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Aboubakr O, Houillier C, Choquet S, Dupont S, Hoang-Xuan K, Mathon B. Epileptic seizures in patients with primary central nervous system lymphoma: A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)01116-5. [PMID: 38042665 DOI: 10.1016/j.neurol.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) accounts for less than 5% of primary brain tumors. Epileptic seizures are a common manifestation of brain tumors; however, literature on the prevalence, characteristics, and oncological implications of seizures in patients with PCNSL is limited, and the management of antiepileptic drugs (AEDs) is unclear. This review aimed to summarize the existing knowledge on seizures in PCNSL, their potential association with surgery, oncological treatment, survival rates, and management of AEDs. METHODS A systematic review was performed according to the PRISMA recommendations and included articles published between 1953 and 2023 describing seizures in patients with PCNSL. RESULTS The search identified 282 studies, of which 21 were included. Up to 33% of patients with PCNSL developed seizures, mostly at the initial presentation. Little information was found on changes in seizure incidence through the course of the disease, and no details were found on seizure frequency, the percentage of treatment-resistant patients, or the evolution of seizures at remission. Younger age, cortical location, and immunodeficiency have been identified as potential risk factors for seizures, but evidence is very limited. The growing use of vigorous treatments including intensive chemotherapy with autologous stem cell transplantation and immunotherapy with CAR-T cells is associated with a higher incidence of seizures. The association between seizure development and patient mortality in PCNSL remains unknown. There are no data on AED prophylaxis or the use of specific AEDs in PCNSL. CONCLUSIONS Further studies are needed to investigate seizures in larger cohorts of PCNSL, to clarify their prevalence, better characterize them, identify risk factors, analyze survival rates, and make recommendations on AED management. We recommend following general practice guidelines for seizures symptomatic of brain tumors and not to prescribe AED prophylaxis in PCNSL.
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Affiliation(s)
- O Aboubakr
- Sorbonne University, Department of Neurosurgery, la Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France
| | - C Houillier
- Department of Neurology 2 Mazarin, la Pitié-Salpêtrière Hospital, IHU, ICM, AP-HP, Sorbonne University, 75013 Paris, France
| | - S Choquet
- Department of Hematology, la Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France
| | - S Dupont
- Epileptology Unit, Department of Rehabilitation, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, 75013 Paris, France
| | - K Hoang-Xuan
- Department of Neurology 2 Mazarin, la Pitié-Salpêtrière Hospital, IHU, ICM, AP-HP, Sorbonne University, 75013 Paris, France
| | - B Mathon
- Sorbonne University, Department of Neurosurgery, la Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne University, UMRS 1127, 75013 Paris, France; GRC 23, Brain Machine Interface, la Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France.
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Stifano V, Della Pepa GM, Offi M, Montano N, Carcagnì A, Pallini R, Lauretti L, Olivi A, D'Alessandris QG. Resection versus biopsy for management of primary central nervous system lymphoma: a meta-analysis. Neurosurg Rev 2023; 46:37. [PMID: 36645525 DOI: 10.1007/s10143-022-01931-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/11/2022] [Accepted: 12/17/2022] [Indexed: 01/17/2023]
Abstract
The role of surgery in the management of primary central nervous system lymphomas (PCNSL) is currently confined to diagnosis. However, over recent years, an increasing number of papers have suggested a possible positive prognostic impact of surgery in selected cases. The present work aims to perform a meta-analysis of the available literature evidence. A meta-analysis with meta-regression on the role of surgical resection compared to biopsy in the management of PCNSL was conducted according to the PRISMA statement, searching MEDLINE via PubMed and Embase. The random effect model was used. The quality of evidence was assessed using the GRADE framework. After screening 1395 records, we included 11 papers in our analysis. Patients who underwent surgical resection harbored superficial and single-lesion tumors. At 1-, 2-, and 5-year follow-up, progression-free survival did not differ between the two groups, while overall survival favored resection, even if in a non-significant fashion. Meta-regression analysis showed that the overall survival rate at 2 years, but not at 1 or 5 years, was significantly influenced by tumor location. There were no differences in terms of age, sex, Karnofsky performance status, adjuvant therapy, or procedure-related complications. Overall, the quality of evidence is low. The results of the present meta-analysis do not change the current standard of care for PCNSL. However, surgery could be non-inferior to biopsy with an acceptable risk profile in selected patients harboring single and superficial lesions. The low quality of evidence prompts future randomized studies.
