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Nanah A, Al Hadidi S. Bing-Neel Syndrome: Update on the Diagnosis and Treatment. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e213-e219. [PMID: 34674984 DOI: 10.1016/j.clml.2021.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/09/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022]
Abstract
Bing-Neel syndrome (BNS) is a rare syndrome that occurs in patients with Waldenstrom macroglobulinemia and is characterized by lymphoplasmacytic infiltration into the leptomeningeal tissue and/or the central nervous system. It represents an extramedullary manifestation which may translate into various neurological symptoms. Accurate diagnosis of BNS can be established via histologic sampling and cerebrospinal fluid examination with molecular analysis of some genetic markers including immunoglobulin heavy locus rearrangements and MYD88 L265P mutation. The use of Bruton tyrosine kinase inhibitors such as ibrutinib resulted in promising outcomes. In this review, we discuss the pathophysiology, clinical manifestations, diagnostic characteristics, and an overview of the current treatment modalities of BNS.
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Affiliation(s)
| | - Samer Al Hadidi
- Myeloma Section, Winthrop P. Rockefeller Cancer Institute at the University of Arkansas for Medical Sciences, Little Rock, AR.
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2
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Alessandrino F, DiPiro PJ, Jagannathan JP, Babina G, Krajewski KM, Ramaiya NH, Giardino AA. Multimodality imaging of indolent B cell lymphoma from diagnosis to transformation: what every radiologist should know. Insights Imaging 2019; 10:25. [PMID: 30796644 PMCID: PMC6386758 DOI: 10.1186/s13244-019-0705-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/14/2018] [Indexed: 12/28/2022] Open
Abstract
Indolent B cell lymphomas are a group of lymphoid malignancies characterized by their potential to undergo histologic transformation to aggressive lymphomas. While different subtypes of indolent B cell lymphomas demonstrate specific clinical and imaging features, histologic transformation can be suspected on cross-sectional imaging when disproportionate lymph node enlargement or new focal lesions in extranodal organs are seen. On PET/CT, transformed indolent lymphoma may show new or increased nodal FDG avidity or new FDG-avid lesions in different organs. In this article, we will (1) review the imaging features of different subtypes of indolent B cell lymphomas, (2) discuss the imaging features of histologic transformation, and (3) propose a diagnostic algorithm for transformed indolent lymphoma. The purpose of this review is to familiarize radiologists with the spectrum of clinical and imaging features of indolent B cell lymphomas and to define the role of imaging in raising concern for transformation and in guiding biopsy for confirmation.
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Affiliation(s)
- Francesco Alessandrino
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA. .,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Pamela J DiPiro
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jyothi P Jagannathan
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Gosangi Babina
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Katherine M Krajewski
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Nikhil H Ramaiya
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Angela A Giardino
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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3
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Imaging spectrum of Bing–Neel syndrome: how can a radiologist recognise this rare neurological complication of Waldenström’s macroglobulinemia? Eur Radiol 2018; 29:102-114. [DOI: 10.1007/s00330-018-5543-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/22/2018] [Accepted: 05/16/2018] [Indexed: 12/19/2022]
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4
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Agard E, El Chehab H, Vanquaethem H, Malclès A, Drouet A, Dot C, Guilloton L. [Bilateral infiltrative optic neuropathy as presenting sign of Waldenström macroglobulinemia]. J Fr Ophtalmol 2017; 40:e95-e96. [PMID: 28318712 DOI: 10.1016/j.jfo.2016.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 12/18/2015] [Accepted: 01/04/2016] [Indexed: 11/16/2022]
Affiliation(s)
- E Agard
- Service d'ophtalmologie, hôpital d'instruction des armées desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France.
