Narrative review of primary central nervous system lymphoma: treatment-related neurotoxicity

Primary central nervous system lymphoma (PCNSL) is infrequent and often poses diagnostic conundrums due to its protean manifestations. We present the case of a South Asian young man presenting with raised intracranial pressure and a lymphocytic cerebrospinal fluid (CSF) with pronounced hypoglycorrhachia. Progression of the neuro-ophthalmic signs while on early stages of antitubercular treatment led to additional investigations that produced a final diagnosis of primary leptomeningeal lymphoma. Treatment with chemoimmunotherapy (methotrexate, cytarabine, thiotepa and rituximab (MATRix)) achieved full radiological remission followed by successful autologous transplant. This case highlights the difficulties and diagnostic dilemmas when PCNSL presents as a chronic meningeal infiltrative process. While contextually this CSF is most often indicative of central nervous system tuberculosis and justifies empirical treatment initiation alone, it is essential to include differential diagnoses in the investigation work-up, which also carry poor prognosis without timely treatment. High suspicion, multidisciplinary collaboration and appropriate CSF analysis were the key for a correct diagnosis.

Download Full-text

Magnetic resonance and its diagnostic accuracy of glioblastoma: narrative review

10.5327/1516-3180.294 ◽

2021 ◽

Author(s):

Pedro da Cunha Dantas ◽

Lucas Pablo Almendro ◽

Ana Caroline Fonseca Silva ◽

André Douglas Marinho da Silva

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Magnetic Resonance ◽

Diffusion Tensor ◽

Central Nervous System Lymphoma ◽

Narrative Review ◽

Differential Diagnoses ◽

Key Words Glioblastoma ◽

Pubmed Database ◽

Magnetic Resonance Imaging Mri

Introduction: Glioblastoma (GBM) is the most common and lethal Central Nervous System (CNS) malignant cancer, and the exclusion of differential diagnoses - eg primary central nervous system lymphoma (PCNSL) - often occurs via various Magnetic Resonance Imaging (MRI) methodologies. Objective: To describe which best image sequences are critical for greater accuracy in the diagnosis of GBM and for their distinction from other CNS tumors. Methods: This is a literature narrative review, initiated by research in Pubmed database, using associated Key words: “Glioblastoma” and “Magnetic Resonance”; and filters: systematic reviews + last 5 years publications. Productions that didn’t meet the objective were discarded. Results: MRI has accuracy for diagnosing GBM using the combination T2 + FLAIR + T1 with pre and post-gadolinic contrast. Diffusion and perfusion-weighted MRI association show an improvement in specificity. Computed tomography is used when MRI is unviable, identifying calcifications or hemorrhages and determining the lesion location and surgical potential. Also, spectroscopic MRI, diffusion tensor imaging and PET 18F-FDG, and 11C-MET were reported as important additional diagnostic criteria. Diffusion MRI (DWI) is a non-invasive, convenient, economical, and quick procedure when compared to GBM biopsy. Therefore, adding reliable evidence for moderate differentiation between GBM and PCNSL through DWI. Conclusion: Reliable methods are needed for GBM accurate diagnosis and its differential diagnoses, using at least T2 + FLAIR + T1, and physiological exams to enhance specificity.

Download Full-text

Primary Central Nervous System Lymphoma: Treatment and Nursing Management of Immunocompetent Patients

Clinical Journal of Oncology Nursing ◽

10.1188/21.cjon.439-448 ◽

2021 ◽

Vol 25 (4) ◽

pp. 439-448

Author(s):

Kurt David ◽

Mary Elizabeth Davis

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Central Nervous System Lymphoma ◽

Nursing Management ◽

Lymphoma Treatment ◽

Immunocompetent Patients

Download Full-text

Safety and efficacy of primary central nervous system lymphoma treatment in elderly population

Neurological Sciences ◽

10.1007/s10072-015-2371-2 ◽

2015 ◽

Vol 37 (1) ◽

pp. 131-133

Author(s):

Paola Gaviani ◽

G. Simonetti ◽

A. Innocenti ◽

E. Lamperti ◽

A. Botturi ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Elderly Population ◽

Central Nervous System Lymphoma ◽

Safety And Efficacy ◽

Lymphoma Treatment

Download Full-text

A narrative review of consolidation strategies for young and fit patients with newly-diagnosed primary central nervous system lymphoma

Expert Review of Hematology ◽

10.1080/17474086.2022.2018297 ◽

2021 ◽

Author(s):

Sara Steffanoni ◽

Teresa Calimeri ◽

Nicoletta Anzalone ◽

Sara Mastaglio ◽

Massimo Bernardi ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Central Nervous System Lymphoma ◽

Narrative Review ◽

Newly Diagnosed

Download Full-text

Cardiovascular Outcomes in the Patients With Primary Central Nervous System Lymphoma: A Multi-Registry Based Cohort Study of 4,038 Cases

Frontiers in Oncology ◽

10.3389/fonc.2021.691038 ◽

2021 ◽

Vol 11 ◽

Author(s):

Zicong Qiu ◽

Yongshi Tang ◽

Yanting Jiang ◽

Miao Su ◽

Xuemin Wang ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Central Nervous System Lymphoma ◽

Clinical Information ◽

Cardiovascular Death ◽

Cardiovascular Outcomes ◽

First Year ◽

Non Hodgkin Lymphoma ◽

Elder Patients ◽

Lymphoma Treatment

Primary central nervous system lymphoma (PCNSL) is a rare but highly aggressive non-Hodgkin lymphoma. Treatment-related cardiovascular lesion has become one of the most common complications in patients with tumor. However, very little is known about the cardiovascular death (CVD) of the patients with PCNSL. This study aims at identifying the cardiovascular outcomes of PCNSL patients and making comparison on CVD with extra central nervous system lymphoma (ECNSL). Clinical information of PCNSL and ECNSL was retrieved from the Surveillance, Epidemiology and End Results database. The risk factors of CVD in PCNSL patients and the comparison on the CVD hazard between PCNSL and ECNSL were assessed with the competing risks regression. A 1:2 propensity score matching was used to reduce the imbalanced baseline characteristics between PCNSL and ECNSL. Four thousand thirty-eight PCNSL subjects and 246,760 ECNSL subjects were enrolled in this retrospective study. CVD was the leading cause (41.2%) of non-cancer death in PCNSL patients and mostly occurred within the first year of diagnosis. Age over 60s and diagnosis in 2000–2008 were significantly associated with the elevated risk of CVD in PCNSL patients, while chemotherapy and radiotherapy play no role on the cardiovascular outcomes. Compared with ECNSL patients, the risk of CVD in PCNSL patients were 40% approximately lower. The risk of CVD in the patients with PCNSL still remains unclear currently. Clinicians ought to pay more attention on the risk of CVD in PCNSL patients, especially the elder patients within the first year of diagnosis.

Download Full-text