Primary lymphomas of the central nervous system (PCLCS) are relatively rare tumors, usually having a multifocal manifestation in the brain and rapid progression. It is not always possible to make a correct diagnosis for MRI, since similar radiological manifestations (markers) of this disease, when using routine protocols, MRI can occur, for example, in malignant gliomas. This article presents a clinical case of a refinement diagnosis — PLCNS when using MRI in sequence (SWI), which was confirmed by the data of histological examination of surgical material.
Abstract
High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HDT-ASCT) is listed as a consolidation therapy option for primary central nervous system (CNS) lymphoma in the guidelines of western countries. The advantages of HDT-ASCT for primary CNS lymphoma as consolidation are believed to be high rates of long-term remission and lower neurotoxicity, even though its eligibility is limited to younger fit patients. In the Japanese guideline, HDT-ASCT for primary CNS lymphoma is however not recommended in daily practice, mainly because thiotepa was unavailable since 2011. The Japanese registry data for hematopoietic transplantation have shown that primary CNS lymphoma patients were treated with various HDT regimens and thiotepa-containing HDT was associated with better progression free survival (P=.019), lower relapse (P=.042) and a trend toward a survival benefit (Kondo E et al, Biol Blood Marrow Transplant 2019). A pharmacokinetic study of thiotepa(DSP-1958) in HDT-ASCT for lymphoma was conducted in 2017, and thiotepa was approved for HDT-ASCT in lymphoma this March, meaning that optimal HDT regimen for CNS lymphoma is now available in Japan. The treatment strategy of CNS lymphoma needs further development to improve survival and reduce toxicity.
Magnetic Susceptibility MRI in Differential Diagnostics of Primary CNS Lymphoma and Anaplastic Astrocytoma Clinical Observation
