohtani ◽  
Yohei Ishishita ◽  
Takashi Yamaguchi ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Fdg Pet ◽  
Single Photon ◽  
Photon Emission ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
Emission Computed Tomography ◽  
Stereotactic Brain Biopsy ◽  
Imaging Results

Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma, but its diagnosis is challenging in some cases. A brain biopsy is the gold standard for diagnosing PCNSL, but its invasiveness can be problematic. Thus, noninvasive imaging examinations have been developed for the pre-surgical diagnosis of PCNSL, including gadolinium-enhanced magnetic resonance imaging (MRI), 123I-N-isopropyl-p-iodoamphetamine single-photon emission computed tomography (123I-IMP SPECT), and positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG PET). Here, we report the case of a 71-year-old woman with negative imaging findings for PCNSL, but who was diagnosed with PCNSL by a brain biopsy and histological analysis. Her imaging results were negative for gadolinium-enhanced cranial MRI, with low uptake in 123I-IMP SPECT and hypometabolism in 18F-FDG PET. However, a stereotactic brain biopsy from an abnormal lesion revealed that many round cells had infiltrated into the brain. Moreover, many infiltrating cells were positive for cluster of differentiation (CD)20 and CD79a, and proliferation marker protein Ki-67-positive cells accounted for nearly 80% of all cells. Based on these results, our final pathological diagnosis was PCNSL. The present case highlights the possibility of a PCNSL diagnosis even when all imaging-related examinations display negative results.

Analysis of immunoglobulin H gene rearrangement by polymerase chain reaction in primary central nervous system lymphoma

2002 ◽  
Vol 97 (6) ◽  
pp. 1390-1396 ◽  
Author(s):  
Johan M. Kros ◽  
Eniko K. Bagdi ◽  
Pingpin Zheng ◽  
Wim C. Hop ◽  
Maarten J. Driesse ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Polymerase Chain Reaction ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
The Body ◽  
Chain Reaction ◽  
Content Type ◽  
Pcr Method ◽  
Polymerase Chain ◽  
Fine Print

Object. Diagnosing primary central nervous system lymphoma (PCNSL) may be difficult either because of a paucity of tumor cells in the brain biopsy specimens or a failure to demonstrate monoclonality on immunomorphological studies. Monoclonality can also be demonstrated by amplification of the rearranged immunoglobulin H genes by polymerase chain reaction (PCR) to the framework region (FR)3 and FR2 complementarity determining region (CDR)-III and CDR-II of these genes. The PCR method is feasible with formalin-fixed, paraffin-embedded biopsy material and has proven to be helpful in the diagnosis of non-Hodgkin lymphoma on biopsy samples obtained from various locations in the body. Nevertheless, few studies have addressed the value of this method in the context of PCNSL. In the present study, the contribution of both FR3 single and FR2 seminested PCR procedures for confirming the diagnosis of PCNSL was estimated retrospectively in 30 cases of PCNSL and in three cases of epidural lymphoma. Methods. Twenty-eight cases of immunophenotypically confirmed PCNSL and two of suspected lymphoma were studied. Tissue specimens obtained in 22 cases of other cerebral diseases, among which were various inflammatory conditions, were used as negative controls. In 18 (60%) of 30 cases the results of FR3 PCR demonstrated monoclonality, whereas FR2 PCR showed monoclonality in 12 cases (40%). In 11 cases FR3 PCR yielded monoclonal patterns and FR2 PCR did not, whereas reversibly in five cases FR2 PCR proved monoclonality and FR3 PCR failed to do so. Adding the results of FR3 to those of FR2 PCR, monoclonal patterns were obtained in 23 (77%) of 30 cases. In both cases in which lymphoma was suspected but not proven immunomorphologically, FR3 PCR revealed monoclonality, as did FR2 PCR in one case. In all 22 control lesions either polyclonal patterns were seen or no consistent patterns were obtained. In the PCNSL group, older age of patients and multifocal presentation of lesions on neuroimaging were significantly associated with worse survival. No correlation between histological subtype and clinical outcome was elucidated. Conclusions. The application of FR3 and FR2 PCR is a useful additional tool in making the diagnosis of PCNSL. Moreover, in some cases the PCR method may be essential in distinguishing neoplasia from reactive conditions.

