Stereotaxic Biopsy Diagnosis of Central Nervous System Lymphoma

Abstract

Twelve cases of central nervous system lymphoma diagnosed by stereotaxic brain biopsy are reviewed to determine the most effective method to establish the diagnosis given the small amount of tissue obtained by this technique. The stereotaxic biopsy material was examined cytologically, histologically, and immunocytochemically. The diagnosis was established by a smear made at the time of biopsy in eight cases. Histologic sections were diagnostic of lymphoma in 11 of 12 cases. Accurate classification according to the Working Formulation was possible in six cases, with diagnosis of diffuse small non-cleaved non-Burkitt's in three, large cell immunoblastic in two, and mixed small and large cell type in one. Five additional cases were diagnosed as high-grade lymphoma but could not be further subclassified because of the small biopsy size or formalin fixation. Immunocytochemical stains for lymphoid markers on paraffin-embedded material confirmed the diagnosis in ten cases, and, in one of these, the demonstration of monoclonality on air-dried cytospins identified an atypical polymorphous lymphocytic population as neoplastic.

Role of stereotactic biopsy in the diagnosis and management of brain tumors

“…This is particularly true in astrocytic and lymphoid neoplasms, where astrocytes and lymphocytes can represent both neoplastic cells and reactive cellular elements around a lesion [20]. Special studies such as lymphoid markers and gene rearrangement studies would then be required to determine the neoplastic cell line [21].…”

Primary central nervous system lymphoma

“…Stereotactic biopsy of intracranial lesions has an established role in obtaining an accurate histologic diagnosis without the attendant risks of craniotomy (Apuzzo et al 1987;O'Neill et al 1987;Namiki et al 1988;Feiden et al 1990;Sherman et al 1991). Feiden et al (1990) demonstrated that stereotactic brain biopsy is an excellent means of obtaining tissue in order to establish the diagnosis of PCNSL.…”

Cerebrospinal fluid cytology: Selected issues

“…High-grade lymphomas consisting of immunoblasts or small noncleaved undifferentiated (so-called Burkitt-like) cells predominate in these patients, although histologic types associated with less aggressive clinical behavior and a variety of T-cell lymphomas and leukemias have also been reported. 56,[71][72][73][74][75] CNS lymphomas that constitute space-occupying/focal lesions are amenable to diagnosis by FNA or tissue biopsy, 76 while those associated with diffuse leptomeningeal infiltrates are usually diagnosed by review of CSF smears. Large lymphoma cells must be distinguished from poorly differentiated carcinoma cells while smaller lymphoma cells must be distinguished from primary and metastatic round/small cell nonhematopoietic tumors.…”