Parenchymal central nervous system involvement in aggressive B-cell lymphoma: retrospective analysis of clinical and MRI features in a Chinese population

Abstract

BackgroundSecondary central nervous system lymphoma (SCNSL) is defined as secondary central nervous system (CNS) involvement in patients with systemic lymphoma. It is considered a profoundly adverse complication with inferior clinical outcome. Parenchymal involvement in the CNS in aggressive B-cell lymphoma is not frequently seen and remains a diagnostic dilemma.MethodsIn our study, we retrospectively analyzed the clinical and magnetic resonance imaging (MRI) features of 26 parenchymal SCNSL patients. In addition, we compared MRI features of SCNSL and primary CNS lymphoma (PCNSL) patients after 1:1 propensity score matching. Also we presented two SCNSL cases with atypical MRI appearance.ResultsAmong SCNSL patients, the median CNS relapse time was 3 months, and multiple lesions were found in 76.9% of the cases. In PCNSL, this percentage was 42.3% (p = 0.011). None of the SCNSL patients and 23.1% of the PCNSL patients had solitary infratentorial lesions (p = 0.003).ConclusionsThe majority of parenchymal involvement occurred within the first year of systemic lymphoma, in which mostly cases presenting with multiple and supratentorial locations, unlike what was found in PCNSL.

Central nervous system involvement in adult-onset hemophagocytic lymphohistiocytosis secondary to lymphoma: a case presentation and literature analysis

“…Secondary CNS lymphoma mostly involves deep gray or white matter, and lesions show enhancement on enhanced T1-weighted image and diffusion restriction ( 27 , 28 ). The patient described in this report had no limited space-occupying lesions and no enhancement, which is inconsistent with lymphoma.…”

Branch-like enhancement on contrast enhanced MRI is a specific finding of cerebellar lymphoma compared with other pathologies

“…The difference between PCNSL and SCNSL is rarely investigated. Some studies have shown that SCNSL typically presents with leptomeningeal involvement 16 , and deep gray matter and infratentorial involvement are less common in SCNSL than in PCNSL 17 . Some studies have shown no significant difference between PCNSL and SCNSL, both predominantly presenting as multiple lesions with consistent supratentorial white matter involvement 18 , 19 .…”