Mononeuropathy multiplex due to infiltration of lymphoma in hematologic remission

Walk, David; Handelsman, Avi; Beckmann, Enrique; Kozloff, Mark; Shapiro, Cheri J.

doi:10.1002/(sici)1097-4598(199806)21:6<823::aid-mus21>3.0.co;2-s

“…Two of our patients had experienced prior follicular lymphoma. Nine cases of the combined series were not classified at all, b. References: Barron et al, 1960;Carey et al, 2000;Gherardi et al, 1986;Ince et al, 1987;Jellinger et al, 1979;Kohut, 1946;Kuntzer et al, 2000;Lachance et al, 1991;Stack, 1991;Swarnkar et al, 1997;Valencia et al, 1999. c. References: Abdel-Aziz and van Loveren, 1999; Galetta et al, 1992;Kajiya et al, 1995;Manon-Espaillat et al, 1990;Teoh et al, 1980;Wilkins and Samhouri, 1979;Young et al, 1945. d. References: Allison andGordon, 1955;Borit and Altrocchi, 1971;Diaz-Arrastia et al, 1992;Gerardi et al, 1986;Grisold et al, 1993;Guberman et al, 1978;Julien et al, 1991;Krendel et al, 1991;Mauney and Sciotto, 1983;Moore and Oda, 1962;Pattengale et al, 1979;Schoenfeld et al, 1983;Vallat et al, 1995;Zuer et al, 1988. e. References: Eusebi et al, 1990;Kanamori et al, 1995;Misdraji et al, 2000;Pillay et al, 1988;Purohit et al, 1986;Roncaroli et al, 1997;vanBolden et al, 1987;van den Bent et al, 1995. f. References: van den Bent et al, 1999;Walk et a...…”

Section: Histopathologymentioning

confidence: 99%

Neurolymphomatosis: diagnosis, management, and outcomes in patients treated with rituximab

Gan

¹

,

Azad

²

,

Cher

³

et al. 2009

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The term "neurolymphomatosis" (NL) has included infiltration of the peripheral nervous system by lymphoma and nontumor lymphocytes. We describe NL as a lymphoma entity that affects cranial and peripheral nerves and roots. We reviewed the medical records of patients at the Massachusetts General Hospital (MGH) who registered between 1972 and 2000, as well as cases published in the English-language literature. Inclusion criteria were (A) histopathologic demonstration of lymphoma within peripheral nerve, nerve root/plexus, or cranial nerve or (B) CT/MRI or intraoperative evidence of nerve enlargement and/or enhancement beyond the dural sleeve in the setting of prior or concurrent lymphoma in systemic or CNS sites. We identified 25 patients with NL in addition to 47 reported by others. Four clinical presentations were (1) painful involvement of nerves or roots, (2) cranial neuropathy with or without pain, (3) painless involvement of peripheral nerves, (4) painful or painless involvement of a single peripheral nerve. Twenty of our patients and 44 of those reported had histopathologic confirmation of lymphoma infiltrating root or nerve. In the remainder, diagnosis was based upon clinical presentation, nodular nerve enlargement or enhancement, and lymphoma cells in spinal fluid or extraneural sites. For antemortem diagnosis, imaging studies were of greatest utility, followed by biopsy. Thirty-three patients of the combined series were not correctly diagnosed until postmortem examination. Systemic chemotherapy was used to address the multiple potential sites of involvement. When properly treated, NL carries a prognosis similar to primary CNS lymphoma in the modern era.

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“…Two of our patients had experienced prior follicular lymphoma. Nine cases of the combined series were not classified at all, b. References: Barron et al, 1960;Carey et al, 2000;Gherardi et al, 1986;Ince et al, 1987;Jellinger et al, 1979;Kohut, 1946;Kuntzer et al, 2000;Lachance et al, 1991;Stack, 1991;Swarnkar et al, 1997;Valencia et al, 1999. c. References: Abdel-Aziz and van Loveren, 1999; Galetta et al, 1992;Kajiya et al, 1995;Manon-Espaillat et al, 1990;Teoh et al, 1980;Wilkins and Samhouri, 1979;Young et al, 1945. d. References: Allison andGordon, 1955;Borit and Altrocchi, 1971;Diaz-Arrastia et al, 1992;Gerardi et al, 1986;Grisold et al, 1993;Guberman et al, 1978;Julien et al, 1991;Krendel et al, 1991;Mauney and Sciotto, 1983;Moore and Oda, 1962;Pattengale et al, 1979;Schoenfeld et al, 1983;Vallat et al, 1995;Zuer et al, 1988. e. References: Eusebi et al, 1990;Kanamori et al, 1995;Misdraji et al, 2000;Pillay et al, 1988;Purohit et al, 1986;Roncaroli et al, 1997;vanBolden et al, 1987;van den Bent et al, 1995. f. References: van den Bent et al, 1999;Walk et al, 1998....…”