| | - H El Chehab
- Service d'ophtalmologie, hôpital d'instruction des armées desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
| | - H Vanquaethem
- Service de médecine interne, hôpital d'instruction des armées desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
| | - A Malclès
- Service d'ophtalmologie, hôpital d'instruction des armées desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
| | - A Drouet
- Service de neurologie, hôpital d'instruction des armées desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
| | - C Dot
- Service d'ophtalmologie, hôpital d'instruction des armées desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
| | - L Guilloton
- Service de neurologie, hôpital d'instruction des armées desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
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5
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Minnema MC, Kimby E, D'Sa S, Fornecker LM, Poulain S, Snijders TJ, Kastritis E, Kremer S, Fitsiori A, Simon L, Davi F, Lunn M, Castillo JJ, Patterson CJ, Le Garff-Tavernier M, Costopoulos M, Leblond V, Kersten MJ, Dimopoulos MA, Treon SP. Guideline for the diagnosis, treatment and response criteria for Bing-Neel syndrome. Haematologica 2016; 102:43-51. [PMID: 27758817 DOI: 10.3324/haematol.2016.147728] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 10/06/2016] [Indexed: 12/31/2022] Open
Abstract
Bing Neel syndrome is a rare disease manifestation of Waldenström's macroglobulinemia that results from infiltration of the central nervous system by malignant lymphoplasmacytic cells. In this guideline we describe the clinical symptoms, as well as the appropriate laboratory and radiological studies, that can aid in the diagnosis. The presentation of Bing Neel syndrome may be very diverse, and includes headaches, cognitive deficits, paresis, and psychiatric symptoms. The syndrome can present in patients with known Waldenström's macroglobulinemia, even in the absence of systemic progression, but also in previously undiagnosed patients. Diagnostic work-up should include cerebral spinal fluid analysis with multiparameter flow cytometry to establish B-cell clonality, protein electrophoresis and immunofixation for the detection and classification of a monoclonal protein as well as molecular diagnostic testing for immunoglobulin gene rearrangement and mutated MYD88. MRI of the brain and spinal cord is also essential. The second challenge is to expand our knowledge of prognosis and treatment outcome. Prospective clinical trials on Bing Neel syndrome patients that employ uniform treatment along with appropriate laboratory cerebral spinal fluid assessments and standardized MRI protocols will be invaluable, constituting a significant step forward in delineating treatment outcome for this intriguing disease manifestation.
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Affiliation(s)
- Monique C Minnema
- Department of Hematology, UMC Utrecht Cancer Center, the Netherlands
| | - Eva Kimby
- Hematology Center, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Shirley D'Sa
- Cancer Division, University College London Hospitals NHS Foundation Trust, UK
| | - Luc-Matthieu Fornecker
- Department of Oncology and Hematology, Hôpital Universitaires de Strasbourg and Université de Strasbourg, France
| | - Stéphanie Poulain
- Service d'Hématologie-Immunologie-Cytogénétique, Centre Hospitalier de Valenciennes/Laboratoire d'Hématologie, Centre de Biologie et Pathologie, CHRU de Lille/INSERM, France
| | - Tom J Snijders
- Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, UMC Utrecht, The Netherlands
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece
| | - Stéphane Kremer
- Pôle d'Imagerie-Neuroradiologie, Hôpital de Hautepierre/CHU Strasbourg, France
| | - Aikaterini Fitsiori
- Pôle d'Imagerie-Neuroradiologie, Hôpital de Hautepierre/CHU Strasbourg, France
| | - Laurence Simon
- Department of Oncology and Hematology, Hôpital Universitaires de Strasbourg and Université de Strasbourg, France
| | - Frédéric Davi
- Laboratory of Hematology, Hôpital Pitié Salpêtrière, Paris, France
| | - Michael Lunn
- Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Jorge J Castillo
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical; School, Boston, MA, USA
| | - Christopher J Patterson
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical; School, Boston, MA, USA
| | | | | | | | - Marie-José Kersten
- Department of Hematology, Academic Medical Center, Amsterdam, the Netherlands
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece
| | - Steven P Treon
- Bing Center for Waldenstrom's Macroglobulinemia, Dana Farber Cancer Institute and Harvard Medical; School, Boston, MA, USA
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6
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Simon L, Fitsiori A, Lemal R, Dupuis J, Carpentier B, Boudin L, Corby A, Aurran-Schleinitz T, Gastaud L, Talbot A, Leprêtre S, Mahe B, Payet C, Soussain C, Bonnet C, Vincent L, Lissandre S, Herbrecht R, Kremer S, Leblond V, Fornecker LM. Bing-Neel syndrome, a rare complication of Waldenström macroglobulinemia: analysis of 44 cases and review of the literature. A study on behalf of the French Innovative Leukemia Organization (FILO). Haematologica 2015; 100:1587-94. [PMID: 26385211 DOI: 10.3324/haematol.2015.133744] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/18/2015] [Indexed: 11/09/2022] Open