scholarly journals Diagnostic Yield and Complication of Frameless Stereotactic Brain Biopsy

2019 ◽  
Vol 10 (01) ◽  
pp. 78-84 ◽  
Author(s):  
Chin Taweesomboonyat ◽  
Thara Tunthanathip ◽  
Sakchai Sae-Heng ◽  
Thakul Oearsakul
Keyword(s):  
Diagnostic Yield ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
High Grade Glioma ◽  
Intracerebral Hematoma ◽  
Low Grade ◽  
Essential Factor ◽  
Stereotactic Brain Biopsy ◽  
Intraoperative Bleeding ◽  
Positive Biopsy

Background: With the advancement of neuronavigation technologies, frameless stereotactic brain biopsy has been developed. Previous studies proved that frameless stereotactic brain biopsy was as effective and safe as frame-based stereotactic brain biopsy. The authors aimed to find the factors associated with diagnostic yield and complication rate of frameless intracranial biopsy. Materials and Methods: Frameless stereotactic brain biopsy procedures, between March 2009 and April 2017, were retrospectively reviewed from medical records including imaging studies. Using logistic regression analysis, various factors were analyzed for association with diagnostic yield and postoperative complications. Results: Eighty-nine frameless stereotactic brain biopsy procedures were performed on 85 patients. The most common pathology was primary central nervous system lymphoma (43.8%), followed by low-grade glioma (15.7%), and high-grade glioma (15%), respectively. The diagnostic yield was 87.6%. Postoperative intracerebral hematoma occurred in 19% of cases; however, it was symptomatic in only one case. The size of the lesion was associated with both diagnostic yield and postoperative intracerebral hematoma complication. Lesions, larger than 3 cm in diameter, were associated with a higher rate of positive biopsy result (P = 0.01). Lesion 3 cm or smaller than 3 cm in diameter, and intraoperative bleeding associated with a higher percentage of postoperative intracerebral hematoma complications (P = 0.01). Conclusions: For frameless stereotactic brain biopsy, the size of the lesion is the essential factor determining diagnostic yield and postoperative intracerebral hematoma complication.

scholarly journals ML-13 Primary central nervous system malignant lymphoma in a patient with rheumatoid arthritis receiving tocilizumab

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi24-vi24
Author(s):  
Masasuke Ohno ◽  
Syunichiro Kuramitsu ◽  
Syohei Ito ◽  
Masayuki Kimata ◽  
Takumi Asai ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Central Nervous System ◽  
Nervous System ◽  
Malignant Lymphoma ◽  
Low Dose ◽  
Central Nervous System Lymphoma ◽  
Stereotactic Brain Biopsy ◽  
Dose Methotrexate ◽  
First Case ◽  
Risk Of Cancer

Abstract Background: Although the risk of developing malignant lymphoma is higher in patients with rheumatoid arthritis (RA) than in the general population, the occurrence of primary central nervous system lymphoma (PCNSL) in patients with RA is extremely rare. In recent years, there has been concern that biological disease-modifying antirheumatic drugs (DMRADs), which are widely administered to patients with RA, may increase the risk of developing cancer. We report the first case of PCNSL in a patient with RA who was treated with the biological DMRADs, tocilizumab. Case description: A 70-year-old man, who was diagnosed with RA in 2010 was treated with low-dose methotrexate from 2010 to 2015. He was started on tocilizumab in 2012. In 2018, he suffered from gait disturbance and was diagnosed with lumbar spinal stenosis. He underwent L2/3 posterior fusion surgery, but his paraplegia gradually deteriorated. Two months after the surgery, a head Gd-MRI showed multiple contrast-enhanced lesions in the basal ganglia and brain stem. A stereotactic brain biopsy was performed and DLBCL was diagnosed, and finally PCNSL was diagnosed because of no neoplastic lesions in other organs. He was treated with 5 courses of MTX 3.5g/m2 with rituximab and has been in remission for 23 months. He has maintained an independent life with residual paraplegia, but his ADLs gradually worsened. He was restarted on tocilizumab with a diagnosis of worsening RA. Conclusion: Low-dose methotrexate and biological DMRADs including tocilizumab, have been concerned to increase the risk of cancer in patients with RA, but there is no solid evidence. Since it has been a short time since the use of biological DMRADs, further accumulation of cases and careful follow-up are necessary.

