Imaging of primary central nervous system lymphoma

2006 ◽  
Vol 21 (5) ◽  
pp. 1-6 ◽  
Author(s):  
John L. Go ◽  
Sandy C. Lee ◽  
Paul E. Kim

✓Primary central nervous system lymphoma (PCNSL) is an aggressive neoplastic process that occurs in both immuno-competent and immunocompromised patients. Over the past 30 years there has been a steady increase in the number of cases in both patient populations. The imaging features for the disease and demographic characteristics within these patient populations vary, and in this article the authors describe the salient features of these two groups.

2021 ◽  
Author(s):  
Jian Zheng ◽  
Buyi Zhang ◽  
Zhaoxu Huang ◽  
Hui Ling ◽  
Zhangqi Dou ◽  
...  

Abstract Purpose Primary central nervous system lymphoma (PCNSL) of the cerebellopontine angle (CPA) is rare, thus the preoperative diagnosis is still a challenge.MethodsWe searched the database at our institution and performed a search of English literature in PubMed and Google Scholar. Keywords used were as follows: “primary central nervous system lymphoma”; “cerebellopontine angle”; “lymphoma”. Only cases in the English language that were located in the CPA and contained adequate clinical information pertinent to the analysis were included.Results297 cases of pathologically confirmed PCNSLs were recorded between January 2009 and October 2020 at our institution. 6 cases were located in the CPA, accounting for 2.0% of all PCNSLs. 26 cases meeting the above criteria were found in the literature. Including ours, a total of 32 patients were analyzed. Females were more frequently affected (F/M ratio, 2.2:1). There was a preponderance of left-sided lesions in the PCNSLs of the CPA (L/R ratio, 1.5:1). On CT, 80.0% of them presented as hyperdense lesions. On T1-weighted image, 66.7% appeared isointense. While on T2-weighted image (T2WI), 68.4% appeared isointense/hypointense. After contrast administration, 86.2% presented intense homogeneous enhancement.ConclusionPCNSL of the CPA is extremely rare, accounting for 2.0% of all PCNSLs in our study. There is a preponderance of females and left-sided lesions in this disease. Contrast-enhanced magnetic resonance imaging with T2WI is very helpful in the preoperative diagnosis of the CPA PCNSL. Although rare, lymphoma should be included in the differential diagnosis of CPA lesions.


2017 ◽  
Vol 19 (suppl_6) ◽  
pp. vi70-vi70 ◽  
Author(s):  
Joe Mendez ◽  
Quinn Ostrom ◽  
Haley Gittleman ◽  
Carol Kruchko ◽  
Jill Barnholtz-Sloan ◽  
...  

2021 ◽  
Author(s):  
Jian Zheng ◽  
Buyi Zhang ◽  
Zhaoxu Huang ◽  
Hui Ling ◽  
Zhangqi Dou ◽  
...  

Abstract Purpose Primary central nervous system lymphoma (PCNSL) of the cerebellopontine angle (CPA) is rare, thus the preoperative diagnosis is still a challenge.Methods We searched the database at our institution and performed a search of English literature in PubMed and Google Scholar. Keywords used were as follows: “primary central nervous system lymphoma”; “cerebellopontine angle”; “lymphoma”. Only cases in the English language that were located in the CPA and contained adequate clinical information pertinent to the analysis were included.Results 297 cases of pathologically confirmed PCNSLs were recorded between January 2009 and October 2020 at our institution. 6 cases were located in the CPA, accounting for 2.0% of all PCNSLs. 26 cases meeting the above criteria were found in the literature. Including ours, a total of 32 patients were analyzed. Females were more frequently affected (F/M ratio, 2.2:1). There was a preponderance of left-sided lesions in the PCNSLs of the CPA (L/R ratio, 1.5:1). On CT, 80.0% of them presented as hyperdense lesions. On T1-weighted image, 66.7% appeared isointense. While on T2-weighted image (T2WI), 68.4% appeared isointense/hypointense. After contrast administration, 86.2% presented intense homogeneous enhancement.Conclusion PCNSL of the CPA is extremely rare, accounting for 2.0% of all PCNSLs in our study. There is a preponderance of females and left-sided lesions in this disease. Contrast-enhanced magnetic resonance imaging with T2WI is very helpful in the preoperative diagnosis of the CPA PCNSL. Although rare, lymphoma should be included in the differential diagnosis of CPA lesions.


Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4751-4751
Author(s):  
Hirokazu Nagai ◽  
Takashi Odawara ◽  
Atsushi Ajisawa ◽  
Shotaro Hagiwara ◽  
Tomoko Uehira ◽  
...  

Abstract Abstract 4751 Background Primary central nervous system lymphoma (PCNSL) is one of an acquired immunodeficiency syndrome (AIDS)-defining illness and is the second common cerebral mass lesion after toxoplasmosis in HIV infected population. The introduction of highly active antiretroviral therapy (HAART) significantly improved the survival of AIDS related PCNSL. But, the standard procedure to manage these patients still remains to be established. We performed the nationwide retrospective survey to elucidate the actual status and the significant prognostic variables of AIDS-related PCNSL in the HAART era. Methods All AIDS related PCNSL newly diagnosed at 12 regional center hospitals for HIV/AIDS in Japan during the period 2002-2008 were registered. The data about diagnostic modalities, CD4 counts, performance status (PS), HAART regimens, treatment modalities, and clinical outcomes were collected. A multivariate and univariate Cox regression analysis was performed to assess the effects of treatment and the clinical variables on OS. Results Twenty four AIDS related PCNSLs were registered. Median age was 41 (21-60) year old, and male gender was 96%. Ten patients were diagnosed as PCNSL based on imaging features and positive EBV DNA PCR of cerebrospinal fluid without brain biopsy. HAART was administrated in 88%. Twenty two patients were treated by radiotherapy alone, and only one cases were received the combined modality treatment. Multivariate analysis revealed that the significant predictor of improved survival was completion of whole brain radiotherapy (WBRT) with a total dosage more than 30 Gy (P=0.017). Furthermore, 9 of 10 patients with good PS (0-2) group were alive with CR (all were received WBRT), nevertheless 64% of poor PS (3 or 4) group (9/14) died sometimes with short clinical course. The estimated 3yrs overall survival rate of each group was 100% and 38% respectively (p=0.0198). The incidence and grade of radiation related leukoencephalopathy was limited in good PS group. Conclusion Radiotherapy alone with HAART is shown to be the most common treatment for the AIDS-related PCNSLs, but the role of systemic chemotherapy should be elucidated. Some AIDS-related PCNSLs, especially with good PS, achieved the durable remission by WBRT with the curative intent dose, in the HAART era. Disclosures: No relevant conflicts of interest to declare.


2013 ◽  
Vol 13 (1) ◽  
pp. 39-44
Author(s):  
Aleksejs Repnikovs ◽  
Daina Apskalne

Summary Introduction. Primary central nervous system lymphoma (PCNSL) is a rare tumor. It is diagnosed in 1-3% of all primary malignant tumors of the CNS. However its incidence increased over the past ten years amongst the immunesupressed and also the immunocompetent patients. PCNSL incidence amongst neurooncology patients is increasing in Latvia as well, therefore it is important to draw more attention to this problem. Aim of the study. Research and analyse the experience of the Riga Eastern Clinical University hospital (RECUH) in the management of the patients with PCNSL over the last 11 years (from 2001 till 2012). In this research the data about the incidence of the disease, the connection between the age and sex, as well as the diagnostic and therapeutic possibilities are discussed. Materials and methods. This is a retrospective descriptive study. In this study were included all the patients with morphologically confirmed PCNSL (n=18) that were operated in the neurosurgical clinic in the 11-year time period (from 2001 till 2012). The statistical analysis of the data was made by means of the Microsoft Excel 2010 and SPSS 20th version of the descriptive statistical methods. Results. Over 11 years (from 2001 till 2012) PCNSL was confirmed in 18 patients, 17 (94.44%) of which were immunocompetent and in 1 patient (5.56%) HIV C1 stadium was diagnosed. Amongst immunocompetent patients 47.06% (n=8) were male and 52.94% (n=9) were female in the age between 45 and 79 years with average age of 64.41 years. Most often PCNSL was diagnosed in the age group between 65 and 69 years. 83.33% of all the PCNSL cases were diagnosed beginning with 2007. In all of the PCNSL patients a B-cell-lymphoma was morphologically confirmed. By admission the average Karnofsky Performance Scale Index was 57.78 in all patients, but after receiving a combination of therapy it was 77.78. The median survival amongst all of the patients was 515 days or 17 month, but amongst the patients, that received the full range combination therapy, the median survival achieved 867 days or 29 month. Conclusions. The analysed data demonstrates that the incidence of PCNSL has mighty increased over the past six years and PCNSL is more often diagnosed in elderly, in which the KPS index and the median survival considerably increases after the combination therapy.


