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

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.

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Usefulness of Dual Isotope 123I-IMP and 201Tl SPECT for the Diagnosis of Primary Central Nervous System Lymphoma and Glioblastoma

10.21203/rs.3.rs-234133/v1 ◽

2021 ◽

Author(s):

Sho Osawa ◽

Masahiko Tosaka ◽

Keishi Horiguchi ◽

Azusa Tokue ◽

Tetsuya Higuchi ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Single Photon ◽

Photon Emission ◽

Area Under The Curve ◽

Central Nervous System Lymphoma ◽

Emission Computed Tomography ◽

Dual Isotope ◽

Apparent Diffusion Coefficient Values ◽

The Mean

Abstract IntroductionPreoperative differential diagnosis between glioblastoma (GBM) and primary central nervous system lymphoma (PCNSL) is important because these tumors require different surgical strategies. This study investigated the usefulness of dual isotope, iodine-123-labeled N-isopropyl-p-iodoamphetamine (123I-IMP) and thallium-201 chloride single photon emission computed tomography (201Tl SPECT) for the differential diagnosis.MethodsTwenty-five PCNSL patients and 27 GBM patients who underwent dual isotope, 123I-IMP and 201Tl SPECT are included. Tumor to normal (T/N) ratio was calculated from the ratio of maximum tracer counts in the contrast-enhanced lesion to the mean counts in the contralateral cerebral cortex. The mean and minimum apparent diffusion coefficient values (ADCmean, and ADCmin, respectively) on magnetic resonance imaging were also analyzed. ResultsTumor to normal (T/N) ratios of PCNSL were significantly higher than that of GBM for both isotopes and phases (P < 0.001). Both ADC values of PCNSL were significantly lower than those of GBM (P < 0.001). Delayed phase 123I-IMP gave the most accurate findings for differentiation between PCNSL and GBM with the optimum cut-off value of 1.009, sensitivity 92.0%, specificity 88.9%, and area under the curve 0.945 (95% confidence interval, 0.883-1.000). Fifty of 52 patients (96.2%) showed retention index of 201Tl SPECT 0.7 or higher, which indicates malignant brain tumors. ConclusionsDelayed phase 123I-IMP SPECT could differentiate between PCNSL and GBM with the highest accuracy. 201Tl SPECT was useful for estimation of the malignancy and localization of the tumors. Dual isotope 123I-IMP and 201Tl SPECT was useful for the preoperative diagnosis of PCNSL and GBM.

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

Neuro-Oncology Practice ◽

10.1093/nop/npz015 ◽

2019 ◽

Vol 6 (6) ◽

pp. 415-423 ◽

Cited By ~ 1

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.

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Imaging of central nervous system sarcoidosis with gallium-67 single photon emission computed tomography

British Journal of Radiology ◽

10.1259/0007-1285-69-818-192 ◽

1996 ◽

Vol 69 (818) ◽

pp. 192-194 ◽

Cited By ~ 6

Author(s):

P R Jarman ◽

M K B Whyte ◽

D M Glass ◽

A M Peters

Keyword(s):

Computed Tomography ◽

Central Nervous System ◽

Nervous System ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Single Photon Emission ◽

Single Photon Emission Computed ◽

Photon Emission Computed Tomography ◽

Gallium 67

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

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.255 ◽

2016 ◽

Vol 43 (5) ◽

pp. 721-725 ◽

Cited By ~ 15

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.

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