Posttransplant primary CNS lymphoma

Abstract

The records and neuro-imaging studies of 8 cases of posttransplant primary CNS lymphoma (PT-PCNSL) diagnosed at Mayo Clinic Rochester between 1970 and 1998 were reviewed retrospectively. All patients received organ transplantation. Patients who had hematologic transplantation were not included in the analysis. The median and mean age of the 4 men and 4 women was 45 years (range, 34 to 50 years). The median duration of symptoms before diagnosis was 36 days (range, 5 to 98 days). At diagnosis, the neurologic examination was focally abnormal in 6 of 8 patients. Compared with the initial computed tomographic study, MRI showed 25 additional brain lesions. Only 43.7% of lesions enhanced with contrast agent; of those that did, all but one were heterogeneous. Ependymal contact occurred in 5 patients. MRI lesion burden increased proportionally to the interval between scans. Diagnostic tissue was obtained by stereotactic biopsy from 6 patients and by open biopsy from 2. Hemorrhage occurred in the biopsy area in 4 patients who had stereotactic biopsy and 2 died (all had normal coagulation studies). Slides available for review (7 patients) showed that the tumors were of CD20-positive lineage and were positive for Epstein-Barr virus, using in situ hybridization. Six patients died. Median survival for the cohort was 13 weeks. PT-PCNSL has clinical and imaging features distinct from typical PCNSL. In our series, (1) PT-PCNSL presented nonspeci cally and progressed rapidly, (2) stereotactic brain biopsy had signi cant morbidity, and (3) despite multimodal therapy, survival was poor. NeuroOncology 2, 229-238, 2000 (Posted to Neuro-Oncology [serial online], Doc. 00-034, September 13, 2000

Pathology of primary central nervous system lymphoma

“…In contrast to lesions involved in systemic posttransplant lymphoproliferative disorders, which are heterogeneous and include low-grade proliferations, those arising in the CNS seem to be uniformly high-grade B-cell lymphomas. 7,31 Similar to PCNSLs seen in patients with AIDS, these tumors tend to be multifocal, necrotic, and mostly located in the cerebral cortex and white matter and in the basal ganglia.…”

“…21,31 Histologically, PCNSLs in AIDS patients are high-grade, diffuse large B-cell tumors, often of the immunoblastic subtype. The low-grade lymphomas seen occasionally in immunocompetent individuals occur even less frequently in AIDS patients.…”

Posttransplant Lymphoproliferative Disorders of the Central Nervous System After Kidney Transplantation: Single Center Experience Over 40 Years -Two Case Reports-

“…The predominance of the monomorphic type over the polymorphic type (100% vs. 0%) has been reported in CNS PTLD. 5,17) However, another study reported a contradictory result (21% vs. 79%). 20) Both of our cases involved polymorphic PTLD, but classification of PTLD in the Asian population has not been determined.…”

“…Most cases obtaining complete remission were treated with other therapeutic modalities, including surgical resection, chemotherapy, and radiotherapy. 5,16,17,20) Chemotherapy such as CHOP (cyclophosphamide, adriamycin, vincristine, and prednisolone) and anti-B-cell antibody have been also used in the treatment of non-CNS PTLD. 9) However, CNS PTLD is considered resistant to these agents, because of the low drug permeability of the bloodbrain barrier.…”

Limited role of surgery in the management of primary central nervous system lymphoma (Review)

“…After a 3-fold rise two decades ago, the incidence of PCNSL continues to increase at a rate of 0.46 per 100,000 patient-years (1,3). The increasing incidence can be partially attributed to prolonged survival of AIDS patients and the extensive use of immunosuppressive therapy in organ transplantation and autoimmune disease (4). However, there has also been a 3-fold increase in the incidence of PCNSL among immunocompetent patients, within some studies representing more than 6% of primary intracerebral neoplasms (5).…”