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Affiliation(s)
- Vito Stifano
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Giuseppe M Della Pepa
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Martina Offi
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Antonella Carcagnì
- Facility of Epidemiology and Biostatistics - Gemelli Generator, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Roberto Pallini
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Liverana Lauretti
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
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Okano A, Kanai M, Kita T, Nakai Y, Okada H, Yamaguchi K. [A case of primary intramedullary spinal cord lymphoma diagnosed by spinal cord biopsy of long spinal cord lesions showing persistent gadolinium contrast enhancement]. Rinsho Shinkeigaku 2021; 61:856-861. [PMID: 34789630 DOI: 10.5692/clinicalneurol.cn-001655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An 82-year-old man presented with subacute bilateral lower limb paralysis, deep sensory disturbance, and vesico-rectal disturbance. MRI of the spinal cord revealed a large gray matter-dominant lesion extending from the medulla oblongata to the lower thoracic spinal cord. The patient was treated with steroid-pulse therapy for myelitis, but without symptomatic improvement. A spinal cord biopsy was performed for treatment-resistant myelopathy, and histopathology revealed a diffuse large B-cell lymphoma, that was diagnosed as a primary intramedullary spinal cord lymphoma because systemic examination didn't show any other findings suggestive of malignant lymphoma. A spinal cord biopsy is necessary for the definitive diagnosis of this disease, but in the case of poor response to treatment and a progressive course, intramedullary malignant lymphoma should be considered if there is a persistent elevation of CSF IL-10 or a prolonged contrast effect.
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4
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Erdem MB, Kale A, Yaman ME, Emmez H. A Rare Entity in the Lumbar Epidural Region: T-Cell Lymphoblastic Lymphoma. Int J Spine Surg 2021; 14:S52-S56. [PMID: 33900945 DOI: 10.14444/7165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND T-cell lymphoblastic lymphoma is a rare disease and an aggressive neoplasm of precursor lymphoblasts. We present a case of lumbar epidural T-cell lymphoblastic lymphoma which appeared with clinical features of epidural spinal cord compression. METHODS A 38-year-old male patient presented with weakness in the lower extremities and newly developed urinary incontinence. His medical history included precursor T-cell acute lymphoblastic leukemia and treatment with allogeneic bone-marrow transplantation 5 years previously. Spinal magnetic resonance imaging (MRI) revealed an epidural mass lesion at L2-L4 levels and there was no sign of leukemia or lymphoma in clinical, laboratory, and radiological examinations. Surgery was planned for obtaining diagnostic material. Decompressive laminectomy and subtotal excision of the tumor were performed. RESULTS At surgery, the tumor consisted of yellow-colored and hypovascular soft tissue fragments. It was encircling the spinal cord and spreading through the left L3 foramen. The patient underwent adjuvant chemoradiotherapy after the histopathological evaluation. At 2-month follow-up, the patient was able to walk without assistance, but the urinary incontinence was the same. At 5-month follow-up, the disease progressed, and the patient passed away because of infective endocarditis. CONCLUSION Spinal lymphomas may display its characteristic "wrap-around" fashion in the MRI. In this report, we shared the microsurgical appearance of this fashion. As the lymphomas are chemoradiosensitive tumors, the treatment should be managed with a multidisciplinary approach.
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Affiliation(s)
- Münibe Büşra Erdem
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Aydemir Kale
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mesut Emre Yaman
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hakan Emmez
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
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Moussaly E, Nazha B, Zaarour M, Atallah JP. Primary Non-Hodgkin's Lymphoma of the Spine: A Case Report and Literature Review. World J Oncol 2015; 6:459-463. [PMID: 28983348 PMCID: PMC5624672 DOI: 10.14740/wjon947w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/11/2022] Open
Abstract
Primary non-Hodgkin’s lymphoma (NHL) of the spine is a rare form of extranodal lymphoma. This entity constitutes a diagnostic challenge due to its mimicking of other spinal diseases and the difficulty in establishing a tissue diagnosis. In fact, core biopsy can be inconclusive, oftentimes requiring surgical biopsy. Definitive evidence is lacking regarding the treatment of choice. As a result, the prognosis remains unfavorable. We present the case of an adult female who presented with back pain and was found to have a spinal NHL. We also review the literature regarding this rare occurrence.