Abstract
Central nervous system involvement by malignant cells is a rare complication of Waldenström macroglobulinemia, and this clinicopathological entity is referred to as the Bing-Neel syndrome. There is currently no consensus on the diagnostic criteria, therapeutic approaches and response evaluation for this syndrome. In this series, we retrospectively analyzed 44 French patients with Bing-Neel syndrome. Bing-Neel syndrome was the first manifestation of Waldenström macroglobulinemia in 36% of patients. When Waldenström macroglobulinemia was diagnosed prior to Bing-Neel syndrome, the median time interval between this diagnosis and the onset of Bing-Neel syndrome was 8.9 years. This study highlights the possibility of the occurrence of Bing-Neel syndrome without any other evidence of progression of Waldenström macroglobulinemia. The clinical presentation was heterogeneous without any specific signs or symptoms. Biologically, the median lymphocyte count in the cerebrospinal fluid was 31/mm(3). Magnetic resonance imaging revealed abnormalities in 78% of the cases. The overall response rate after first-line treatment was 70%, and the overall survival rate after the diagnosis of Bing-Neel syndrome was 71% at 5 years. Altogether, these results suggest that Bing-Neel syndrome should be considered in the context of any unexplained neurological symptoms associated with Waldenström macroglobulinemia. The diagnostic approach should be based on cerebrospinal fluid analysis and magnetic resonance imaging of the brain and spinal axis. It still remains difficult to establish treatment recommendations or prognostic factors in the absence of large-scale, prospective, observational studies.
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Affiliation(s)
- Laurence Simon
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Aikaterini Fitsiori
- Department of Radiology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Richard Lemal
- Department of Cell Therapy and Clinical Hematology, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Hôpital Henri Mondor, AP-HP, Créteil, France
| | | | - Laurys Boudin
- Department of Medical Oncology, Hôpital d'Instruction des Armées, Toulon, France
| | - Anne Corby
- Department of Hematology, Centre Hospitalier Universitaire, Angers, France
| | | | - Lauris Gastaud
- Department of Onco-Hematology, Centre Antoine Lacassagne, Nice, France
| | - Alexis Talbot
- Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP and Université Paris Diderot, Sorbonne Paris Cité, France
| | | | - Béatrice Mahe
- Department of Hematology, Centre Hospitalier Universitaire, Nantes, France
| | - Camille Payet
- Department of Hematology, Centre Hospitalier Universitaire, Besançon, France
| | - Carole Soussain
- Department of Hematology, Institut Curie-Hôpital René Huguenin, Saint-Cloud, France
| | - Charlotte Bonnet
- Department of Neurosurgery, Centre Hospitalier Universitaire, Bordeaux, France
| | - Laure Vincent
- Department of Hematology, Centre Hospitalier Universitaire, Montpellier, France
| | - Séverine Lissandre
- Department of Hematology, Centre Hospitalier Universitaire, Tours, France
| | - Raoul Herbrecht
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Stéphane Kremer
- Department of Radiology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | - Véronique Leblond
- Department of Hematology, APHP Hôpital Pitié-Salpêtrière, UPMC Paris, GRECHY, France
| | - Luc-Matthieu Fornecker
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
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Van Cauwenberge MG, Depreter B, Dumoulin EN, Emmerechts J, Nollet F, Vanopdenbosch LJ. Bing-Neel syndrome: Two unexpected cases and a review of the literature. J Neurol Sci 2015; 356:19-26. [PMID: 26159625 DOI: 10.1016/j.jns.2015.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 06/01/2015] [Accepted: 06/13/2015] [Indexed: 10/23/2022]
Abstract
Waldenström macroglobulinemia (WM) is a lymphoplasmacytic lymphoma characterized by the proliferation of small B-lymphocytes in the bone marrow that produce monoclonal immunoglobulin M (IgM). We describe two patients with WM who presented with neurological symptoms due to infiltration of lymphoplasmacytoid tumor cells in the central nervous system, a condition known as Bing-Neel syndrome. A literature review revealed that this syndrome is rare and commonly missed in clinical practice due to its variable presentation and a lack of awareness or knowledge. Brain and spinal magnetic resonance imaging may show a focal mass or diffuse infiltration. The diagnosis of Bing-Neel syndrome requires proof of IgM or lymphoplasmacytoid cells in cerebrospinal fluid or in a brain biopsy. Treatment with intravenous and/or intrathecal chemotherapy and cranial radiotherapy is described in literature with generally poor outcome, although a combination of these therapies seems to improve outcome. Nevertheless, insufficient data are currently available to make general treatment recommendations.