Section: Histopathologymentioning

confidence: 99%

Neurolymphomatosis

Baehring¹

2003

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The term "neurolymphomatosis" (NL) has included infiltration of the peripheral nervous system by lymphoma and nontumor lymphocytes. We describe NL as a lymphoma entity that affects cranial and peripheral nerves and roots. We reviewed the medical records of patients at the Massachusetts General Hospital (MGH) who registered between 1972 and 2000, as well as cases published in the English-language literature. Inclusion criteria were (A) histopathologic demonstration of lymphoma within peripheral nerve, nerve root/plexus, or cranial nerve or (B) CT/MRI or intraoperative evidence of nerve enlargement and/or enhancement beyond the dural sleeve in the setting of prior or concurrent lymphoma in systemic or CNS sites. We identified 25 patients with NL in addition to 47 reported by others. Four clinical presentations were (1) painful involvement of nerves or roots, (2) cranial neuropathy with or without pain, (3) painless involvement of peripheral nerves, (4) painful or painless involvement of a single peripheral nerve. Twenty of our patients and 44 of those reported had histopathologic confirmation of lymphoma infiltrating root or nerve. In the remainder, diagnosis was based upon clinical presentation, nodular nerve enlargement or enhancement, and lymphoma cells in spinal fluid or extraneural sites. For antemortem diagnosis, imaging studies were of greatest utility, followed by biopsy. Thirty-three patients of the combined series were not correctly diagnosed until postmortem examination. Systemic chemotherapy was used to address the multiple potential sites of involvement. When properly treated, NL carries a prognosis similar to primary CNS lymphoma in the modern era.

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“…The presentation of NL can also be the first sign of lymphoma 47 or of a relapse. 48 Tomita et al 20 observed a number of instances of focal and multifocal nerve damage in a small selected series. The diagnosis in suspected cases of NL needs to be histologically confirmed by biopsy.…”

Section: Neurolymphomatosismentioning

confidence: 98%

Neuropathies associated with lymphoma†

Grisold

¹

,

Grisold

²

,

Marosi

³

et al. 2015

Neuro-Oncology Practice

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Neuropathy occurs with various manifestations as a consequence of lymphoma, and an understanding of the etiology is necessary for proper treatment. Advances in medical imaging have improved the detection of peripheral nerve involvement in lymphoma, yet tissue diagnosis is often equally important. The neoplastic involvement of the peripheral nervous system (PNS) in lymphoma can occur within the cerebrospinal fluid (CSF), inside the dura, or outside of the CSF space, affecting nerve root plexuses and peripheral nerves. The infiltration of either cranial or peripheral nerves in lymphoma is termed neurolymphomatosis (NL). These infiltrations can occur as mononeuropathy, multifocal neuropathy, symmetric neuropathies, or plexopathies. In rare cases, intravascular lymphoma (IL) can affect the PNS and an even rarer condition is the combination of NL and IL. Immune-mediated and paraneoplastic neuropathies are important considerations when treating patients with lymphoma. Demyelinating neuropathies, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy, occur more frequently in non-Hodgkin's lymphoma than in Hodgkin's disease. Paraproteinemic neuropathies can be associated with lymphoma and paraneoplastic neuropathies are rare. While the treatment of lymphomas has improved, a knowledge of neurotoxic, radiotherapy, neoplastic, immune-mediated and paraneoplastic effects are important for patient care.

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Mononeuropathy multiplex due to infiltration of lymphoma in hematologic remission

Cited by 17 publications

References 26 publications

Neurolymphomatosis: diagnosis, management, and outcomes in patients treated with rituximab

Neurolymphomatosis: diagnosis, management, and outcomes in patients treated with rituximab

Neurolymphomatosis

Neuropathies associated with lymphoma†

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