Rapid distinction of acute demyelinating disorders and central nervous system lymphoma by molecular analysis of cerebrospinal fluid cells

Abstract

Polymerase chain reaction (PCR) based automated high-resolution fragment analysis of rearranged immunoglobulin heavy-chain genes is a highly sensitive means for identifying clonal B-cell responses. We used this technique to distinguish polyclonal inflammatory from monoclonal neoplastic B-cell populations in the cerebrospinal fluid (CSF) of three patients with acute demyelinating disorders of the central nervous system whose clinical, magnetic resonance imaging (MRI) and CSF features did not permit unequivocal exclusion of primary central nervous system lymphoma (pC-NSL). This approach is highly suitable for detecting CNS inflammation particularly when lymphomatous involvement cannot be ruled out by noninvasive diagnostic procedures alone.

Immunoglobulin gene rearrangement analysis in cerebrospinal fluid of patients with lymphoproliferative processes

“…25 (top gel) and 26 (bottom gel)). This case is representative of the four false positive cases (see Table 1b [18,29]. In a study comprised of 17 patients with primary or secondary CNS lymphoma and inflammatory or viral CNS diseases, spinal fluid IGHR analysis of two patients revealed a clonal band in patients who were thought to harbor an encephalitic process on clinical grounds [30].…”

Benign course of tumour-like multiple sclerosis. Report of five cases and literature review

“…The presence of oligoclonal bands may help in differentiating MS from brain tumours. The presence of IgH CDR3 in the CSF may be useful in differentiating CNS lymphoma from tumefactive MS [30]. Molecular markers of axonal damage/neuronal death, such as 14-3-3 protein, may be elevated in the CSF of MS patients, but they have not been specifically studied in tumour-like cases.…”

Single-cell PCR analysis of the immunoglobulin heavy-chain CDR3 region for the diagnosis of leptomeningeal involvement of B-cell malignancies using standard cerebrospinal fluid cytospins

“…Positive PCR reactions were characterized by a sharp band in the range between 80 and 120 base pairs (bp). Amplicons were additionally analyzed by gene scan analysis as recently described [5][6][7]. …”