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Affiliation(s)
- M G Van Cauwenberge
- Department of Neurology, University Clinic RWTH Aachen, Germany; Department of Neurology, AZ Sint Jan Brugge Oostende, Belgium.
| | - B Depreter
- Department of Laboratory Hematology, University Hospital Ghent, Belgium
| | - E N Dumoulin
- Department of Laboratory Hematology, University Hospital Ghent, Belgium
| | - J Emmerechts
- Department of Laboratory Hematology, AZ Sint Jan Brugge Oostende, Belgium
| | - F Nollet
- Department of Laboratory Hematology, AZ Sint Jan Brugge Oostende, Belgium
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Boudin L, Romeo E, Mavrovi E, Tsitsi Nding P, Blade JS, de Jaureguiberry JP, Gisserot O. [Bing-Neel syndrome: Report of 4 cases and literature review]. Rev Med Interne 2014; 36:418-22. [PMID: 24907109 DOI: 10.1016/j.revmed.2014.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 02/19/2014] [Accepted: 05/06/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Neurological manifestations during Waldenstrom disease are common and are usually related to immune peripheral neuropathy or serum hyperviscosity syndrome. The infiltration of the central nervous system by the lymphoproliferative syndrome is known as the Bing-Neel syndrome. This extremely rare entity remains poorly described in the literature. CASE REPORTS We report on 4 cases of patients for whom central neurological disorders led to the diagnosis of a Bing and Neel syndrome. These four cases illustrate different clinical presentations, diagnosis, therapeutic options, and outcome in this syndrome. Based on our literature review, we discuss about these differences. CONCLUSION The polymorphic clinical manifestations of Bing and Neel syndrome can mimic many diagnoses. However, it may be necessary to consider this diagnosis. Cerebrospinal fluid analysis and MRI may allow rapid diagnosis or guide a biopsy. Prolonged remissions are possible with appropriate treatment.
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Affiliation(s)
- L Boudin
- Service de médecine interne - oncologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France.
| | - E Romeo
- Service de médecine interne - oncologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France
| | - E Mavrovi
- Service de médecine interne - oncologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France
| | - P Tsitsi Nding
- Service de médecine interne - oncologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France
| | - J-S Blade
- Service de médecine interne - oncologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France
| | - J-P de Jaureguiberry
- Service de médecine interne - oncologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France
| | - O Gisserot
- Service de médecine interne - oncologie, HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France
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Ly KI, Fintelmann F, Forghani R, Schaefer PW, Hochberg EP, Hochberg FH. Novel diagnostic approaches in Bing-Neel syndrome. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2012; 11:180-3. [PMID: 21856555 DOI: 10.3816/clml.2011.n.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The central nervous system (CNS) manifestations of Waldenström's macroglobulinemia (WM) are known as the Bing-Neel syndrome (BNS). Patients with BNS can be classified into Group A and Group B based on the presence of lymphoplasmacytoid (LMP) cells within the brain parenchyma, leptomeninges, dura, and/or cerebrospinal fluid (CSF). To identify characteristic imaging findings for both Group A and Group B patients, we reviewed all 36 cases (26 referenced, 10 unreported) of proven WM with CNS symptoms, CSF analysis and/or biopsy, and magnetic resonance imaging (MRI) of the brain and/or spinal cord. Enhancement on MRI suggests invasion of the central neuraxis by LMP cells, and can help distinguish between Group A and Group B patients. In addition to differentiating true WM lesions in the CNS from ischemia, hyperviscosity events, and demyelinating lesions, evaluation of brain and spinal cord with gadolinium-enhanced MRI has the potential to guide management.
