Primary central nervous system lymphoma in immunocompetent patients: A retrospective review of MRI features

Sutherland, Tom; Yap, Kelvin; Liew, Elaine; Tartaglia, Con; Pang, Mai; Trost, Nicholas

doi:10.1111/j.1754-9485.2012.02366.x

Cited by 26 publications

(20 citation statements)

References 30 publications

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“…These lesions are predominantly supratentorial (Koeller et al, 1997;Buhring et al, 2001). Ring like enhancement is rarely observed in immunocompetent patients, but can be commonly found in immunocompromised patients (Johnson et al, 1997;Haldorsen et al, 2008;2009;, Sutherland et al, 2012. In our study ring enhancement was observed in only two cases, one of which was labeled as Tuberculoma on radiological assessment.…”

Section: Discussionmentioning

confidence: 41%

Primary Central Nervous System Lymphoma: A Clinicopathological and Cytomorpholgical Study from A Tertiary Care Centre in Chennai, India

Ambroise

Ghosh²,

Mallikarjuna³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: The aim of this study was to analyze the clinicopathological and immunohistochemical features of primary central nervous system lymphoma (PCNSL) cases occurring in Indian patients and also study the utility of the crush smear preparation in intraoperative diagnosis. Materials and Methods: The immune status, clinical, radiological details, immunohistochemical profile, histopathological findings and cytological features in smear preparation of 32 cases of PCNSL were analyzed. Patients with systemic NHL and skull-base lymphomas were excluded. Results: The mean age of our patients was 52 years with a male: female ratio 1:1. A periventricular location was found in 62.5% of patients. None of our PCNSL cases were associated with AIDS. All cases except one were diffuse large B-cell lymphomas. Intraoperative diagnosis using crush smears allowed correct prediction in 93% of cases. Conclusions: Our study shows that PCNSL is seen predominantly in immunocompetent patients in India .The age of presentation is relatively young as compared to the West. Our study also stresses the utility of crush smear preparation in establishing an intraoperative diagnosis.

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Section: Discussionmentioning

confidence: 41%

Primary Central Nervous System Lymphoma: A Clinicopathological and Cytomorpholgical Study from A Tertiary Care Centre in Chennai, India

Ambroise

Ghosh²,

Mallikarjuna³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…It has been reported that adult PCNSL occurs in supra tentorial location in majority of patients with posterior fossa as a location of tumor only in 7% of the cases[6]. Only 3% cases have been reported to have a brainstem involvement and majority of such lesions are of T-cell lineage.…”

Section: Discussionmentioning

confidence: 99%

“…Contrast enhanced MRI is the preferred imaging modality in these cases of PCNSL. Approximately 90% of these cases present with contrast enhancing lesions[6]. Ring like enhancement is rarely observed in immune competent patients, but commonly found in immune compromised patients[7].…”

Section: Discussionmentioning

confidence: 99%

Primary pediatric mid-brain lymphoma: Report of a rare pediatric tumor in a rare location

Benson

Mallick

Purkait

et al. 2016

WJCC

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Primary central nervous system lymphoma (PCNSL) is a rare disease in pediatric age group. A thirteen-year-old male child presented with complaints of headache for six months, vomiting and diplopia for three days. Magnetic resonance imaging of the brain showed a single lesion of 1.7 cm × 1.6 cm × 1.6 cm in the mid brain and tectum. He underwent a gross total resection of the tumor. The histopathological evaluation revealed B cell high grade non Hodgkin lymphoma. The patient was treated with High dose methotrexate and cranio spinal radiation. The patient was alive without disease 12 mo after completion of treatment. This case highlights importance of keeping PCNSL as differential in brain stem lesions of pediatric patients also. Radiation and chemotherapy remains the most important treatment for such patients.

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“…According to Summary of the nine reported cases and our case of primary isolated lymphoma within the 4 th ventricle a consideration of PCNSL should be warranted if contrast enhancement image shows homogeneous enhancement without necrosis. Besides, Magnetic Resonance Spectrum (MRS), in combination with hyper intensity on CT [10] is helpful for differential diagnosis between PCNSL and other brain tumors. By the way, due to the special location, excision was the preferred choice for PCNSL in the fourth ventricle.…”

Section: Discussionmentioning

confidence: 99%

Primary Central Nervous System Lymphoma in the Fourth Ventricle

Xinyi¹,

Qiu²,

Rong³

et al. 2017

J Neuroinfect Dis

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Primary central nervous system lymphoma (PCNSL), a highly malignant and infrequent tumor, is rarely found within the fourth ventricle. Here we report a case of isolated lymphoma within the fourth ventricle: a 61-year-old male presented with headache, mental disorder, abnormal gait and urinary incontinence. Based on the clinical symptoms and neuroimage, He was initially diagnosed as choroid plexus papilloma. However, post-surgery pathology corrected the diagnosis as a diffuse large B-cell lymphoma. To the best of our knowledge, only nine cases are documented in the literature and all of them were initially diagnosed as other tumours or not determined. Therefore, Thesis unconventional location and atypical clinical manifestation of PCNSL in the fourth ventricle should be included on the list of differential diagnosis of the fourth ventricle tumors. Case ReportA 61-year-old man presented to our hospital complaining of headache for one month and somnolence, abnormal gait and urinary incontinence for one week. During admission, he was in a state of somnolence and physical examination only revealed the mild cervical resistance. His past medical history and laboratory tests including routine blood parameters, blood biochemistry (including lactate dehydrogenase (LDH) HIV testing), routine coagulation parameters and erythrocyte sedimentation rate were normal as well.Brain magnetic resonance imaging (MRI) revealed one irregular nodule occupying the fourth ventricle with a hypo intensity on T1 weighted image (T1WI) and is intensity on T2 weighted image (T2WI) (Figure 1). Post-contrast T1WI showed well-defined and marked homogenous enhancement without necrosis. Furthermore, contrast enhancement image demonstrated that the primary nidus of the mass originated from the roof of the forth ventricle, which was surrounded with choroid plexus (Figure 2). The intraventricular location of the mass and MRI manifestation led us to clinical diagnosis as choroid plexus papilloma (CPP). PET-CT of the whole body showed high metabolism in the fourth ventricle. The special location of the mass prompted our surgical team to choose surgical excision over stereotactic biopsy.Interestingly, post-surgery pathology diagnosed as a diffuse large Bcell lymphoma (Figure 3). The patient refused to undergo radiotherapy or chemotherapy immediately after the surgery. At 6-week follow-up after the resection, brain MRI demonstrated enhanced nodules in the third ventricle and midbrain aqueduct area, which were considered as implantation metastases. Consequently, the patient was administrated with chemotherapy combined with radiotherapy. Another month later, these lesions amazingly disappeared on brain MRI. Currently, 20 months post-surgery, the patient is still under active follow-up.

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Primary central nervous system lymphoma in immunocompetent patients: A retrospective review of MRI features

Abstract: The vast majority of cases of PCNSL in immunocompetent patients have lesions contacting a CSF surface, enhancement and restricted diffusion with no necrosis. These features should alert radiologists to the diagnosis of PCNSL.

Cited by 26 publications

References 30 publications

Primary Central Nervous System Lymphoma: A Clinicopathological and Cytomorpholgical Study from A Tertiary Care Centre in Chennai, India

Primary Central Nervous System Lymphoma: A Clinicopathological and Cytomorpholgical Study from A Tertiary Care Centre in Chennai, India

Primary pediatric mid-brain lymphoma: Report of a rare pediatric tumor in a rare location

Primary Central Nervous System Lymphoma in the Fourth Ventricle

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