Multiple Cerebral Hemorrhages With Microbleeds in Intravascular Large B-Cell Lymphoma

Kimura, Masamune; Fujiwara, Satoru; Tanaka, Atsushi; Omura, Yoshihiro; Yamashita, Daisuke; Hinoda, Takuya; Sakai, Nobuyuki; Kohara, Nobuo

doi:10.1016/j.jstrokecerebrovasdis.2020.104798

Cited by 9 publications

(7 citation statements)

References 5 publications

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“…The lymphoma cells are mainly large cells with prominent nucleoli and mitotic figures [1,3]. Immunohistological analysis has shown that the lymphoma cells are positive for CD20, CD45, CD79a, and MUM1, while they are negative for CD3 [7][8][9][10]. Translocation of the BCL6 gene in IVLBCL has also been reported [11].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is possible that bone marrow and skin biopsies in these types of cases could potentially not determine a correct pathological diagnosis. In other previously reported cases, brain biopsies were required as other biopsy methods were not able to definitively determine a diagnosis, even though the brain lesions exhibited growth or the development of an enhanced mass [7][8][9][10]. All of these previous brain biopsy cases were performed using a craniotomy and not via a stereotactic needle [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…The hemosiderosis indicated microbleeds from the lesions. There have been several previous studies that have reported finding multiple microbleeds around the brain lesions on T2*-weighted or susceptibility-weighted images [ 8 , 10 , 15 ]. The biopsy from the bleeding site showed that there were multiple ruptures of small vessels, in which large clusters of cells existed [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Intravascular Large B-Cell Lymphoma Diagnosed by Open Brain Biopsy and Achievement of Remission After Early Initiation of Chemotherapy: Case Report

Tsukamoto¹,

Tanei²,

Kato³

et al. 2022

Cureus

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A 60-year-old man presented with progressive disturbance of consciousness. His father had died of malignant lymphoma, while his mother and sister died of acute leukemia. Magnetic resonance imaging (MRI) revealed multiple high-intensity lesions in the bilateral cerebral hemispheres on diffusion-weighted images. Serum soluble interleukin 2 receptor was 5,640 U/mL. Screenings of blood antibodies known to rise in autoimmune diseases were all normal. Cerebrospinal fluid examinations demonstrated slight elevation of protein and glucose, while the oligoclonal band and myelin basic protein were not elevated. Biopsies of bone marrow and random skin did not show any malignant features. His consciousness gradually deteriorated over a week, with lesions in his right frontal, left temporal, and bilateral parietal lobes shown to be growing. Therefore, open brain biopsy was performed, and one block of the right frontal lesion was harvested. Histological examination revealed atypical large cells only in the capillaries. Although immunohistochemical examinations showed positive staining for CD20, they were negative for CD3. Histopathological diagnosis was intravascular large B-cell lymphoma. After undergoing six cycles of intravenous chemotherapy with rituximab, cyclophosphamide, doxorubicin, and prednisone, his consciousness and neurological symptoms improved, and he appeared to achieve remission. Two years later, there have been no apparent recurrences, and the brain lesions have disappeared.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intravascular Large B-Cell Lymphoma Diagnosed by Open Brain Biopsy and Achievement of Remission After Early Initiation of Chemotherapy: Case Report

Tsukamoto¹,

Tanei²,

Kato³

et al. 2022

Cureus

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“…Finally, the frequency of each lesion and the presence of imaging patterns were examined. Brain type patients were evaluated based on previous reports (Figure S1) [9,18].…”

Section: Magnetic Resonance Imaging Evaluationmentioning

confidence: 99%

Progressive conus medullaris lesions are suggestive of intravascular large B‐cell lymphoma

