Cerebral lymphoma presenting as a leukoencephalopathy

Ayuso‐Peralta, Lucía; Ortı́-Pareja, M; Zurdo-Hernández, M; Jiménez-Jiménez, F J; J, Tejeiro-Martínez; Ricoy, J R; Lama, A. de la; Bernardo, Ana Isabel

doi:10.1136/jnnp.71.2.243

Cited by 34 publications

(23 citation statements)

References 19 publications

(12 reference statements)

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“…Two infiltration patterns of lymphoma cells have been reported: diffuse scattered infiltration, 3,9,15 and both perivascular proliferation and diffuse scattered infiltration. 6,7,10,11,13,14 Most cases of LC were diagnosed as DLBL. 3,[6][7][8][9][10][11][12][13]15 In this case, the cerebral white matter lesion mimicking diffuse leukoencephalopathy resembled typical LC.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,10,11,13,14 Most cases of LC were diagnosed as DLBL. 3,[6][7][8][9][10][11][12][13]15 In this case, the cerebral white matter lesion mimicking diffuse leukoencephalopathy resembled typical LC. This lesion showed slight hyperintensity on both the DWI and ADC map, indicating that the main pathophysiology of the white matter lesion was vasogenic edema.…”

Section: Discussionmentioning

confidence: 99%

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Primary central nervous system lymphoma initially mimicking lymphomatosis cerebri: An autopsy case report

et al. 2009

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A 59-year-old immunocompetent man was admitted to our hospital because of progressive dementia with concomitant bilateral uveitis. The first brain MRI revealed diffuse hyperintense lesions in the cerebral white matter of both hemispheres on a T2-weighted image and fluid-attenuated inversion recovery image. However, another MRI taken more than 1 month later revealed enhanced cohesive mass lesions in the bilateral thalami, in addition to the white matter lesions. The white matter lesions were slightly hyperintense on a diffusion-weighted image and apparent diffusion coefficient map image, suggesting vasogenic edema. One year after the onset of uveitis, he died of respiratory failure. Pathological diagnosis was diffuse large B-cell lymphoma with perivascular proliferation and diffuse scattered infiltration in the cerebrum and brainstem. Microscopically, cohesive mass lesions in the bilateral thalami were a massive cluster of lymphoma cells. This is a case of primary CNS lymphoma (PCNSL) mimicking 'lymphomatosis cerebri (LC)' at first but later exhibiting typical mass lesions, giving rise to the possibility that cases of LC might unmask features of regular lymphomas in their later course more often than believed thus far.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Primary central nervous system lymphoma initially mimicking lymphomatosis cerebri: An autopsy case report

et al. 2009

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“…11 Diffusely infiltrating PCNSL is very rare in immunocompetent patients and has infrequently been reported. [12][13][14][15][16][17] It is even rarer for T-cell lymphoma to present as diffuse cerebral infiltration. 18 Although we believe this to be a primary CNS lymphoma, the poorly characterized lowerextremity lesions may suggest the presence of a rare metastatic primary cutaneous T-cell lymphoma like mycosis fungoides (MF).…”

Section: Discussionmentioning

confidence: 99%

Lymphomatosis Cerebri Presenting as Rapidly Progressive Dementia

Weaver¹,

Vinters²,

Koretz³

et al. 2007

The Neurologist

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“…Computed tomography (CT) scans and magnetic resonance imaging (MRI) typically show unique or multiple periventricular, homogeneously enhancing lesions [32][33][34]. But PCNSL is potentially associated with a large spectrum of radiological presentations and can simulate inflammatory (sarcoidosis, multiple sclerosis) or infectious (acute disseminated encephalomyelitis) diseases or other brain tumors (meningiomas, malignant gliomas, gliomatosis cerebri, brain metastases) [35][36][37] (Fig. 1).…”

Section: Diagnosis and Workupmentioning

confidence: 99%

Primary CNS Lymphoma in Immunocompetent Patients

et al. 2009

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Primary central nervous system lymphoma (PCNSL) constitutes a rare group of extranodal non-Hodgkin's lymphomas (NHLs), primarily of B cell origin, whose incidence has markedly increased in the last three decades. Immunodeficiency is the main risk factor, but the large majority of patients are immunocompetent. Recent evidence suggests a specific tumorigenesis that may explain their particular clinical behavior compared with systemic NHL. The addition of i.v. high-dose methotrexate (MTX) chemotherapy to whole-brain radiotherapy (WBRT) has considerably improved the prognosis, leading to a threefold longer median survival time compared with WBRT alone and represents the current standard of care. However, this combined treatment exposes the patient, especially the elderly, to a high risk for delayed neurotoxicity. In the older population (>60 years), there is growing evidence that MTX-based chemotherapy alone as initial treatment is the best approach to achieve effective tumor control without compromising patient quality of life. In the younger population, the risk for neurotoxicity is much lower, and this strategy is controversial because it may be associated with higher relapse rates. Future efforts should focus on the development of new polychemotherapy regimens allowing the reduction or deferral of WBRT in order to minimize the risk for delayed neurotoxicity. In this setting, intensive chemotherapy with autologous blood stem cell transplantation was recently demonstrated to be feasible and efficient as salvage therapy and is currently being evaluated as part of primary treatment. This review highlights the recent advances in the pathogenesis and treatment of PCNSL in the immunocompetent population.

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Cerebral lymphoma presenting as a leukoencephalopathy

Cited by 34 publications

References 19 publications

Primary central nervous system lymphoma initially mimicking lymphomatosis cerebri: An autopsy case report

Primary central nervous system lymphoma initially mimicking lymphomatosis cerebri: An autopsy case report

Lymphomatosis Cerebri Presenting as Rapidly Progressive Dementia

Primary CNS Lymphoma in Immunocompetent Patients

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