The challenge of adequate imaging surveillance in primary central nervous system lymphoma

Schlegel, Uwe; Korfel, Agnieszka

doi:10.1093/neuonc/now273

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…[ 1 ] It remains a diagnostical challenge as PCNSL may present with diverse neurological symptoms. [ 2 – 4 ] Radiologically, PCNSL lesions most typically enhance homogeneously on T1-weighted magnetic resonance imaging (MRI) and appear T2-hypointense, but high variability in MRI features is commonly encountered. [ 2 ] Besides, these MRI findings can mimic high-grade gliomas, metastatic tumors, tumefactive demyelinating lesions, or infectious and granulomatous diseases.…”

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confidence: 99%

Cell-Block cytology in diagnosis of primary central nervous system lymphoma

Huang

Li-ling²,

Tong³

2020

Medicine

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Introduction: Primary Central Nervous System Lymphoma (PCNSL) remains a diagnostic challenge due to the variable clinical manifestations. Liquid biopsies, particularly those involving cell-free DNA (cfDNA) from plasma, are rapidly emerging as important and minimally invasive adjuncts to traditional biopsies. However, conventional pathology may be still essential to obtain a diagnosis. Patient concerns: A 56-year-old woman presented with a progressive headache, dizziness, blurred vision, and lower limbs weakness with dysesthesia. Atypical clinical and radiological presentations, previous empirical treatment in another hospital, together with the patient's refusal to stereotactic brain biopsy made it challenging to diagnose. Her status deteriorated continuously during hospitalization. Diagnosis: Lumber punctual was performed, and CSF cytological analysis revealed malignancy cells with a high nuclear-cytoplasmic ratio. However, these cells were too loose to perform immunohistochemical stains. Genetic aberrations detections with CSF and peripheral blood sample were also inconclusive. We made a “cell-block” using the sedimentary cells collected from CSF collected through multiple aspirations via an Omaya reservoir. We further performed cytopathological and immunohistochemical analysis using this “cell-block,” which finally confirmed the diagnosis of diffuse large-B cell PCNSL. Interventions: Intracranial chemotherapy began afterwards (MTX 15 mg and dexamethasone 5 mg, twice per weeks). Outcomes: Unfortunately, this patient was dead 2 weeks later due to severe myelosuppression and secondary septic shock. Conclusion: We provided “cell-block” method, which collects cell components from large amount of CSF for cytology and immunohistochemical analysis. “Cell-block” cytology can be an alternative diagnostic method in diagnosis of PCNSL.

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