Central Nervous System Lymphoma Initially Diagnosed as Tumefactive Multiple Sclerosis after Brain Biopsy

Ohe, Yasuko; Hayashi, Takeshi; Mishima, Kazuhiko; Nishikawa, Ryo; Sasaki, Atsushi; Uchino, Akira; Tanahashi, Norio

doi:10.2169/internalmedicine.52.8531

Cited by 22 publications

(18 citation statements)

References 14 publications

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“…Demyelinating lesions are called "sentinel lesions" and are associated with contrast enhancement on MRI (3). Similar cases of the development of "sentinel lesions" preceding primary CNS lymphoma have been reported (4,5).…”

Section: Discussionsupporting

confidence: 72%

Primary Central Nervous System Cytotoxic T-cell Lymphoma Mimicking Demyelinating Disease

et al. 2014

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A 40-year-old man visited to our hospital due to progressive right hemiparesis. Magnetic resonance imaging demonstrated a heterogeneous contrast-enhanced lesion in the left basal ganglia with compression of the ventricles. A brain biopsy did not demonstrate central nervous system (CNS) lymphoma, although acute demyelination was observed. Despite the administration of steroids, the lesion increased in size, and the patient died three months after admission. An autopsy disclosed perivascular and parenchymal infiltration of lymphoma cells. An immunohistochemical analysis showed that the lesion was a cytotoxic T-cell lymphoma. This case indicates that the development of primary CNS lymphoma of this immunophenotype may be preceded by demyelination with subsequent rapid progression, thus requiring a careful evaluation and meticulous diagnosis.

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Section: Discussionsupporting

confidence: 72%

Primary Central Nervous System Cytotoxic T-cell Lymphoma Mimicking Demyelinating Disease

et al. 2014

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“…In addition, Ohe et al . reported a case of PCNSL that was initially diagnosed as tumefactive multiple sclerosis after brain biopsy . This case demonstrated that PCNSL can mimic multiple sclerosis both clinically and radiologically.…”

Section: Discussionmentioning

confidence: 84%

Intraoperative rapid diagnosis of primary central nervous system lymphomas: Advantages and pitfalls

et al. 2014

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To study the advantages and pitfalls of intraoperative rapid diagnosis (IRD) of primary central nervous system lymphomas (PCNSL), pathology reports and frozen sections in our institution were reviewed. We examined 27 cases of PCNSL, one case of anaplastic glioma, and one case of metastatic brain tumor that were diagnosed on neuroimaging. Fifteen cases of intraoperative cytological preparations were also reviewed in a correlative manner. Among the 27 cases initially diagnosed as PCNSL, 18 were also diagnosed as PCNSL by IRD. However, IRD identified four of the 27 cases as gliosis, two as demyelination, one as atypical epithelial cells, one as malignant glioma and anaplastic astrocytoma. In addition, the case identified as metastatic brain tumor on neuroimaging was corrected to a diagnosis of PCNSL based on IRD. The final accuracy of IRD in the present study was 89.6% (26/29). After postoperative definitive diagnosis, two cases of anaplastic astrocytoma and one case of PCNSL by IRD were corrected to PCNSL, anaplastic oligodendroglioma and demyelination, respectively. PCNSL were sometimes histologically indistinguishable from malignant gliomas or demyelinating diseases in the present study, particularly in frozen sections. Notably, all cases for which both intraoperative cytology and frozen section were performed concomitantly were correctly diagnosed in the present study. In particular, lymphoglandular bodies were highly characteristic cytological findings of PCNSL. Both intraoperative cytology and frozen sections should therefore be performed concomitantly when PCNSL are suspected.

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“…Ohe et al . described a case of primary CNS lymphoma that was initially diagnosed as tumefactive multiple sclerosis after brain biopsy, and demonstrated that primary CNS lymphomas can resemble demyelinating disease both clinically and radiologically . Sharma et al .…”

Section: Primary Cns Lymphomas and Demyelinating Diseasesmentioning

confidence: 99%

“…Ohe et al described a case of primary CNS lymphoma that was initially diagnosed as tumefactive multiple sclerosis after brain biopsy, and demonstrated that primary CNS lymphomas can resemble demyelinating disease both clinically and radiologically. 39 Sharma et al reported that primary CNS lymphomas have an accompanying component of demyelination that may increase following corticosteroid-induced tumor regression. 40 In addition, several cases of spontaneous regression of primary CNS lymphomas without steroid administration have been reported.…”

Section: Primary Cns Lymphomas and Demyelinating Diseasesmentioning

confidence: 99%

Primary central nervous system lymphomas and related diseases: Pathological characteristics and discussion of the differential diagnosis

et al. 2015

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Although primary diffuse large B-cell lymphomas of the CNS are designated as primary CNS lymphomas according to the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissue in 2008, a variety of other lymphomas (Burkitt lymphomas, EBV-positive diffuse large B-cell lymphoma of the elderly) and related diseases (lymphomatoid granulomatosis) that are also found in the CNS have been spotlighted in recent years. The histopathology of primary CNS Burkitt lymphomas mimics that of primary diffuse large B-cell lymphomas of the CNS after steroid administration. Therefore, for correct diagnosis of the involved lymphoma, comprehensive fluorescent in situ hybridization analysis for c-MYC and BCL2 is recommended in all primary CNS lymphoma cases with aggressive clinical course, multifocal involvement of the CNS, and a high proliferation index. The pathological characteristics of primary CNS EBV-positive diffuse large B-cell lymphoma of the elderly have similarities with those of the latency phenotype III, EBV lymphoproliferative disorders that arise in the setting of immunodeficiency. These age-related lymphomas usually occur in elderly immunocompetent patients, and the incidence of this disease was estimated to range from 4.0% to 13.6% of all primary CNS lymphomas. Shorter overall survival has been reported for patients with this disease. Lymphomatoid granulomatosis (LYG) is a systemic, EBV-driven, angiocentric and angiodestructive lymphoproliferative disorder. Primary LYG that shows distinct clinicopathological features compared with systemic LYG was recently reported. Finally, this review focuses on the relationship between primary CNS lymphomas and demyelinating diseases, and the concomitant use of intraoperative cytology and frozen sections that are helpful in rapid intraoperative diagnosis.

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Central Nervous System Lymphoma Initially Diagnosed as Tumefactive Multiple Sclerosis after Brain Biopsy

Cited by 22 publications

References 14 publications

Primary Central Nervous System Cytotoxic T-cell Lymphoma Mimicking Demyelinating Disease

Primary Central Nervous System Cytotoxic T-cell Lymphoma Mimicking Demyelinating Disease

Intraoperative rapid diagnosis of primary central nervous system lymphomas: Advantages and pitfalls

Primary central nervous system lymphomas and related diseases: Pathological characteristics and discussion of the differential diagnosis

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