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Shah T, Venur VA. Central Nervous System Lymphoma. Semin Neurol 2023; 43:825-832. [PMID: 37995744 DOI: 10.1055/s-0043-1776783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Central nervous system lymphoma (CNSL) is a rare and aggressive malignancy that primarily affects the brain, spinal cord, and meninges. This article provides a comprehensive overview of the current understanding of CNSL encompassing its epidemiology, pathophysiology, clinical presentation, diagnosis, treatment modalities, and prognosis. Although the main focus is on primary CNS lymphoma (PCNSL), ocular lymphoma, primary leptomeningeal lymphoma, and secondary CNS lymphoma are also discussed. The pathobiology of CNSL involves the infiltration of malignant lymphocytes within the CNS parenchyma or leptomeninges. Various risk factors and immunological mechanisms contribute to its development, including immunodeficiency states, chronic inflammation, and genomic alterations. Accurate diagnosis is crucial for appropriate management, given the heterogeneous clinical presentation. The neuroimaging, systemic imaging, and other modalities for diagnosis and evaluation for extent of disease involvement will be discussed. Additionally, the importance of histopathological examination, cerebrospinal fluid (CSF) analysis, and molecular testing in confirming the diagnosis and guiding treatment decisions are highlighted. The treatment landscape for CNSL has evolved significantly. Therapeutic approaches encompass a multimodal strategy combining high-dose methotrexate-based chemotherapy, consolidation with whole-brain radiation therapy, and high-dose chemotherapy with stem cell rescue. Recent advancements in targeted therapies and immunomodulatory agents offer promising avenues for future treatment options. We review the clinical outcomes and prognostic factors influencing the survival of CNSL patients, including age, performance status, disease stage, and genetic abnormalities.
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Affiliation(s)
- Trusha Shah
- Department of Neurology, University of Washington, Seattle, Washington
| | - Vyshak A Venur
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington
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Hanif Z, Gonzalez Ramos KN, Razminia P, Aigbe E, Ghafourian P. A Perplexing Case of Bladder Mass Biopsy-Proven Neurosarcoidosis. Cureus 2023; 15:e40865. [PMID: 37489187 PMCID: PMC10363404 DOI: 10.7759/cureus.40865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
Sarcoidosis is a multi-organ systemic disease that presents with several clinical manifestations, and patients can develop neurologic complications. Neurosarcoidosis may be life-threatening; therefore, early recognition and treatment are key. Here, we present a case of a 55-year-old African American male who presented with a complaint of dizziness and left-sided weakness; he ultimately received a diagnosis of neurosarcoidosis after elaborate radiographic investigations and bladder mass biopsy. Neurosarcoidosis remains a diagnostic dilemma as it can clinically and radiographically mimic multiple conditions including multiple sclerosis, central nervous system lymphoma, multiple myeloma, and progressive multifocal leukoencephalopathy.
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Affiliation(s)
- Zainab Hanif
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | | | - Pouyan Razminia
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Eboselum Aigbe
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
| | - Pegah Ghafourian
- Internal Medicine, HCA Florida Orange Park Hospital, Orange Park, USA
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Mirmosayyeb O, Mohammadzamani M, Bagherieh S, Ghaffary EM, Azimi ES, Shaygannejad A, Shaygannejad V. Neurosarcoidosis in an adult man with a family history of MS: A case report. Clin Case Rep 2023; 11:e7605. [PMID: 37361664 PMCID: PMC10288071 DOI: 10.1002/ccr3.7605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 04/13/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Key clinical message According to this report, a biopsy revealed a diagnosis of neurosarcoidosis in a patient with a history of MS. The development of the disease can be slowed down by early diagnosis and appropriate treatment. Abstract Neurosarcoidosis is a rare type of sarcoidosis that affects the central nervous system (CNS). Herein, we present a case of neurosarcoidosis with a history of multiple sclerosis (MS). Based on the pathological findings of the biopsy, a diagnosis of neurosarcoidosis was established. The administration of appropriate treatment at an early stage can assist in decelerating its progression.
