Intravascular lymphoma presenting as a longitudinally-extensive myelitis: Diagnostic challenges and etiologic clues

Kumar, Neeraj; Keegan, B. Mark; Rodríguez, Fausto J.; Hammack, Julie E.; Kantarci, Orhun H.

doi:10.1016/j.jns.2010.12.016

Cited by 22 publications

(28 citation statements)

References 37 publications

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“…лярное поражение составляет менее 1% всех лимфом Ходжкина и неходжкинских лимфом [1][2][3]. Особенно высок риск возникновения лимфомы нервной системы у пациентов при синдроме приобретенного иммуно-дефицита, врожденном иммунодефиците, поражении вирусом Эпштейна-Барр [3,4]. Большинство интра-медуллярных опухолей -неходжкинские лимфомы (диффузные В-крупноклеточные), располагаются преимущественно в верхнегрудном или нижнешей-ном отделах спинного мозга [5].…”

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“…Результаты лечения лим-фомы Ходжкина лучше, здесь продолжительность жизни варьирует от 5 месяцев до 15 лет [2,8]. Однако часто поражение ТОСМ возникает после длительного лечения лимфомы Ходжкина, когда химиотерапия уже неэффективна, что обусловливает небольшую продолжительности жизни после возникновения процессов в спинном мозге [4,6].…”

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“…При вторичной генерализации процесса, неэффективности химиотерапии отмечают тенденцию к диссеминированному поражению оболочек мозга. Нередко опухоли могут быть множественными [4,5].…”

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“…Нейрохирургическая тактика при таких новообразованиях различна в за-висимости от их варианта, особенностей топографии и клинических проявлений [1,4].…”

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Surgical tactics and treatment results at spinal lymphomas

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Surgical tactics and treatment results at spinal lymphomas

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“…That biopsy was characteristic of IVL with multiple cortical vessels (M4 branches) pathologically distended with neoplastic lymphocytes positive for CD20 by immunohistochemistry. Biopsies of the central nervous system in IVL patients have revealed neoplastic lymphocytes within large and medium arteries, distal cortical vessels, leptomeningeal perforators, capillaries, and even veins [2][3][4][5][6] Department of Radiology, University of Utah, Salt Lake City, UT 84132, USA also highly variable. The resolution of current vwMRI protocols, 0.5-0.7 mm voxels, does not allow reliable assessment of the distal intracranial vessels, which introduces the possibility of a false negative study, as in the case of our patient.…”

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Response to “High-Resolution Vessel Wall MRI: Appearance of Intravascular Lymphoma Mimics Central Nervous System Vasculitis”

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McNally

2016

Clin Neuroradiol

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System Vasculitis," [1] Schaafsma et al. describe two interesting cases of biopsy-proven intravascular lymphoma (IVL) that mimicked the vessel wall MRI (vwMRI) appearance of vasculitis, with concentric arterial wall thickening and enhancement. To our knowledge these are the first reported cases of IVL that have had vwMRI. We have scanned over 200 patients with vwMRI at our institution, including a 47-year-old female with biopsy-proven large B-cell IVL. Her vwMRI showed multiple areas of evolving ischemic infarction, parenchymal hemorrhage, edema, and leptomeningeal enhancement; however, on vwMRI there was no vessel wall thickening or enhancement, including the right parietal lobe, where she had infarction with edema and the location of her brain biopsy. That biopsy was characteristic of IVL with multiple cortical vessels (M4 branches) pathologically distended with neoplastic lymphocytes positive for CD20 by immunohistochemistry. Biopsies of the central nervous system in IVL patients have revealed neoplastic lymphocytes within large and medium arteries, distal cortical vessels, leptomeningeal perforators, capillaries, and even veins [2][3][4][5][6] Department of Radiology, University of Utah, Salt Lake City, UT 84132, USA also highly variable. The resolution of current vwMRI protocols, 0.5-0.7 mm voxels, does not allow reliable assessment of the distal intracranial vessels, which introduces the possibility of a false negative study, as in the case of our patient. Furthermore, as the authors note, in vasculitis the intramural lymphocytic invasion provides a pathophysiologic mechanism for concentric vessel wall enhancement, whereas in IVL the vessel wall itself is spared. Given these challenges, we would suggest that, for diagnostic purposes, their findings be interpreted with caution. Conflict of interest

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FDG-PET/CT is a pivotal imaging modality to diagnose rare intravascular large B-cell lymphoma: case report and review of literature

et al. 2014

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Intravascular large B-cell lymphoma (IVLBCL) remains a diagnostic challenge, because of non-specific findings on clinical, laboratory, and imaging studies. We present a case in which 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography was particularly useful to suspect the diagnosis, to detect unexpected locations, to guide contributive biopsy, and to assess the response to treatment. In case of initial negative results, FDG-PET should be repeated in the course of clinical evolution. In the presence of neurological or hormonal symptoms without brain magnetic resonance imaging abnormality, FDG-PET brain slices could depict additional pituitary and/or brain hypermetabolisms. We discuss the potential interests of FDG-PET in IVLBCL by a literature review.

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Intravascular lymphoma presenting as a longitudinally-extensive myelitis: Diagnostic challenges and etiologic clues

Cited by 22 publications

References 37 publications

Surgical tactics and treatment results at spinal lymphomas

Surgical tactics and treatment results at spinal lymphomas

Response to “High-Resolution Vessel Wall MRI: Appearance of Intravascular Lymphoma Mimics Central Nervous System Vasculitis”

FDG-PET/CT is a pivotal imaging modality to diagnose rare intravascular large B-cell lymphoma: case report and review of literature

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