NIMG-10. ATYPICAL RADIOLOGICAL FINDINGS OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL): A 12-YEAR SINGLE-CENTER REVIEW

Abstract OBJECTIVE To identify clinico-radiographic characteristics associated with delayed treatment initiation in central nervous system lymphoma (CNSL). INTRODUCTION Clinical and radiographic characteristics of CNSL are often varied with a broad differential diagnosis, potentially leading to delays in diagnosis and treatment. METHODS A single-center retrospective review of clinico-radiographic data was performed at Columbia University Irving Medical Center in patients with pathologically confirmed CNSL diagnosed from 1/2010–12/2018. Descriptive statistics and univariate logistic regression were used to identify variables associated with delayed treatment. Using visual binning, delayed treatment time was designated as >33 days from first presentation to medical attention to first chemotherapy for CNSL. Variables of interest included demographic data, presenting symptomatology, radiographic characteristics, location of initial presentation, and diagnostic and therapeutic interventions performed before biopsy. RESULTS Seventy patients (36 men (51%); median age at diagnosis 70 years, IQR 14.75 years; median time from first presentation to treatment 21 days, IQR 41.25 days) were included. Presentation with cognitive deficits suggested a strong, but not statistically significant, association with delayed treatment (OR=1.93, p=0.20), whereas presentation with focal neurologic deficits suggested protection against delayed treatment (OR=0.25, p=0.05). Initial presentation to a hospital suggested a strong, but not statistically significant, trend against delayed treatment (OR=0.41, p=0.08). Multifocal disease on neuroimaging (OR=7.18, p=0.001), pre-biopsy cerebrospinal fluid (CSF) sampling (OR=5.18, p=0.002), and pre-biopsy immunomodulatory treatment (including high-dose intravenous corticosteroids) for suspected neuroinflammatory disease (OR=6.33, p=0.03) had statistically significant associations with delayed treatment. Antimicrobial treatment before biopsy for suspected CNS infection suggested a trend toward delayed treatment, but the association was not statistically significant (OR=5.1, p=0.06). CONCLUSIONS Multifocal disease and pre-biopsy CSF sampling and immunomodulatory therapy were associated with delayed treatment initiation for CNSL in our single-center cohort. Recognizing factors associated with delayed treatment may allow physicians to circumvent these factors and permit more rapid diagnosis through tissue sampling.

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Atypical radiological findings of primary central nervous system lymphoma

Neuroradiology ◽

10.1007/s00234-020-02377-0 ◽

2020 ◽

Vol 62 (6) ◽

pp. 669-676

Author(s):

Xuling Lin ◽

Iram Rais Alam Khan ◽

Ying Hao Christopher Seet ◽

Hwei Yee Lee ◽

Wai-Yung Yu

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Central Nervous System Lymphoma ◽

Radiological Findings

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Treatment with methotrexate, rituximab, and cytosine arabinoside followed by autologous stem cell transplantation in primary central nervous system lymphoma: A single-center experience

Hematology/Oncology and Stem Cell Therapy ◽

10.1016/j.hemonc.2017.05.030 ◽

2018 ◽

Vol 11 (1) ◽

pp. 13-17 ◽

Cited By ~ 3

Author(s):

Pinar Ataca Atilla ◽

Erden Atilla ◽

Sinem Civriz Bozdag ◽

Meltem Kurt Yuksel ◽

Selami Kocak Toprak ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Stem Cell ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Autologous Stem Cell Transplantation ◽

Cytosine Arabinoside ◽

Central Nervous System Lymphoma ◽

Single Center ◽

Single Center Experience

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Characteristics and Outcomes of Patients With Primary Central Nervous System Lymphoma: A Single Center Experience and Review of the Literature

International Journal of Hematology and Oncology ◽

10.4999/uhod.11088 ◽

2012 ◽

Vol 22 (4) ◽

pp. 227-232

Author(s):

Serdal Korkmaz

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Central Nervous System Lymphoma ◽

Review Of The Literature ◽

Single Center ◽

Single Center Experience

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ML-01 Pathological characteristics of primary central nervous system lymphoma with atypical radiological finding

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa143.065 ◽

2020 ◽

Vol 2 (Supplement_3) ◽

pp. ii15-ii15

Author(s):

Madoka Inukai ◽

Ichiyo Shibahara ◽

Hajime Handa ◽

Wakiko Saruta ◽

Sumito Sato ◽

...

Keyword(s):

Central Nervous System ◽

Blood Flow ◽

Nervous System ◽

Blood Vessels ◽

Central Nervous System Lymphoma ◽

Radiological Findings ◽

Adc Value ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background: If the brain tumor is suspected to be a primary central nervous system lymphoma (PCNSL) on radiological findings, it is general to perform biopsy to obtain the pathological diagnosis. Glioblastomas (GBs) must be distinguished from PCNSLs. In addition to commonly used contrast-enhanced T1-weighted imaging, diffusion-weighted image (DWI), and apparent diffusion coefficient (ADC) value, the following characteristics of PCNSLs were reported to be essential for this purpose: 1) no increase in blood flow on perfusion images obtained by the arterial spin labeling (ASL) method; 2) less microbleeding on T2*-weighted images (T2*). However, we experienced some exceptional cases. Purpose: To clarify the histopathological features of PCNSLs those had atypical radiological findings. Method: 62 consecutive PCNSL cases (40 males, 22 females, mean age 65.4 years, range 35–84) treated in our department from April 2013 to March 2020 were retrospectively analyzed. We compared the following features between 47 biopsy cases showing typical image findings as PCNSLs (Group A) and 15 surgically resected cases with atypical findings (Group B), 1) number of blood vessels per hyper 10 fields, 2) occupying area of blood vessels per unit area, 3) immunoreactivity of vascular endothelial growth factor (VEGF), and 4) germinal center B-cell (GCB) subtype. Results: In Group A, the number of blood vessels in the tumor was 39.3 on average, and the area occupied by blood vessels was 3.8%. In Group B, the former was 133.2, and the latter was 9.9%. There was no significant difference in VEGF expression and GCB subtype. Conclusion: In PCNSLs showing with high blood flow and microbleeds, the blood vessels were rich and partial bleeding was confirmed histologically. We should analyze much more cases to set the threshold both of the ADC value and the absolute value of blood flow calculated by the ASL method to distinguish between PCNSLs and GBs.

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