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Affiliation(s)
- Omid Mirmosayyeb
- Department of Neurology, School of MedicineIsfahan University of Medical SciencesIsfahanIran
- Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Mahtab Mohammadzamani
- Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Sara Bagherieh
- Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Elham Moases Ghaffary
- Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Elham Sadat Azimi
- Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Aysa Shaygannejad
- Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Vahid Shaygannejad
- Department of Neurology, School of MedicineIsfahan University of Medical SciencesIsfahanIran
- Isfahan Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
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Qaid S, Ghaleb R, Ahmed F, Al-shami E, Alyhari Q, Al-wageeh S, Askarpour MR. Giant asymptomatic left renal oncocytoma in a 40-year-old man: a case report. Pan Afr Med J 2022; 42:177. [PMID: 36187032 PMCID: PMC9482213 DOI: 10.11604/pamj.2022.42.177.35965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 11/05/2022] Open
Abstract
Renal oncocytoma is a benign tumor that arises from epithelial cells of the distal renal tubules. It is naturally presented with a small-sized mass, and giant oncocytoma is uncommon. Renal oncocytoma is frequently asymptomatic and challenging to distinguish preoperatively from renal cell carcinoma (RCC). We present a 40-year-old man who presented with intermittent abdominal pain in the last two years. Abdominal computed tomography (CT) scan showed a large, heterogenous left renal mass measured 15 x 16 x 19.5 cm and associated with central calcifications suspected of RCC. The patient underwent a left radical nephrectomy without complication. The histopathological study revealed typical oncocytoma features. There was no detected recurrence or distant metastasis on six months follow-up. In conclusion, it is challenging to distinguish renal oncocytoma from RCC via preoperative radiology images, especially when a giant mass is present. The only histopathology examination of the removed specimen can provide a definitive diagnosis.
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Affiliation(s)
- Sultan Qaid
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb, Yemen
| | - Radman Ghaleb
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb, Yemen,,Department of Urology, Alhamd Hospital, Ibb, Yemen
| | - Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb, Yemen,,Corresponding author: Faisal Ahmed, Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb, Yemen.
| | - Ebrahim Al-shami
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb, Yemen
| | - Qasem Alyhari
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb, Yemen
| | - Saleh Al-wageeh
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb, Yemen
| | - Mohammad Reza Askarpour
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Humann C, Raymond C, Wendling D, Verhoeven F. Clinical Images: Motor deficiency and radicular pain secondary to sarcoidosis. Arthritis Rheumatol 2022; 74:1138. [PMID: 35245417 DOI: 10.1002/art.42108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Daniel Wendling
- CHRU de Besançon and Franche-Comté University, Besançon, France
| | - Frank Verhoeven
- CHRU de Besançon and Franche-Comté University, Besançon, France
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Fritzhand SJ, Esmaeli B, Sun J, Debnam JM. Primary disease sites and patterns of spread in cases of neurolymphomatosis in the orbit associated with lymphoma. Cancer Imaging 2021; 21:39. [PMID: 34039437 PMCID: PMC8157741 DOI: 10.1186/s40644-021-00409-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurolymphomatosis involving the cranial nerves (CNs) is rare. We sought a better understanding of the primary disease sites and patterns of spread in neurolymphomatosis of the orbit and retro-orbital cranial nerves. METHODS Patients with lymphoma and MRI evidence of neurolymphomatosis of CN II, III, IV, V1, or V2 were retrospectively reviewed. Demographics and primary disease site and sites of neurolymphomatosis on MRI were recorded. Wilcoxon rank sum test was used to compare number of sites of neurolymphomatosis with lymphoma type and survival. RESULTS The study included 18 patients. The most frequent types of lymphoma were diffuse large B-cell (DLBCL) (n = 9) and marginal zone (n = 3). In 9 patients, lymphoma presented as a mass (n = 7) or infiltrative disease (n = 2) directly involving the orbit; in 6, a maxillofacial mass spread directly to CNs; and in 3, lymphoma at remote sites spread to orbital CNs. Overall, 81 sites of neurolymphomatosis were noted. The most common sites were the maxillary nerve (V2) including at the infraorbital fissure or foramen rotundum (17 patients; 19 nerves), pterygopalatine fossa (16 patients; 19 nerves), and cavernous sinus (9 patients; 12 nerves). Number of sites of neurolymphomatosis was significantly lower for DLBCL than for other lymphoma types (p = 0.007). Number of sites of neurolymphomatosis did not affect survival (p = 0.26). The mean interval between the pathologic diagnosis and MRI documentation of the full extent of neurolymphomatosis was 39 days after pathologic diagnosis. CONCLUSIONS Based on our study results, neurolymphomatosis in the orbit appears to be frequently associated with an orbital and/or maxillofacial mass and commonly involves CN V2, the pterygopalatine fossa, and the cavernous sinus. DLBCL may be associated with fewer sites of neurolymphomatosis than other lymphomas. In patients with lymphoma, a systematic search for neurolymphomatosis is imperative for early detection.
