Primary central nervous system lymphoma - A hospital based study of incidence and clinicopathological features from India (1983-2003)

Abstract

Over the last two decades, an increase in the incidence of PCNSL cases has been reported in the West, both among immunosuppressed and immunocompetent patients. The present study was undertaken to assess the trend of incidence of PCNSL cases in India. To the best of our knowledge, only a single such report is available from India. All biopsy proven PCNSL cases obtained from the Neurosurgical databases of two large referral hospitals, one in Northern India (AIIMS, New Delhi) and another in Southern India (NIMHANS, Bangalore) from the period 1980 to 2003, were reviewed. Immunophenotyping was done and relevant clinical details collected. Appropriate statistical analysis was done to assess any change in trend of incidence or age at presentation. PCNSL cases constituted 0.95% and 0.92% of the total intracranial neoplasms at AIIMS and at NIMHANS, respectively. The mean age for cases diagnosed at AIIMS was 44.35 years, while that for NIMHANS was 39.51 years. Statistical analysis to evaluate any change in trend either of incidence or of age at presentation, over the study period, did not reveal any significant change. All the cases occurred in immunocompetent patients, except one case of HIV positive at NIMHANS, and one case of renal transplant at AIIMS. Frontal lobe was the most common site of involvement. Majority of the cases were diffuse, high grade, large cell lymphoma, B-cell immunophenotype. Thus, this multicentric hospital based study did not reveal any increase in incidence of PCNSL cases in India over the past 24 years. Further, in contrast to the West, majority of the cases in this Indian study were immunocompetent and a decade younger than in the West. The association of PCNSL with HIV/AIDS has been low in India, possibly due to early death in AIDS on account of opportunistic infections.

Increasing incidence and continued dismal outcome of primary central nervous system lymphoma in Norway 1989–2003

“…It reportedly has increased in the United States, 1-3 the United Kingdom, 4 the Netherlands, 5 and Japan 6 but has remained stable in Canada, 7 Denmark, 8 Scotland, 9 Hong Kong, 10 and India. 11,12 In a previous study from Norway, we observed a nonsignificant trend toward increased incidence from 1989 to 1998 (P 5 .069). 13 The treatment of PCNSL has changed considerably the last decades.…”

Primary Extra Nodal Non Hodgkin Lymphoma: A 5 Year Retrospective Analysis

“…Inspite of alarming increase in incidence of PCNL in the West (because of HIV/AIDS), the incidence is fairly low or at least, stable in the Middle East and Asian countries, including India. As suggested by Sarkar et al (2005), early infection related deaths among Indian HIV patients might be an explanation for this trend in South East Asia. Moreover, the increased number of PCNL in our series is possibly explained because of improved neuroimaging techniques and stereotactic brain biopsies studied rather than anything else.…”

“…Formerly a rare tumour, PCNL has shown increased incidence both in immunocompromised (congenital, acquired or iatrogenic) high-risk groups and in the general population (Zucca et al, 1999). Various multi institutional studies from India in recent past, have addressed the changing trends of PCNL in regard to incidence, risk factors, and pathophysiology (Sarkar et al, 2005;Paul et al, 2008;Mahhdoomi et al, 2011). Compared to western data, the incidence of PCNL in India, in last decade, has been fairly constant, and is unrelated to HIV or other immunodeficiency states.…”

“…The most dramatic change in trend, in last two decades, has been observed for primary CNS lymphoma (PCNL) which has increased four times as rapidly as other extranodal sites. This is partly due to AIDS pandemic, as well as improved diagnostic modalities, and it continues to rise in immunocompetent hosts of all ages and in both genders as well (Sarkar et al, 2005;Paul et al, 2008;Mahhdoomi et al, 2011).…”

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

“…At present, primary CNS lymphomas constitutes about 2.2% of all brain tumours in the USA (Dolecek et al, 2012). However studies from Asia and India have revealed certain differences in PCNSL features compared to the West (Sarkar et al, 2005;Shibamoto et al, 2008;Zhang et al, 2010). CNS cancers are increasing in India and to understand the etiology of these cancers, in depth, analytic epidemiological studies should be planned in the near future (Yeole, 2008) In the present study we analyze the clinicopathological features of 32 cases of PCNSL and also assess the utility of the crush smear preparation in the intra-operative diagnosis of PCNSL.…”