2017 ◽  
Vol 20 (5) ◽  
pp. 687-694 ◽  
Author(s):  
Joe S Mendez ◽  
Quinn T Ostrom ◽  
Haley Gittleman ◽  
Carol Kruchko ◽  
Lisa M DeAngelis ◽  
...  

2020 ◽  
Vol 13 (1) ◽  
pp. 6-15
Author(s):  
Ali El Dirani ◽  
Zahraa Hachem ◽  
Assaad Mohanna ◽  
Amira J. Zaylaa

Introduction: The diagnosis of Central Nervous System Lymphoma, especially the Primary Central Nervous System Lymphoma is carried out based on brain imaging, thus avoiding an unnecessary extend of surgery. But the traditional imaging techniques, such as Computed Tomography and Magnetic Resonance Imaging, were not satisfactory. Aims: This study was conducted to characterize the spectrum of advanced Neuroimaging, such as the advanced Magnetic Resonance Imaging features in the Central Nervous System Lymphoma patients in a comprehensive medical center in Lebanon, and compare them to what has been described in the literature review. Methods: It is a retrospective exploratory study of the clinical data and imaging features for patients admitted to the emergency and radiology departments with ages above 10 years, and who were diagnosed histopathologically with intracranial lymphoma. This study may be the first to make a Radiological evaluation of Central Nervous System Lymphoma on the local population of patients over 9 years . Results: Results showed that the study of the Computed Tomography and Magnetic Resonance Imaging data of 10 immunocompetent patients with Central Nervous System Lymphoma concurs with the previously described patient populations, except for the gender parameter. Tumors were mostly presented in the fifth or Sixth decade and they could be solitary or multi-focal. Lesions were typically located Preprint submitted to The Open Neuroimaging Journal May 14, 2020 in the supratentorial compartment. On the brain Computed Tomography, the lesions were hyperdense, and in pre-contrast Magnetic Resonance images, the lesions appeared hypointense on T1 and hyperintense on T2-Weighted images, but hypointense with respect to the grey matter. The lesions were also surrounded with a mild to moderate edema as compared to other intracranial neoplasms, such as glioblastomas. Evaluation results showed that on post-contrast Magnetic Resonance images, the majority of lesions exhibited a homogeneous enhancement of 50%. Majority of the lesions also showed a less common heterogeneous ring-like enhancement of 40%, and revealed the uncommon absence of enhancement of 10%. Calcifications, hemorrhage, and necrosis were rare findings and were present in only one patient. Conclusion: As a future prospect, studying whether the advanced imaging techniques may provide not only non-invasive and morphological characteristics but also non-invasive biological characteristics and thus accurate diagnosis could be considered.


Author(s):  
Joe S. Mendez ◽  
Christian Grommes

Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin lymphoma that is typically confined to the brain, eyes, and cerebrospinal fluid (CSF) without evidence of systemic spread. PCNSL is an uncommon tumor, and only four randomized trials and one phase III trial have been completed so far, all in the first-line setting. The prognosis of patients with PCNSL has improved during the past few decades with the introduction of high-dose methotrexate (HD-MTX), which now serves as the backbone of all first-line treatment regimens. Despite recent progress, results after treatment are durable in half of patients, and therapy can be associated with late neurotoxicity. Novel insights into the pathophysiology of PCNSL have identified the B-cell receptor (BCR) pathway as a key mechanism in the pathogenesis of PCNSL. The use of novel agents targeting components of the BCR pathway, namely the Bruton tyrosine kinase (BTK) inhibitor ibrutinib, and immunomodulatory drugs (IMIDs) like lenalidomide and pomalidomide, has so far been limited to patients who have recurrent/refractory PCNSL with promising high response rates. Within the past 5 years, there has been a peak in clinical trials investigating small molecules and novel reagents in the recurrent/refractory setting, including immune checkpoint inhibitors, IMIDs, and BTK and PI3K/AKT/mTOR inhibitors.


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