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Affiliation(s)
- Seth J Fritzhand
- School of Nursing and Health Studies, Georgetown University, Washington, DC, USA
| | - Bita Esmaeli
- Orbital Oncology & Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J Matthew Debnam
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Blvd., Unit 1482, Houston, TX, 77030, USA.
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Liu KC, Hennessey MA, McCall CM, Proia AD. Ocular involvement in neurolymphomatosis. Am J Ophthalmol Case Rep 2018; 10:148-151. [PMID: 29780925 PMCID: PMC5956672 DOI: 10.1016/j.ajoc.2018.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/31/2018] [Accepted: 02/26/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose To describe the ophthalmic symptoms and histopathological findings in a case of primary neurolymphomatosis (NL). Observations A man in his 60s with a prior diagnosis of chronic inflammatory demyelinating polyneuropathy developed facial numbness, diplopia, drooling, and difficulty swallowing. Over a 3-month period, he developed total ptosis and ophthalmoplegia of the right eye with a dilated, non-reactive pupil considered secondary to cranial nerve III and VI palsies. His left pupil subsequently became non-reactive to light and accommodation, and extraocular motility of the left eye was partially limited in all directions of gaze without ptosis. Autopsy findings included primary NL, diffuse large B-cell lymphoma of activated B-cell subtype, involving right and left cranial nerves V, VI, IX, and X; spinal nerve roots; both femoral nerves; and extrascleral, intrascleral, and intraocular short and long posterior ciliary nerves with extension into the adjacent choroid of both eyes. No evidence of lymphoma was identified elsewhere in the body. Conclusions and importance Our patient is only the second histological demonstration of ciliary nerve involvement by NL, and the first, to our knowledge, of primary NL spreading secondarily from the ciliary nerves into the choroid. Our patient demonstrates that NL, though rare, should be included in the differential diagnosis of ocular cranial nerve palsies and ophthalmoplegia.
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Affiliation(s)
- Katy C Liu
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Chad M McCall
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Alan D Proia
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
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Davidson T, Kedmi M, Avigdor A, Komisar O, Chikman B, Lidar M, Goshen E, Tzila Zwas S, Ben-Haim S. FDG PET-CT evaluation in neurolymphomatosis: imaging characteristics and clinical outcomes. Leuk Lymphoma 2017; 59:348-356. [PMID: 28750592 DOI: 10.1080/10428194.2017.1352096] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neurolymphomatosis (NL) often represents unidentified non-Hodgkin lymphoma relapses. Considering its severity, early detection and treatment are crucial. We outline one hospital's 18F-FDG-PET-CT imaging findings of NL, along with the patients' clinical characteristics. Clinical records and imaging findings of 19 NL patients, PET-CT diagnosed, were retrospectively reviewed. Patient data, FDG-PET-CT findings and the presence of coexisting diseases, especially CNS involvement, were documented. Available MRI and clinical data verified the findings. All cases had increased linear FDG uptake along anatomic nerve sites. CTs showed varying degrees of corresponding soft-tissue-thickening. Clinical correlations also contributed to the diagnosis. In 4/19 patients, lymphoma presented with NL, in 15/19 it appeared with disease recurrence/progression. In 9/19, clinical symptoms suggested neural involvement while 10/19 had nonspecific symptoms. Eleven died of lymphoma within 0.9 years of diagnosis despite directed-therapy. Eight, however, survived up to 7.82 years post-diagnosis. Whole-body FDG-PET-CT can assist in early NL diagnosis, possibly enhancing survival.
