Importance of complete staging in non-Hodgkin's lymphoma presenting as a cerebral mass lesion

Ferreri, Andrés J.M.; Reni, Michele; Zoldan, Maria C.; Terreni, Maria Rosa; Villa, Eugenio

doi:10.1002/(sici)1097-0142(19960301)77:5<827::aid-cncr4>3.0.co;2-b

Cited by 79 publications

(33 citation statements)

References 37 publications

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“…Edema is less prominent than with other CNS malignancies, such as glioma or metastasis. CT of chest, abdomen, and pelvis may be indicated to evaluate for metastasis in patients with B symptoms [8].…”

Section: Neuroimagingcontrasting

confidence: 56%

Primary Cns Lymphoma: Current Diagnosis and Management

Singh¹

2016

JCPCR

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Section: Neuroimagingcontrasting

confidence: 56%

Primary Cns Lymphoma: Current Diagnosis and Management

Singh¹

2016

JCPCR

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“…The latter may be a confounding factor. Moreover, it is necessary to exclude systemic involvement for PCNSL, because the identification of a systemic site of the lymphoma has important implications in the clinical and therapeutical management [40].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic delay and prognosis in primary central nervous system lymphoma compared with glioblastoma multiforme

et al. 2015

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Glioblastoma multiforme (GBM) and primary central nervous system lymphoma (PCNSL) are malignant cerebral neoplasms associated with poor prognosis. Early diagnosis and subsequent planning of adequate treatment strategy are relevant to improve survival and reduce neurological deficit. Two groups of patients affected by GBM and PCNSL were compared to identify: (1) factors influencing the time necessary to obtain a correct diagnosis; (2) the influence of the interval time from clinical onset to diagnosis on the prognosis. Fifty-six patients (28 PCNSL and 28 GBM, 23 females and 33 males) referred to the same hospital setting were retrospectively evaluated. The mean age at diagnosis was 61 years. The two groups were comparable in terms of age, sex, clinical symptoms at onset and performance status. There was no relevant difference in time span from clinical onset to first neuroimaging examination, while time span from first neuroimaging to final morphological diagnosis was much longer in PCNSL patients (p = 0.008). Multivariate Cox regression analysis, including both PCNSL and GBM cases, showed a significant association of the overall survival with: time to diagnosis (HR 0.06), age at onset (HR 1.04). Our results show a significant diagnostic delay in PCNSL cases. Age at onset of disease and time to diagnosis emerge as clinical factors affecting overall survival in both groups. Stereotactic-guided biopsy should be chosen as routine method to early diagnose PCNSL. The clinical relevance of early diagnosis in GBM and PCNSL needs to be emphasized to maximize the overall survival in both neoplasms.

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“…Conventional lymphoma staging demonstrates the presence of extraneural disease in 4%-12% of patients with presumptive diagnosis of PCNSL. 24 Specific baseline evaluations and staging have been standardized by The International PCNSL Collaborative Group (Figure 1). 10 During staging, we pay particular attention to ophthalmic examinations, which allow the detection of asymptomatic ocular involvement in 5% of PCNSLs.…”

Section: Should Steroids Be Interrupted Before Biopsy?mentioning

confidence: 99%

How I treat primary CNS lymphoma

Ferreri¹

2011

Blood

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Primary CNS lymphoma (PCNSL) is a rare malignancy with peculiar clinical and biologic features, aggressive course, and unsatisfactory outcome. It represents a challenge for multidisciplinary clinicians and scientists as therapeutic progress is inhibited by several issues. Molecular and biologic knowledge is incomplete, limiting the identification of new therapeutic targets, and the particular microenvironment of this malignancy, and sanctuary sites where tumor cells grow undisturbed, strongly affects treatment efficacy. Moreover, active treatments are known to be associated with disabling neurotoxicity, posing the dilemma of whether to intensify therapy to improve the cure rate or to de-escalate treatment to avoid sequels. The execution of prospective trials is also difficult because of the rarity of the tumor and the impaired general condition and poor performance status of patients. Thus, level of evidence is low, with consequent uncertainties in therapeutic decisions and lack of consensus on primary endpoints for future trials.Despite this unfavorable background, laboratory and clinical researchers are coordinating efforts to develop new ideas, resulting in the recent publication of studies on PCNSL's biology and molecular mechanisms and of the first international randomized trials. Herein, these important contributions are analyzed to provide recommendations for everyday practice and the rationale for future trials. (Blood. 2011;118(3):510-522) IntroductionPrimary CNS lymphoma (PCNSL) is an aggressive malignancy arising exclusively in the CNS, that is, the brain parenchyma, spinal cord, eyes, cranial nerves, and/or meninges. 1 This lymphoma represents 4% of intracranial neoplasms and 4%-6% of all extranodal lymphomas but some registry studies suggest that its incidence in immunocompetent patients is progressively increasing. 2 PCNSL exhibits peculiar clinical and biologic features and constitutes a diagnostic and therapeutic challenge for multidisciplinary clinicians and scientists. Its outcome remains unsatisfactory if compared with that of patients with extra-CNS lymphomas of a similar stage and histotype, and several factors prevent therapeutic progress. First, molecular and biologic knowledge is insignificant compared with other lymphomas, which limits the identification of new therapeutic targets. Second, patients with PCNSL usually exhibit impaired general condition and poor performance status (PS) more often than subjects with other lymphomas. 1 This usually interferes with the enrollment of patients in prospective trials. In fact, current therapeutic knowledge is only based on 3 randomized trials, some single-arm phase 2 trials, anecdotal meta-analyses, and a few multicenter retrospective studies. Thus, available level of evidence is low, with consequent uncertainties in therapeutic decisions and lack of consensus on primary endpoints for future trials.In this manuscript, I discuss available clinical and biologic data on PCNSL in immunocompetent patients and provide recommendations for everyday pract...

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Importance of complete staging in non-Hodgkin's lymphoma presenting as a cerebral mass lesion

Abstract: In our experience, complete staging allowed detection of systemic lymphoma in two patients initially considered to have PCNSL.

Cited by 79 publications

References 37 publications

Primary Cns Lymphoma: Current Diagnosis and Management

Primary Cns Lymphoma: Current Diagnosis and Management

Diagnostic delay and prognosis in primary central nervous system lymphoma compared with glioblastoma multiforme

How I treat primary CNS lymphoma

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