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Affiliation(s)
- K Ina Ly
- Massachusetts General Hospital Cancer Center, Boston, USA
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10
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Kim HJ, Suh SI, Kim JH, Kim BJ. Brain magnetic resolution imaging to diagnose bing-neel syndrome. J Korean Neurosurg Soc 2009; 46:588-91. [PMID: 20062579 DOI: 10.3340/jkns.2009.46.6.588] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 05/12/2009] [Accepted: 10/26/2009] [Indexed: 11/27/2022] Open
Abstract
Radiologic findings of Bing-Neel syndrome, which is an extremely uncommon complication resulting from malignant lymphocyte infiltration into the central nervous system (CNS) in patients with Waldenström's macroglobulinemia (WM), have been infrequently reported due to extreme rarity of the case. A 75-year-old man with WM presented at a neurology clinic with progressive gait and memory disturbances, and dysarthria of 2 months duration. Cerebrospinal fluid and serum protein electrophoresis and immunofixation electrophoresis showed IgM kappa-type monoclonal gammopathy. Brain magnetic resonance imaging revealed multifocal, hyperintense lesions on T2 weighted-images. Brain diffusion-weighted imaging (DWI) demonstrated hyperintensities in cerebral and cerebellar lesions that appeared isointense on apparent diffusion coefficient maps, which were compatible with vasogenic edema. Although histologic analysis is a confirmative study to prove direct cell infiltration into the brain, brain MRI with DWI may be a good supportive study to diagnose Bing-Neel syndrome.
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Affiliation(s)
- Ho-Jung Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
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Grewal JS, Brar PK, Sahijdak WM, Tworek JA, Chottiner EG. Bing-Neel syndrome: a case report and systematic review of clinical manifestations, diagnosis, and treatment options. CLINICAL LYMPHOMA & MYELOMA 2009; 9:462-6. [PMID: 19951888 DOI: 10.3816/clm.2009.n.091] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bing-Neel syndrome is an extremely rare neurologic complication of Waldenström macroglobulinemia (WM) that was first described in 1936. It is associated with central nervous system infiltration by neoplastic lymphoplasmacytoid and plasma cells with or without cerebrospinal fluid (CSF) hyperglobulinemia. CASE REPORT We report a case of a 69-year-old white man with a 10-year history of WM. He was diagnosed with Bing-Neel syndrome based on magnetic resonance imaging and pathology studies of CSF. In addition, a comprehensive review of the reported cases of Bing-Neel syndrome in the up-to-date English-language literature was performed. RESULTS Our patient underwent successful treatment with cranial radiation and intrathecal chemotherapy. He has been in clinical and pathologic remission for 3 years following the completion of his treatment. Based on our literature review, we also summarize and discuss clinical manifestations, diagnosis, and treatment options for Bing-Neel syndrome. CONCLUSION Bing-Neel syndrome is a rare and potentially treatable complication of WM. Patients with a history of WM presenting with neurologic symptoms should be evaluated for possible Bing-Neel syndrome. Cranial radiation therapy alone or in combination with intrathecal chemotherapy is more likely to achieve sustainable remission than intrathecal chemotherapy alone.
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Affiliation(s)
- Jaspreet S Grewal
- Department of Internal Medicine, St. Joseph Mercy Hospital, Reichert Health Center, 5333 McAuley Dr, Ste 3009, Ann Arbor, MI 48106-0995, USA.
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12
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Bing–Neel syndrome: an illustrative case and a comprehensive review of the published literature. J Neurooncol 2009; 96:301-12. [DOI: 10.1007/s11060-009-9968-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
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13
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Fintelmann F, Forghani R, Schaefer PW, Hochberg EP, Hochberg FH. Bing-Neel Syndrome revisited. ACTA ACUST UNITED AC 2009; 9:104-6. [PMID: 19362988 DOI: 10.3816/clm.2009.n.028] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since the 1936 seminal description of neurologic difficulties in patients with hyperglobulinemia, the "Bing-Neel Syndrome" has been applied to a range of neurologic symptoms. To clarify the central nervous system (CNS) manifestations of Waldenström macroglobulinemia (WM), we performed a literature search (years 1936 to 2008) of reports of "Bing-Neel Syndrome" or "WM affecting the CNS" (WM-CNS). We excluded cases of hyperviscosity, malignant transformation, vasculitis, and purely ophthalmologic manifestations. After analysis of symptoms, cerebrospinal fluid (CSF), imaging, and histopathology, we separate WM-CNS into (1) lymphoplasmacytoid cells infiltrating the CNS, and (2) a non-cellular form, in which other mechanisms, such as IgM deposition, might produce the neurologic symptoms.
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Affiliation(s)
- Florian Fintelmann
- Department of Radiology, Massachusetts General Hospital, Boston MA 02114, USA
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