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Affiliation(s)
- Tima Davidson
- a Department of Nuclear Medicine , Chaim Sheba Medical Center , Tel Hashomer , Israel.,b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel
| | - Meirav Kedmi
- b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel.,c Division of Hematology and Bone Marrow Transplantation , Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Abraham Avigdor
- b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel.,c Division of Hematology and Bone Marrow Transplantation , Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Orna Komisar
- d Department of Diagnostic Imaging , Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Bar Chikman
- e Division of Surgery , Assaf Harofeh Medical Center , Zerifin , Israel
| | - Merav Lidar
- b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel.,f Rheumatology Unit , Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - Elinor Goshen
- a Department of Nuclear Medicine , Chaim Sheba Medical Center , Tel Hashomer , Israel.,b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel
| | - S Tzila Zwas
- a Department of Nuclear Medicine , Chaim Sheba Medical Center , Tel Hashomer , Israel.,b Sackler School of Medicine , Tel Aviv University , Ramat Aviv , Israel
| | - Simona Ben-Haim
- a Department of Nuclear Medicine , Chaim Sheba Medical Center , Tel Hashomer , Israel.,g Institute of Nuclear Medicine , University College London and UCL Hospitals, NHS Trust , London , UK
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Maxwell G, Reading P. Bell’s that did not ring true. Pract Neurol 2017; 17:154-158. [DOI: 10.1136/practneurol-2016-001512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 11/04/2022]
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Kinoshita H, Yamakado H, Kitano T, Kitamura A, Yamashita H, Miyamoto M, Hitomi T, Okada T, Nakamoto Y, Sawamoto N, Takaori-Kondo A, Takahashi R. Diagnostic utility of FDG-PET in neurolymphomatosis: report of five cases. J Neurol 2016; 263:1719-26. [PMID: 27286845 DOI: 10.1007/s00415-016-8190-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
Abstract
Neurolymphomatosis (NL) is a rare condition involving the infiltration of lymphoma cells into the peripheral nervous system. NL can be primary or secondary in the setting of an unknown or known hematologic malignancy, respectively. Here, we report five cases in which F-18 2-fluoro-2-deoxy-glucose positron emission tomography/computed tomography (F-18 FDG-PET/CT) had great value for diagnosing NL. Two cases were rare primary NL, and the other three were secondary NL. Clinical presentations were asymmetric sensorimotor disturbances in the extremities with or without involvement of cranial nerves. Furthermore, all patients experienced spontaneous pain in the face or affected extremities. Cerebrospinal fluid analysis was cytologically negative in two of five cases. Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) detected abnormalities in the cranial nerves, nerve roots, and cauda equina in all cases except case 1 and the recurrent stage of case 2. F-18 FDG-PET/CT showed clear visualization of almost all the lymphomatous involvement of peripheral nerves and other tissues in all patients. Furthermore, F-18 FDG-PET/CT detected abnormalities including asymptomatic lesions that were not detected with MRI, and also identified the appropriate lesion for diagnostic biopsy. However, as in case 3, the lesions in the left oculomotor nerve and the cauda equina were detected only with Gd-enhanced MRI, which has superior spatial resolution. In conclusion, F-18 FDG-PET/CT is a sensitive modality that can suggest the presence of malignancy and identify appropriate places for diagnostic biopsies. It is especially useful when combined with Gd-enhanced MRI, even in patients with primary NL that is usually difficult to diagnose.
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Sakai N, Ito-Yamashita T, Takahashi G, Baba S, Koizumi S, Yamasaki T, Tokuyama T, Namba H. Primary neurolymphomatosis of the lower cranial nerves presenting as Dysphagia and hoarseness: a case report. J Neurol Surg Rep 2014; 75:e62-6. [PMID: 25083392 PMCID: PMC4110151 DOI: 10.1055/s-0033-1363505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 11/03/2013] [Indexed: 11/13/2022] Open
Abstract
Primary neurolymphomatosis is an extremely rare tumor. We report the case of a 74-year-old patient presenting with dysphagia and hoarseness. Initial contrast-enhanced computed tomography of the head, neck, and chest did not reveal any lesions. His symptoms improved with short-term administration of prednisone but recurred and deteriorated. Magnetic resonance (MR) imaging revealed a tumor along the ninth and tenth cranial nerves across the jugular foramen. Fluorine-18 fluorodeoxyglucose positron emission tomography indicated this was a primary tumor. Repeated MR imaging after 2 months revealed considerable tumor enlargement. A left suboccipital craniotomy was performed to remove the tumor that infiltrated the ninth and tenth cranial nerves. The histopathologic diagnosis was diffuse large B-cell lymphoma. Although focal radiation therapy was administered to ensure complete eradication of the tumor, the patient died of aspiration pneumonia with systemic metastasis. To our knowledge, this is the first reported case of primary neurolymphomatosis in the lower cranial nerves.