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Affiliation(s)
- Elias Moussaly
- Department of Internal Medicine, Staten Island University Hospital, North Shore - LIJ Health System, 475 Seaview Avenue, Staten Island, New York 10305, USA
| | - Bassel Nazha
- Department of Internal Medicine, Staten Island University Hospital, North Shore - LIJ Health System, 475 Seaview Avenue, Staten Island, New York 10305, USA
| | - Mazen Zaarour
- Department of Internal Medicine, Staten Island University Hospital, North Shore - LIJ Health System, 475 Seaview Avenue, Staten Island, New York 10305, USA
| | - Jean Paul Atallah
- Division of Hematology and Oncology, Department of Internal Medicine, Staten Island University Hospital, North Shore - LIJ Health System, 475 Seaview Avenue, Staten Island, New York 10305, USA
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6
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Sivri M, Erdoğan H, Allahverdiyev I, Koplay M, Temizöz O. A rare cause of spinal mass: primary intramedullary spinal cord lymphoma. Spine J 2015; 15:e43-4. [PMID: 26070282 DOI: 10.1016/j.spinee.2015.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/01/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Mesut Sivri
- Department of Radiology, School of Medicine, Selcuk University, The Central Campus, 42075, Konya, Turkey
| | - Hasan Erdoğan
- Department of Radiology, School of Medicine, Selcuk University, The Central Campus, 42075, Konya, Turkey
| | - Ilgar Allahverdiyev
- Department of Radiology, School of Medicine, Selcuk University, The Central Campus, 42075, Konya, Turkey
| | - Mustafa Koplay
- Department of Radiology, School of Medicine, Selcuk University, The Central Campus, 42075, Konya, Turkey
| | - Osman Temizöz
- Department of Radiology, School of Medicine, Selcuk University, The Central Campus, 42075, Konya, Turkey
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7
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Kim YH, Song SW, Lee JY, Kim JW, Kim YH, Phi JH, Park CK, Kim JE, Kim SK, Paek SH, Chung CK, Wang KC, Kim DG, Jung HW. Surgically Treated Brain Tumors: A Retrospective Case Series of 10,009 Cases at a Single Institution. World Neurosurg 2011; 76:555-63. [DOI: 10.1016/j.wneu.2011.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 02/23/2011] [Accepted: 04/27/2011] [Indexed: 11/15/2022]
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8
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Ebner FH, Roser F, Acioly MA, Schoeber W, Tatagiba M. Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management. Neurosurg Rev 2008; 32:287-300; discussion 300-1. [PMID: 18820958 DOI: 10.1007/s10143-008-0173-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 08/01/2008] [Accepted: 08/19/2008] [Indexed: 10/21/2022]
Abstract
The medullary conus represents a distinct entity of the spinal cord regarding its anatomical, clinical and microsurgical features. An overview of the pathologic processes of this region is provided. Epidemiological, clinical and neuroradiological characteristics of neoplastic (glial tumors, non-glial tumors, metastasis, primary melanomas) and non-neoplastic lesions (granulomatous lesions, abscess, parasitic infections, vascular, demyelinating and dysembryogenetic lesions) are discussed. Main MR imaging characteristics used to differentiate neoplastic from non-neoplastic lesions consist in pathological spinal cord expansion, gadolinium-enhancement and tumoural cyst formation. Management strategies differ substantially, depending on the kind of lesion. According to the suspected pathological entity radical resection, biopsy or conservative treatments are reasonable options. Intraoperative electrophysiological monitoring is a fundamental part of the surgical setting.
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Affiliation(s)
- Florian H Ebner
- Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Germany.
