Atypical radiological findings of primary central nervous system lymphoma

Lin, Xuling; Khan, Iram; Seet, Ying Hao Christopher; Lee, Hwei Yee; Yu, Wai‐Yung

doi:10.1007/s00234-020-02377-0

Cited by 11 publications

(7 citation statements)

References 16 publications

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“…Our study found that patients with CNS lymphoma presenting with acute (53%), subacute (20%) or chronic (27%) vestibular symptoms mostly had an isolated vestibular syndrome without other accompanying neurological signs. However, with a diffusion restriction adjacent to the subarachnoid space and a lesion crossing the corpus callosum are also characteristic MRI findings of PCNSL [30]. In contrast, imaging features of secondary CNS lymphoma include leptomeningeal, dural, subependymal and cranial nerve enhancements [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

“…PCNSL primarily involves the brain parenchyma as a single enhanced lesion or multiple enhanced lesions in the periventricular and superficial brain. A strongly enhanced lesion with a diffusion restriction adjacent to the subarachnoid space and a lesion crossing the corpus callosum are also characteristic MRI findings of PCNSL [30]. In contrast, imaging features of secondary CNS lymphoma include leptomeningeal, dural, subependymal and cranial nerve enhancements [31–33].…”

Section: Discussionmentioning

confidence: 99%

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Ocular motor and vestibular dysfunction in central nervous system lymphoma

Lee,

Choi,

Choi

et al. 2024

Euro J of Neurology

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Background and purposeDiagnosis of lymphoma involving the central nervous system (CNS) is challenging. This study aimed to explore the abnormal vestibular and ocular motor findings in CNS lymphoma.MethodsA retrospective search of the medical records identified 30 patients with CNS lymphoma presenting ocular motor and vestibular abnormalities from four neurology clinics of university hospitals in South Korea (22 men, age range 14–81 years, mean 60.6 ± 15.2). The demographic and clinical features and the results of laboratory, radiological and pathological evaluation were analyzed.ResultsPatients presented with diplopia (13/30, 43%), vestibular symptoms (15/30, 50%) or both (2/30, 7%). In 15 patients with diplopia, abnormal ocular motor findings included ocular motor nerve palsy (n = 10, 67%), internuclear ophthalmoplegia (n = 2, 13%), external ophthalmoplegia (n = 2, 13%) and exophoria (n = 1, 7%). The vestibular abnormalities were isolated in 14 (82%) of 17 patients with vestibular symptoms and included combined unilateral peripheral and central vestibulopathy in three from lesions involving the vestibular nuclei. CNS lymphoma involved the brainstem (53%), cerebellum (33%), leptomeninges (30%), deep gray nuclei (23%) or cranial nerves (17%). Two patients showed the “double‐panda” sign by involving the midbrain.ConclusionsThis study expands the clinical and radiological spectra of CNS lymphoma. Neuro‐ophthalmological and neuro‐otological evaluation may guide the early diagnosis of CNS lymphoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ocular motor and vestibular dysfunction in central nervous system lymphoma

Lee,

Choi,

Choi

et al. 2024

Euro J of Neurology

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“…On an MRI scan, PCNSL is typically iso-hypointense on T1-weighted imaging and iso-hypointense to gray matter on T2-weighted imaging; in a previous study, in 85% of patients, a strong homogeneous pattern of enhancement was detected, due to its hypercellularity (21). However, PCNSL lesions may be non-contrast-enhancing, and can contain atypical features of hemorrhage, calcification, cysts and necrosis (23).…”

Section: Brain Imagingmentioning

confidence: 96%

Diagnosis, prognosis and treatment of primary central nervous system lymphoma in the elderly population (Review)

Liu

Yao

2021

Int J Oncol

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Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin lymphoma that is unique and different from systemic diffuse large B-cell lymphomas. The median age at diagnosis of PCNSL is 65 years and its incidence is rising rapidly in the elderly population. A total of ≥20% of all patients with PCNSL are ≥80 years old. Notably, age has been identified as an independent poor prognostic factor for PCNSL. Elderly patients have an inferior prognosis to that of younger patients and are more severely affected by iatrogenic toxicity; therefore, elderly patients represent a unique and vulnerable treatment subgroup. The present review summarized the available literature to provide an improved understanding of the epidemiology, clinical characteristics, diagnosis, prognosis and management of PCNSL in the elderly population. Notably, the incidence of PCNSL in immunocompetent elderly patients, predominantly in men, is increasing. For the diagnosis of CNSL, imaging-guided stereotactic biopsy is considered the gold standard. When stereotactic biopsy is not possible or conclusive, certain biomarkers have been described that can help establish a diagnosis. PCNSL has a very poor prognosis in the elderly, even though several prognostic scoring systems exist and several prognostic markers have been reported in patients with PCNSL. Furthermore, the treatment of elderly patients remains challenging; it is unlikely that a novel agent could be used as a curative monotherapy; however, a combination of novel agents with polychemotherapy or its combination with other novel drugs may have therapeutic potential. Contents1. Epidemiology 2. Clinical manifestation 3. Brain imaging

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“…When compared to these CNS conditions, PCNSL lesions show lower ADC values, thereby reflecting their higher cellularity. In the case series of Lin et al [ 78 ], aiming to assess the role of ADC quantification for this purpose, the ROIs were placed avoiding cystic, necrotic, and hemorrhagic regions in enhancing lesions and, for non-enhancing lesions, in the areas showing restricted diffusion. Interestingly, only 3 (18.8%) patients were diagnosed with lymphoma on neuroimaging, and in the remaining 13 cases, 9 were misdiagnosed as glioblastoma; the remaining patients were misdiagnosed as demyelinating disease (n = 2), vasculitis (n = 1), and meningioma (n = 1).…”

Section: Neuroimaging Clues In the Main Differential Diagnosesmentioning

confidence: 99%

Tumor-like Lesions in Primary Angiitis of the Central Nervous System: The Role of Magnetic Resonance Imaging in Differential Diagnosis

Zedde,

Napoli,

Moratti

et al. 2024

Diagnostics

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Primary Angiitis of the Central Nervous System (PACNS) is a rare disease and its diagnosis is a challenge for several reasons, including the lack of specificity of the main findings highlighted in the current diagnostic criteria. Among the neuroimaging pattern of PACNS, a tumefactive form (t-PACNS) is a rare subtype and its differential diagnosis mainly relies on neuroimaging. Tumor-like mass lesions in the brain are a heterogeneous category including tumors (in particular, primary brain tumors such as glial tumors and lymphoma), inflammatory (e.g., t-PACNS, tumefactive demyelinating lesions, and neurosarcoidosis), and infectious diseases (e.g., neurotoxoplasmosis). In this review, the main features of t-PACNS are addressed and the main differential diagnoses from a neuroimaging perspective (mainly Magnetic Resonance Imaging—MRI—techniques) are described, including conventional and advanced MRI.

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Atypical radiological findings of primary central nervous system lymphoma

Cited by 11 publications

References 16 publications

Ocular motor and vestibular dysfunction in central nervous system lymphoma

Ocular motor and vestibular dysfunction in central nervous system lymphoma

Diagnosis, prognosis and treatment of primary central nervous system lymphoma in the elderly population (Review)

Tumor-like Lesions in Primary Angiitis of the Central Nervous System: The Role of Magnetic Resonance Imaging in Differential Diagnosis

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