scholarly journals A Rare Case of Spontaneous Remission and Relapse of a Primary Central Nervous System Lymphoma

2018 ◽  
Vol 31 (12) ◽  
pp. 777 ◽  
Author(s):  
Rui Ramos ◽  
João Soares Fernandes ◽  
Marta Almeida ◽  
Rui Almeida
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Rare Case ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
B Cell Lymphoma ◽  
Spontaneous Remission ◽  
Neurological Deficits ◽  
Pubmed Search ◽  
The Central Nervous System

Primary central nervous system lymphoma remission after steroid treatment is a well-known phenomenon, but remission without any type of treatment is extremely rare. We present a rare case of spontaneous remission of a diffuse large B-cell lymphoma of the central nervous system as well as its subsequent reappearance in another location. The atypical presentation misled the neurosurgeons and neurologists, delaying diagnosis and treatment. The patient underwent brain biopsy after the relapse and started radiotherapy and chemotherapy with cytarabine + methotrexate + rituximab. As of 32 months after the diagnosis, the patient remained asymptomatic, with no focal neurological deficits and the disease in complete remission. A PubMed search of the literature up to June 2017 regarding spontaneous remission central nervous system lymphoma was also carried out.

Primary central nervous system lymphoma and brain biopsy in AIDS

The Lancet ◽  
1993 ◽  
Vol 341 (8857) ◽  
pp. 1411-1412 ◽  
Author(s):  
Andrea Antinori ◽  
Adriana Ammassari ◽  
Rita Murri ◽  
Mario Tumbarello ◽  
Luigi Ortona ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy

Expression of B-cell–attracting chemokine 1 (CXCL13) by malignant lymphocytes and vascular endothelium in primary central nervous system lymphoma

Blood ◽  
2003 ◽  
Vol 101 (3) ◽  
pp. 815-821 ◽  
Author(s):  
Justine R. Smith ◽  
Rita M. Braziel ◽  
Samantha Paoletti ◽  
Martin Lipp ◽  
Mariagrazia Uguccioni ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
B Cell ◽  
Vascular Endothelium ◽  
Tumor Development ◽  
Cell Movement ◽  
Central Nervous System Lymphoma ◽  
Brain Biopsy ◽  
B Cell Lymphoma ◽  
Biopsy Specimens

Abstract Primary central nervous system lymphoma (PCNSL) is a rare but often rapidly fatal form of non-Hodgkin B-cell lymphoma that arises within the central nervous system (CNS) and has a low propensity to metastasize. We performed immunohistochemistry on formalin-fixed, paraffin-embedded brain biopsy specimens from 24 patients with PCNSL to investigate the expression of B cell–attracting chemokine 1 (BCA-1, CXCL13), a lymphoid chemokine involved in B-cell compartmental homing within secondary lymphoid organs and recently implicated in the pathogenesis of inflammatory and malignant lymphocyte-mediated diseases. Whereas BCA-1 was not detected in normal human brain, all 24 brain biopsy specimens containing PCNSL were positive for BCA-1. Double immunostaining on selected specimens localized BCA-1 to malignant B lymphocytes and vascular endothelium. In contrast, 2 chemokines implicated particularly in T-cell movement, secondary lymphoid tissue chemokine (SLC, CCL21) and Epstein-Barr virus–induced molecule 1 ligand chemokine (ELC, CCL19), were expressed only by occasional stromal cells in 2 and 4 of the 24 specimens, respectively. Tumor cells stained positively for CXCR5, the primary receptor for BCA-1. In situ hybridization verified the expression of BCA-1 mRNA by malignant B cells, but not vascular endothelium, within the tumor mass, suggesting that vascular endothelial BCA-1 expression may be consequent to transcytosis. In PCNSL, expression of BCA-1 by malignant lymphocytes and vascular endothelium may influence tumor development and localization to CNS.

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