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Taillibert S, Guillevin R, Menuel C, Sanson M, Hoang-Xuan K, Chiras J, Duffau H. Brain lymphoma: usefulness of the magnetic resonance spectroscopy. J Neurooncol 2007; 86:225-9. [PMID: 17786533 DOI: 10.1007/s11060-007-9468-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Accepted: 08/13/2007] [Indexed: 11/24/2022]
Abstract
The diagnosis of primary central nervous system lymphoma (PCNSL) should always be considered as an emergency because of the therapeutic consequences it implies. In immunocompetent patients, it relies on stereotactic biopsy. Unfortunately, clinical and radiological features may be misleading and delay the diagnostic procedure. The case we report here illustrates the contribution of magnetic resonance spectroscopy in the diagnostic approach of a very atypical PCNSL.
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Affiliation(s)
- Sophie Taillibert
- Department of Neuro-oncology, Pitié Salpêtrière Hospital, 47-83 boulevard de l'hôpital, Paris, France
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10
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Loh JK, Lin CK, Hwang YF, Hwang SL, Kwan AL, Howng SL. Primary spinal tumors in children. J Clin Neurosci 2005; 12:246-8. [PMID: 15851074 DOI: 10.1016/j.jocn.2004.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 03/24/2004] [Indexed: 10/25/2022]
Abstract
Nine patients, 16 years of age or younger with primary spinal cord tumors, diagnosed between 1991 and 2003 at The Kaohsiung University Hospital, were reviewed retrospectively. There were 2 female and 7 male patients. Two tumors were located primarily in the cervical cord (1 meningioma, 1 neurofibroma), five were predominantly thoracic (1 lymphoma, 1 meningioma, 1 astrocytoma, 1 fibrosarcoma and 1 osteoblastoma), one lumbar (ependymoma), and one sacral (Ewing's sarcoma). The most common clinical presentation was limb weakness (100%) followed by back pain (44.4%). All the patients underwent laminectomy for removal of their tumors. Five children with benign tumors improved postoperatively. At discharge, these 5 children could walk without assistance and have remained stable with long-term of follow-up. Radical surgery should be considered in benign primary spinal cord tumors. As would be expected, patients diagnosed and treated early and in whom a total resection was achieved had a better prognosis.
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Affiliation(s)
- Joon-Khim Loh
- Department of Surgery, Kaohsiung Municipal Hsiaokang Hospital, Kaohsiung, Taiwan
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11
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Dubuisson A, Kaschten B, Lénelle J, Martin D, Robe P, Fassotte MF, Rutten I, Deprez M, Stevenaert A. Primary central nervous system lymphoma report of 32 cases and review of the literature. Clin Neurol Neurosurg 2005; 107:55-63. [PMID: 15567554 DOI: 10.1016/j.clineuro.2004.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2003] [Revised: 03/12/2004] [Accepted: 03/23/2004] [Indexed: 10/26/2022]
Abstract
We retrospectively analyzed 32 cases of primary central nervous system lymphoma (PCNSL). Five cases were diagnosed in the period 1987-1994, for 27 cases in the period 1995-2002. There were 17 men and 15 women whose median age was 69 years. Three patients were immunodeficient. The commonest symptoms were focal deficit (16 patients) and cognitive/behaviour disturbances (14 patients). Radiologically, a total of 47 contrast-enhancing lesions were observed in 32 patients; 18 patients had deep-seated lesions. All but two patients underwent histological diagnosis following craniotomy (11 patients) and/or stereotaxic biopsy (22 patients); diagnosis was obtained on CSF cytology in one patient with a third ventricle tumour. In the last patient, the diagnosis was based on the finding of marked tumour shrinkage under corticotherapy, despite two negative histological examinations. Treatment included surgical resection (10 patients), chemotherapy (25 patients) and/or radiotherapy (12 patients). According to the therapeutic recommendations of the GELA (Groupe d'Etude des Lymphomes de l'Adulte), 19 patients received at least two courses of high-dose methotrexate; intrathecal chemotherapy was used in 20 patients with methotrexate and/or cytosine arabinoside. Radiation therapy consisted of whole brain irradiation followed by a boost on tumour site. Nine patients received a combined treatment of chemotherapy and radiotherapy. Twelve patients showed rapid progression to death. At the time of last contact, 28/32 patients (88%) had died, all from PCNSL disease or from complications due to its treatment. The median survival time was 13.9 months. We conclude that PCNSL is an increasingly frequent tumour. The diagnosis is obtained by stereotactic biopsy in the majority of cases. The prognosis appears dismal despite an intensive multidisciplinary therapeutic approach.
