Findings at presentation in primary CNS diffuse large B-cell lymphoma of the brain: A comparison of immunocompetent and immunodeficient patients

Abstract

Background/Objectives: Primary central nervous system lymphoma (PCNSL) is a rare tumour with poor prognosis. Due to the increased number of patients with PCNSL over the past two decades our purpose are to describe magnetic resonance imaging (MRI) and Computed Tomography (CT) findings in (PCNSL) of the brain, and to study the differences between immunocompetent and immunodeficient patients with PCNSL. Methods:A retrospective, descriptive study was performed with 59 patients diagnosed of PCNSL in two hospitals from 1997 to 2010. Immunocompetent (n=38) and immunodeficient (n=21) patients were compared and differences between both groups were analyzed. Patients were evaluated according to sex, age, median time from clinical symptoms presentation to pathologic diagnosis, clinical symptoms, location, number of lesions, size, MRI and CT characteristics. Significance was defined as p < 0.05.Results: MRI findings: 50% of lesions in immunocompetent and 52.4% in immunodeficient group were heterogeneous, 89.5% of lesions in immunocompetent and 85,7% in immunodeficient were hypo-isointense on T1WI; 63.2% of lesions in immunocompetent and 76.2% in immunodeficient group were hyperintense on T2WI. CT images: 48.39% of lesions in immunocompetent and 20% in immunodeficient group were hyperdense. Statistically significant differences between immunocompetent and immunodeficient patients were found when evaluating the age (p < 0.000) and median time from clinical symptoms presentation to pathologic diagnosis (p < 0.008).Conclusions: MRI and CT are able to define imaging characteristics of PCNSL, promoting a quick diagnosis. There are no significant differences between immunocompetent and immunodeficient patients for MR and CT features.

Evolution of a Pediatric Primary Cerebral ALK-1-Positive Anaplastic Large Cell Lymphoma on Serial MRI

“…Here, we present the case of a 10-year-old immunocompetent male with evolution of ALK-1-positive anaplastic T-cell lymphoma on MRI, visualized over 24 days with four MRIs. Despite numerous descriptions of radiographic features of PCNSL in immunocompetent patients, there has been no documentation of a PCNSL evolving so rapidly on serial imaging [6,7,9,11,12,13,25,26,27,28,29,30,31,32,33,34]. …”

“…Cerebrospinal fluid cannot effectively distinguish PCNSL from other neoplasms or inflammatory lesions as the changes are inconsistent and nonspecific, such as elevated cell count, protein, albumin, IgG and lactate [10]. Diagnosis by tissue biopsy is frequently delayed by weeks or months following initial presentation while other diagnoses are considered [4,11,12,13]. The documentation of the evolution of PCNSL on serial imaging could provide insight into diagnostic characteristics, particularly during the radiographic evolution of the lesion.…”