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Affiliation(s)
- Naoto Sakai
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Tae Ito-Yamashita
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Goro Takahashi
- Department of Otolaryngology, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Satoshi Baba
- Department of Diagnostic Pathology, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Shinichiro Koizumi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Tomohiro Yamasaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Tsutomu Tokuyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Handayama, Higashiku, Hamamatsu, Japan
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Kamiya-Matsuoka C, Shroff S, Gildersleeve K, Hormozdi B, Manning JT, Woodman KH. Neurolymphomatosis: a case series of clinical manifestations, treatments, and outcomes. J Neurol Sci 2014; 343:144-8. [PMID: 24928074 DOI: 10.1016/j.jns.2014.05.058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neurolymphomatosis (NL) is a rare clinical entity characterized by infiltration of malignant lymphocytes into the peripheral nervous system. We analyzed the clinicoradiological features, treatments, and outcomes in NL patients. METHODS We identified six patients with NL seen at The University of Texas MD Anderson Cancer Center from 01/2010 to 10/2012. We extracted clinical presentations, imagings, CSF cytology, and electrodiagnostic studies from medical records. One patient had a nerve biopsy. We defined therapy response as clinical improvement of neurological deficits. FINDINGS The mean age at onset was 57.1 years. Most were predominantly men with non-Hodgkin lymphoma. Positron emission tomography (PET) was positive in five patients. Nerve conduction demonstrated mononeuritis multiplex, plexopathy, demyelination, and axonal polyradiculoneuropathy, whereas electromyography was nonspecific. All patients received systemic chemotherapy, four intrathecal chemotherapy, and three intravenous immunoglobulin, plasma exchange or both. One patient who received intravenous immunoglobulin showed mild neurological improvement. Two patients responded, and the median overall survival was 15 months. CONCLUSIONS NL is an increasingly recognized complication of NHL and leukemia. A high clinical suspicion is necessary for correct diagnosis. In the present series, patients with leukemia had mononeuritis multiplex, whereas those with lymphoma had plexopathy. Electrodiagnosis and PET scans were useful diagnostic tools. No factors correlated with poorer prognosis. International collaborative studies will help to better determine the risk factors of NL, response to treatment and outcomes.
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Abstract
BACKGROUND Neuro-oncologists are familiar with primary brain tumors, intracerebral metastases meningeal carcinomatosis and extracerebral intracranial tumors as meningeoma. For these conditions, and also some other rare tumor entities several treatment options exist. Cancer can also involve structures around the brain as the dura, the base of the skull, the cavities of the skull and tissue around the bony skull, the skin, the tissue of the neck. and either compress, invade or spread in the central or peripheral nervous system. METHODS A systematic literature research was conducted determining symptoms and signs, tumor sites of nerve invasion, tumor types, diagnostic techniques, mechanisms of nerve invasion, and important differential diagnosis. Additional cases from own experience were added for illustration. RESULTS The mechanisms of tumor invasion of cranial nerves is heterogenous and not only involves several types of invasion, but also spread along the cranial nerves in antero- and retrograde fashion and even spread into different nerve territories via anastomosis. In addition the concept of angiosomas may have an influence on the spread of metastases. CONCLUSION In addition to the well described tumor spread in meningeal carcinomatosis and base of the skull metastases, dural spread, lesions of the bony skull, the cavities of the skull and skin of the face and tissue of the neck region need to be considered, and have an impact on therapeutic decisions.
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Affiliation(s)
- Wolfgang Grisold
- Department Neurology , KFJ Hospital Vienna , Vienna, Austria (W.G.); Department of Neurology , University Hospital of Vienna , Vienna, Austria (A.G.)
| | - Anna Grisold
- Department Neurology , KFJ Hospital Vienna , Vienna, Austria (W.G.); Department of Neurology , University Hospital of Vienna , Vienna, Austria (A.G.)
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Ramirez-Zamora A, Morales-Vidal S, Chawla J, Biller J. Autopsy proven peripheral nervous system neurolymphomatosis despite negative bilateral sural nerve biopsy. Front Neurol 2013; 4:197. [PMID: 24367352 PMCID: PMC3854546 DOI: 10.3389/fneur.2013.00197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/21/2013] [Indexed: 11/29/2022] Open
Abstract
Neurolymphomatosis (NL) refers to a lymphomatous infiltration of peripheral nerves associated with central nervous system or systemic lymphoma, or alternatively, neurodiagnostic evidence of nerve enhancement and/or enlargement beyond the dural sleeve in the setting of primary central nervous system lymphoma or systemic lymphoma. NL is a rare complication of systemic cancer with heterogeneous clinical presentations and an elusive diagnosis. Diagnosis usually requires the demonstration of infiltrating malignant lymphocytes in the peripheral nerve. Infiltration of brain parenchyma, meninges or Virchow–Robin spaces is characteristic of systemic disease at autopsy. We describe a patient presenting with biopsy negative NL affecting exclusively the peripheral nervous system at autopsy.
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Affiliation(s)
| | - Sarkis Morales-Vidal
- Department of Neurology, Maguire Center, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | | | - José Biller
- Department of Neurology, Maguire Center, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
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