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Affiliation(s)
- Annie Dubuisson
- Department of Neurosurgery, CHU Liège, Domaine Universitaire du Sart Tilman B35, 4000 Liège, Belgium.
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12
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Salvesen Haldorsen I, Aarseth JH, Hollender A, Larsen JL, Espeland A, Mella O. Incidence, clinical features, treatment and outcome of primary central nervous system lymphoma in Norway. Acta Oncol 2004; 43:520-9. [PMID: 15370608 DOI: 10.1080/02841860410015640] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The incidence of primary central nervous system lymphoma (PCNSL) has been reported to increase in some parts of the world, while being stable in other regions. In an attempt to characterize the incidence rate, clinical features, treatment, outcome, and prognostic factors of PCNSL in Norway, we report our experience in a large unselected series of patients. Clinical features, histological diagnosis, radiological findings, treatment, and outcome of all patients diagnosed with PCNSL in Norway in the years 1989-1998 were registered. During the 10-year period 58 new cases of histologically verified PCNSL were registered in Norway. The annual incidence rate of PCNSL was on average 1.34 cases per million people with a non-significant increasing trend (p=0.069). For patients diagnosed before death (n=45) the estimated survival following histological diagnosis was 55%, 47%, and 23% at 1, 2, and 5 years, respectively. In Cox-regression analysis age, WHO performance status and treatment had independent prognostic impact on survival. In the studied decade, there was a non-significant trend towards increased incidence of PCNSL, perhaps due to increased availability of diagnostic imaging, especially magnetic resonance imaging.
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13
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Kros JM, Bagdi EK, Zheng P, Hop WC, Driesse MJ, Krenacs L, Dinjens WNM. Analysis of immunoglobulin H gene rearrangement by polymerase chain reaction in primary central nervous system lymphoma. J Neurosurg 2002; 97:1390-6. [PMID: 12507138 DOI: 10.3171/jns.2002.97.6.1390] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Diagnosing primary central nervous system lymphoma (PCNSL) may be difficult either because of a paucity of tumor cells in the brain biopsy specimens or a failure to demonstrate monoclonality on immunomorphological studies. Monoclonality can also be demonstrated by amplification of the rearranged immunoglobulin H genes by polymerase chain reaction (PCR) to the framework region (FR)3 and FR2 complementarity determining region (CDR)-III and CDR-II of these genes. The PCR method is feasible with formalin-fixed, paraffin-embedded biopsy material and has proven to be helpful in the diagnosis of non-Hodgkin lymphoma on biopsy samples obtained from various locations in the body. Nevertheless, few studies have addressed the value of this method in the context of PCNSL. In the present study, the contribution of both FR3 single and FR2 seminested PCR procedures for confirming the diagnosis of PCNSL was estimated retrospectively in 30 cases of PCNSL and in three cases of epidural lymphoma. METHODS Twenty-eight cases of immunophenotypically confirmed PCNSL and two of suspected lymphoma were studied. Tissue specimens obtained in 22 cases of other cerebral diseases, among which were various inflammatory conditions. were used as negative controls. In 18 (60%) of 30 cases the results of FR3 PCR demonstrated monoclonality, whereas FR2 PCR showed monoclonality in 12 cases (40%). In 11 cases FR3 PCR yielded monoclonal patterns and FR2 PCR did not, whereas reversibly in five cases FR2 PCR proved monoclonality and FR3 PCR failed to do so. Adding the results of FR3 to those of FR2 PCR, monoclonal patterns were obtained in 23 (77%) of 30 cases. In both cases in which lymphoma was suspected but not proven immunomorphologically, FR3 PCR revealed monoclonality, as did FR2 PCR in one case. In all 22 control lesions either polyclonal patterns were seen or no consistent patterns were obtained. In the PCNSL group, older age of patients and multifocal presentation of lesions on neuroimaging were significantly associated with worse survival. No correlation between histological subtype and clinical outcome was elucidated. CONCLUSIONS The application of FR3 and FR2 PCR is a useful additional tool in making the diagnosis of PCNSL. Moreover, in some cases the PCR method may be essential in distinguishing neoplasia from reactive conditions.
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Affiliation(s)
- Johan M Kros
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands.