Kitahara

Kanazawa

Natsumeda

et al. 2023

Euro J of Neurology

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Background and purposeSpinal cord lesions are observed in 40% of all central nervous system lesions in intravascular large B‐cell lymphoma (IVLBCL). However, because IVLBCL is a very rare disease, its clinical features are not well defined, which may delay appropriate diagnosis and treatment, whilst the acute to subacute course of brain lesions in patients with IVLBCL is well established. Therefore, this study aimed to clarify the clinical features of spinal cord lesions in patients with IVLBCL.MethodsThe medical records of patients with IVLBCL admitted to our hospital between 2010 and 2020 were searched. The inclusion criteria were preceding neurological symptoms without non‐neurological symptoms and pathologically confirmed IVLBCL in various organs. Clinical features of spinal cord involvement in patients with IVLBCL were assessed and distinguished from those of brain involvement.ResultsSixteen consecutive patients with IVLBCL were divided into two groups: six patients with spinal involvement (spinal cord type) and 10 patients with brain involvement (brain type). In the spinal cord type, four patients had chronic progression and two had subacute progression. Acute progression (0% vs. 80.0%) and sudden onset (0% vs. 50.0%) occurred significantly less frequently in the spinal cord than in the brain. All spinal cord lesions involved the conus medullaris.ConclusionsSpinal cord involvement in IVLBCL has a predominantly chronic progressive course that is exclusive to brain involvement. Conus medullaris lesions are suggestive of IVLBCL and are useful for early and accurate diagnosis and treatment.

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“…Through the reviewing of recent advances in successful antibody-based drugs for neurological disorders, we emphasized the potential in repurposing of these effective antibody drugs for the treatment of cerebral ischemia in the near future. As the increasing amount of evidence showing the pathological roles of such targets as CD19, IL-6, C5 complement, CGRP, and CD20 in the modulating of cerebral ischemia severity in clinical reports or pre-clinical studies [ 93 , 94 , 95 , 96 , 97 ], we believe these currently available antibody-based drugs for different neurological disorders could soon been evaluated and re-purposed as an effective antibody drug for stroke treatment in clinic.…”

Section: Recent Antibody-based Drugs For Neurological Disordersmentioning

confidence: 99%

Advances in Antibody-Based Therapeutics for Cerebral Ischemia

et al. 2022

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Cerebral ischemia is an acute disorder characterized by an abrupt reduction in blood flow that results in immediate deprivation of both glucose and oxygen. The main types of cerebral ischemia are ischemic and hemorrhagic stroke. When a stroke occurs, several signaling pathways are activated, comprising necrosis, apoptosis, and autophagy as well as glial activation and white matter injury, which leads to neuronal cell death. Current treatments for strokes include challenging mechanical thrombectomy or tissue plasminogen activator, which increase the danger of cerebral bleeding, brain edema, and cerebral damage, limiting their usage in clinical settings. Monoclonal antibody therapy has proven to be effective and safe in the treatment of a variety of neurological disorders. In contrast, the evidence for stroke therapy is minimal. Recently, Clone MTS510 antibody targeting toll-like receptor-4 (TLR4) protein, ASC06-IgG1 antibody targeting acid sensing ion channel-1a (ASIC1a) protein, Anti-GluN1 antibodies targeting N-methyl-D-aspartate (NMDA) receptor associated calcium influx, GSK249320 antibody targeting myelin-associated glycoprotein (MAG), anti-High Mobility Group Box-1 antibody targeting high mobility group box-1 (HMGB1) are currently under clinical trials for cerebral ischemia treatment. In this article, we review the current antibody-based pharmaceuticals for neurological diseases, the use of antibody drugs in stroke, strategies to improve the efficacy of antibody therapeutics in cerebral ischemia, and the recent advancement of antibody drugs in clinical practice. Overall, we highlight the need of enhancing blood–brain barrier (BBB) penetration for the improvement of antibody-based therapeutics in the brain, which could greatly enhance the antibody medications for cerebral ischemia in clinical practice.

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Multiple Cerebral Hemorrhages With Microbleeds in Intravascular Large B-Cell Lymphoma

Cited by 9 publications

References 5 publications

Intravascular Large B-Cell Lymphoma Diagnosed by Open Brain Biopsy and Achievement of Remission After Early Initiation of Chemotherapy: Case Report

Intravascular Large B-Cell Lymphoma Diagnosed by Open Brain Biopsy and Achievement of Remission After Early Initiation of Chemotherapy: Case Report

Progressive conus medullaris lesions are suggestive of intravascular large B‐cell lymphoma

Advances in Antibody-Based Therapeutics for Cerebral Ischemia

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