Radiographic findings in 32 cases of primary CNS lymphoma

Jack, C. R.; Reese, David F.; Bw, Scheithauer

doi:10.2214/ajr.146.2.271

Cited by 67 publications

(32 citation statements)

References 3 publications

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“…35 Postmortem examination showed intravascular Bcell lymphoma; when exclusively involving the small vessels of the brain, this is an extremely rare subtype of PCNSL 36,37 that mimics vasculitis, encephalitis, or multiple sclerosis on imaging. 37 Disseminated lesions are a well-known atypical presentation of PCNSL, 18,27 but it was more prevalent in our study than formerly reported (7% versus 1%-3%) 28,38 and might have been even more prevalent at histologic examination. In 1 series, biopsy and postmortem material showed diffuse meningeal or periventricular involvement in 24%.…”

Section: Discussioncontrasting

confidence: 70%

“…8,9,15,[17][18][19][20][21][22][26][27][28][29]33 It further showed that no or disseminated lesions tended to make early histologic diagnosis less likely. Imaging findings in non-AIDS PCNSL remained largely unchanged with time.…”

Section: Discussionmentioning

confidence: 99%

“…15,17,18,21,22,[26][27][28][29] To our knowledge, the present study is the first population-based study focusing on imaging findings in PCNSL and the first exploring changes in such findings with time. Improved CT and MR imaging have been suggested to explain some of the observed increase in incidence of PCNSL, 30 and changes in imaging techniques have been shown to affect the detection rate and imaging findings of brain metastases.…”

mentioning

confidence: 99%

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CT and MR Imaging Features of Primary Central Nervous System Lymphoma in Norway, 1989–2003

Haldorsen¹,

Kråkenes²,

Krossnes³

et al. 2009

AJNR Am J Neuroradiol

112

122

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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CT and MR Imaging Features of Primary Central Nervous System Lymphoma in Norway, 1989–2003

Haldorsen¹,

Kråkenes²,

Krossnes³

et al. 2009

AJNR Am J Neuroradiol

112

122

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“…Its deep location explains why seizures are less frequent than in other brain tumors [30,31]. 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.…”

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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“…Interestingly, 5-ALA-induced fluorescence-guided resection may apply to PCNSL in a similar way surgery applies to malignant gliomas (2). Typically, PCNSLs are supratentorial (75-85%) and appear as a mass or multiple masses that commonly contact the subarachnoid or ependymal surface (7). Recently, in patients with malignant gliomas and PCNSL, 5-ALA-induced fluorescence of the ventricular wall adjacent to the tumor was discovered and considered as tumor infiltration or dissemination (1-3).…”

Section: Discussionmentioning

confidence: 99%

5-aminolevulinic acid-induced fluorescence in cerebellar primary central nervous system lymphoma: a case report and literature review

Yamamoto

Kitagawa²,

Akiba³

et al. 2014

Turkish Neurosurgery

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ABSTRACT5-Aminolevulinic acid (5-ALA)-induced fluorescence-guided resection is a widely used procedure for patients with malignant gliomas. However, the clinical application of 5-ALA for surgery in primary central nervous system lymphoma (PCNSL) is uncommon. Here, we present a case of PCNSL treated using 5-ALA-induced fluorescence-guided resective surgery. A 70-year-old woman presented with cerebellar ataxia, and magnetic resonance imaging revealed an irregularly shaped and homogenously enhanced mass with surrounding brain edema in the vermis that extended to the right hemisphere of the cerebellum. Under the preoperative diagnosis of a malignant glioma in the cerebellum, the patient underwent 5-ALA-induced fluorescence-guided surgery. Under blue light illumination, the tumor revealed strong 5-ALA-induced fluorescence. The tumor was identified as a diffuse large B-cell lymphoma. After partial resection, the patient received adjuvant chemotherapy and radiotherapy. Importantly, the neurological deficit of the patient improved, and recurrence of the tumor was not observed 21 months post-surgery. Together with previous reports, this case study emphasizes the efficacy of the surgical application of 5-ALA for PCNSL.KeywOrds: Glioma, Subventricular zone, Ependyma, Surgery, Diffuse large B-cell lymphoma, Dissemination, 5-ALA ÖZ 5-Aminolevülinik asit (5-ALA) ile indüklenmiş floresans-eşliğinde rezeksiyon malign gliomalı hastalarda yaygın kullanılan bir tekniktir. Ancak primer santral sinir sistemi lenfoması (PSSSL) olan hastaların cerrahisinde 5-ALA kullanımı sık değildir. Burada 5-ALA ile indüklenmiş floresans eşliğinde rezektif cerrahi uygulanan bir PSSSL olgusu sunuldu. Serebellar ataksi ile başvuran 70 yaşındaki kadın hastada manyetik rezonans görüntüleme, vermisden sağ serebellar hemisfere uzanan, düzensiz sınırlı ve homojen kontrast tutan, çevre beyin dokusunda ödeme nedene olan kitle lezyonunu ortaya koydu. Preoperatif olarak serebellumda malign glioma tanısı düşünüldü ve hastaya 5-ALA ile indüklenmiş floresans eşliğinde cerrahi uygulandı. Mavi ışık aydınlatması altında tümör kuvvetli 5-ALA ile indüklenmiş floresans gösterdi. Tümörün histopatolojik inceleme sonucu diffüz geniş B-hücreli lenfoma olarak geldi. Kısmi rezeksiyondan sonra hastaya ilave kemoterapi ve radyoterapi uygulandı. Önemli olarak, hastanın nörolojik defisiti düzeldi ve cerrahiden 21 ay sonra nüks gözlenmedi. Bu konudaki daha önceki raporlarla birlikte, bu olgu çalışması da 5-ALA'nın PSSSL'da cerrahi uygulamasının etkinliğini vurgulamaktadır.

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Radiographic findings in 32 cases of primary CNS lymphoma

Cited by 67 publications

References 3 publications

CT and MR Imaging Features of Primary Central Nervous System Lymphoma in Norway, 1989–2003

CT and MR Imaging Features of Primary Central Nervous System Lymphoma in Norway, 1989–2003

Primary CNS Lymphoma in Immunocompetent Patients

5-aminolevulinic acid-induced fluorescence in cerebellar primary central nervous system lymphoma: a case report and literature review

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