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Kohyama S, Nawashiro H, Shima K, Shimazaki H. Primary central nervous system lymphoma with paraproteinemia. SURGICAL NEUROLOGY 2001; 56:325-8; discussion 329. [PMID: 11750007 DOI: 10.1016/s0090-3019(01)00573-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although 34% to 54% of cases of extraneural non-Hodgkin's lymphoma (NHL) of the B-cell type are associated with monoclonal paraproteinemia, primary central nervous system NHL (PCNSL) with paraproteinemia has rarely been reported. The authors present herein a case of PCNSL with monoclonal immunoglobulin M (IgM) paraproteinemia. METHODS AND RESULTS A 78-year-old woman was referred to our hospital because of hemiparesis and epilepsy. Magnetic resonance imaging showed a round mass in the left frontal region. Serum IgM was 3,820 mg/dL, and immunofixation revealed an IgM kappa monoclonal paraprotein. No lymphoplasmacytic infiltration was observed on bone marrow aspiration. The brain tumor was totally resected. The pathological diagnosis was NHL (diffuse, large B cell). The results of immunohistochemical staining for IgM were strongly positive in the tumor cells. CONCLUSION This type of PCNSL has rarely been reported and little is known about it. It is possible that the true incidence of paraproteinemia caused by PCNSL is higher than has been thought. The clinical features of the tumor and pertinent literature are reviewed.
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Affiliation(s)
- S Kohyama
- Department of Neurosurgery and Pathology, National Defense Medical College, Tokorozawa, Saitama, Japan
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15
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Bekar A, Cordan T, Evrensel T, Tolunay S. A case of primary spinal intramedullary lymphoma. SURGICAL NEUROLOGY 2001; 55:261-4. [PMID: 11516461 DOI: 10.1016/s0090-3019(01)00405-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 41-year-old male presented to our clinic with a 1-month history of left hemiparesis. He had marked left arm weakness. The diagnostic work-up revealed an intramedullary mass at spinal level C2-4. Laminectomies were performed at C2-3-4 and the tumor was subtotally resected. Histological examination identified the mass as a non-Hodgkin's diffuse B-cell lymphoma. The patient was treated with corticosteroids, chemotherapy, and adjuvant radiotherapy. The residual tumor tissue had completely disappeared by 6 months of follow-up; however, the patient presented with intraventricular metastasis at 11 months postsurgery.
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MESH Headings
- Adult
- Cerebral Ventricle Neoplasms/secondary
- Chemotherapy, Adjuvant
- Diagnosis, Differential
- Humans
- Laminectomy
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/therapy
- Magnetic Resonance Imaging
- Male
- Paresis/etiology
- Radiotherapy, Adjuvant
- Spinal Cord Neoplasms/complications
- Spinal Cord Neoplasms/diagnosis
- Spinal Cord Neoplasms/pathology
- Spinal Cord Neoplasms/therapy
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Affiliation(s)
- A Bekar
- Department of Neurosurgery, Uludağ University, Bursa, Turkey
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Kim DG, Kim HJ. The Department of Neurosurgery at Seoul National University: past, present, and future. Neurosurgery 2001; 48:919-28. [PMID: 11322453 DOI: 10.1097/00006123-200104000-00047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The Department of Neurosurgery at Seoul National University College of Medicine is one of the oldest neurosurgical departments in Korea, and it is a center of academic leadership in neurosurgery. In September 1957, the department was established by Bo Sung Sim, and it has produced many leaders of neurosurgery in Korea. Chairmen Bo Sung Sim, Kil Soo Choi, Dae Hee Han, and Byung-Kyu Cho each brought special skills and talents to the development of the department. The current and fifth chair, Hyun Jib Kim, assumed the chairmanship in July 2000. The department comprises 11 full-time faculty members, 5 fellows, and 14 residents. More than 1,700 neurosurgical procedures are performed annually in four operating theaters. A gamma knife was installed in 1997, and approximately 200 gamma knife procedures are performed each year. In addition to clinical activities, research and education for graduate and postgraduate students are also particular strengths of the department. This article traces the clinical, academic, and scientific development of the department, its present activities, and its future direction.
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Affiliation(s)
- D G Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Korea
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Kim DG, Kim HJ. The Department of Neurosurgery at Seoul National University: Past, Present, and Future. Neurosurgery 2001. [DOI: 10.1227/00006123-200104000-00047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Bataille B, Delwail V, Menet E, Vandermarcq P, Ingrand P, Wager M, Guy G, Lapierre F. Primary intracerebral malignant lymphoma: report of 248 cases. J Neurosurg 2000; 92:261-6. [PMID: 10659013 DOI: 10.3171/jns.2000.92.2.0261] [Citation(s) in RCA: 336] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECT The authors present a retrospective analysis of 248 immunocompetent patients with primary intracerebral lymphoma treated at 19 French and Belgian medical centers between January 1980 and December 1995. METHODS This study involved 127 female and 121 male patients with a median age of 61 years (range 2-88 years). All tumors available for review were classic diffuse non-Hodgkin's lymphoma, for which the phenotype was determined in 220 patients: 212 (96.4%) were B-cell and eight (3.6%) were T-cell type tumors. According to the Revised European-American classification of lymphoid neoplasms, most lesions were diffuse large cell tumors (62%). A total of 196 tumors were reviewed in 127 patients for whom preoperative computerized tomography and magnetic resonance studies were available. There was a single lesion in 66% of the cases, with a supratentorial location in 87%. Tumor location in the basal ganglia, corpus callosum, or fornix, infiltration of the periventricular ependyma, or a mirror pattern, were strongly suggestive of a lesion of lymphomatous origin. The histological diagnosis was obtained after surgical resection in 116 patients, with the remainder undergoing biopsy sampling only. Of the 248 patients studied, 129 (52%) received chemotherapy plus radiation therapy, 60 (24%) received radiation therapy alone, 35 (14%) received chemotherapy alone, and 24 (10%) received no postsurgical treatment. CONCLUSIONS Using univariate analysis, the authors determined prognostic factors that were significantly associated with a favorable impact on survival including age younger than 60 years, radiation therapy (without evidence of a dose-response relationship), radiation therapy combined with chemotherapy, and chemotherapy consisting of anthracycline. Partial surgical resection was an unfavorable prognostic factor. Multivariate analysis was used to confirm the independent prognostic value of radiation therapy, age, chemotherapy consisting of anthracyclines or methotrexate, and partial surgical resection. This European survey provides a reasonable basis for the treatment of primary intracerebral lymphoma with the following sequence: stereotactic biopsy sampling, chemotherapy with a methotrexate- and anthracycline-based regimen, followed by cranial irradiation.
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Affiliation(s)
- B Bataille
- Department of Neurological Surgery, Radiation Oncology, Radiology, and Pathology, University of Poitiers Medical School, France.
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Murase S, Saio M, Takenaka K, Shinoda J, Nishimura Y, Sakai N, Takami T. Increased levels of CSF soluble CD27 in patients with primary central nervous system lymphoma. Cancer Lett 1998; 132:181-6. [PMID: 10397472 DOI: 10.1016/s0304-3835(98)00181-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study is to determine the diagnostic value of cerebrospinal fluid (CSF) soluble CD27 (sCD27) as a tumor marker for primary central nervous system lymphoma (PCNSL). We examined sCD27 levels in CSF obtained from various types of brain tumor patients. Forty-two patients were studied (including 12 PCNSL patients) who had not received any therapy for their tumors. In all PCNSL cases, CSF sCD27 levels were more than 15 U/ml (median 84.5 U/ml, range 17-484 U/ml) and in other brain tumor cases, CSF sCD27 levels were all less than 15 U/ml. Our data suggest that CSF sCD27 levels are useful to distinguish PCNSL from other brain tumors.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Central Nervous System Neoplasms/cerebrospinal fluid
- Central Nervous System Neoplasms/pathology
- Child
- Child, Preschool
- Enzyme-Linked Immunosorbent Assay
- Female
- Humans
- Immunohistochemistry
- Infant
- Lymphoma, B-Cell/cerebrospinal fluid
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/cerebrospinal fluid
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Tumor Necrosis Factor Receptor Superfamily, Member 7/blood
- Tumor Necrosis Factor Receptor Superfamily, Member 7/cerebrospinal fluid
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Affiliation(s)
- S Murase
- Department of Neurosurgery, Gifu University School of Medicine, Japan
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