What is the Best Preoperative Quantitative Indicator to Differentiate Primary Central Nervous System Lymphoma from Glioblastoma?

Inoue, Akihiro; Matsumoto, Shirabe; Ohnishi, Takanori; Miyazaki, Yukihiro; Kinnami, Shingo; Kanno, Kazuhisa; Honda, Takatsugu; Kurata, Mie; Taniwaki, Mashio; Kusakabe, Kosuke; Suehiro, Satoshi; Yamashita, Daisuke; Shigekawa, Seiji; Watanabe, Hideaki; Kitazawa, Riko; Kunieda, Takeharu

doi:10.1016/j.wneu.2023.01.065

Cited by 7 publications

(11 citation statements)

References 14 publications

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“…[ 20 ] The general characteristics that high-grade glioma shares with PCNSL are the presence of thick enhancement, periventricular locations, and vasogenic edema; however, most are heterogeneous, with irregular borders, and have a necrotic center and a hemorrhagic component. [ 1 , 13 , 30 , 32 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 ] Its diagnosis, guided by clinical signs and imaging studies, is complex; other inflammatory pathologies, demyelinating diseases, and malignant tumors (including glioblastomas and metastatic tumors) can also be difficult to distinguish from PCNSL. [ 13 ] The predilection sites for this lesion are the periventricular white matter, the corpus callosum, and the basal nuclei. [ 6 ] Cases of bilateral lymphomas have been reported both at the basal nuclei, hypothalamus and even extra-axially in the cerebellopontine angle, unrelated to HIV and other EBV and CMV infections.…”

Section: Introductionmentioning

confidence: 99%

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Primary central nervous system lymphoma: A mirror type presentation in an immunocompetent patient

Chávez,

Arce,

Perea

et al. 2024

Surgical Neurology International

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Background: Primary central nervous system (CNS) lymphoma is a very rare extranodal non-Hodgkin lymphoma. The bilateral pattern, as we call it “mirror type”, has been identified in other CNS lesions such as gliomas, metastases, and demyelinating lesions, so the differential diagnosis includes imaging studies such as magnetic resonance imaging contrasted with spectroscopy, ruling out immunodeficiency or metastatic disease. Case Description: A 65-year-old female presented progressing headache, loss of memory and language alterations, as well as sensory alterations. Neuroimaging showed the presence of two equidistant periventricular lesions at the level of both ventricular atria, a spectroscopy study suggestive of malignancy. Serological studies showed no evidence of immunodeficiency or the presence of positive tumor markers; however, a biopsy was performed, which revealed a histopathological result of primary lymphoma of the CNS. Conclusion: In neuro-oncology, primary CNS tumors with multiple lesions are rare, even more, the “mirror type” lesions. Lymphomas are lesions that can present in different ways on imaging and clinical presentation. These tumors that present a vector effect due to their size, perilesional edema, or that lead to loss of neurological function are highly discussed in diagnostic and surgical treatment. Due to their prognosis, action on diagnosis and treatment must be taken as quickly as hospital resources allow.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Primary central nervous system lymphoma: A mirror type presentation in an immunocompetent patient

Chávez,

Arce,

Perea

et al. 2024

Surgical Neurology International

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“…We consider that key points in the diagnosis of PISCL are imaging findings from 18 F-FDG-PET and CSF. [ 6 ] PET is widely used as a functional imaging modality applying radiotracers such as 11 C-Methionine and 18 F-FDG. [ 14 ] We have previously reported that the TNR of 2.4 from 18 F-FDG-PET was consistent with the pathological diagnosis of PCNSL, with this method offering 83.8% sensitivity and 95.2% specificity.…”

Section: Discussionmentioning

confidence: 99%

“…It is confined to the eye, brain, leptomeninges, and spinal cord, with no systemic involvement. [ 3 , 6 ] On the other hand, primary intramedullary spinal cord lymphoma (PISCL) is extremely rare, accounting for <1.0% of all malignant lymphomas that occur in the central nervous system (CNS). [ 10 , 11 ] The majority of patients present in their 50s, affecting primarily the chest and neck, with low long-term survival rates and high mortality rates.…”

Section: Introductionmentioning

confidence: 99%

Essentials for early diagnosis of primary intramedullary spinal cord lymphoma. How to suspect primary intramedullary spinal cord lymphoma early and proceed to invasive biopsy? A case report and literature review

Shigekawa,

Inoue,

Miyazaki

et al. 2024

Surgical Neurology International

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Background: Primary intramedullary spinal cord lymphoma (PISCL) is an extremely rare condition. Early diagnosis is very difficult due to the nonspecific clinical and imaging findings. A biopsy is essential for a definitive diagnosis, but courage is required to perform the surgery. Here, we present a case of PISCL and suggest useful indicators for accurate diagnosis of this pathological entity. Case Description: A 70-year-old woman presented with subacute bilateral lower-limb paralysis, disturbance of warm and pain sensations, and vesicorectal disturbance. Magnetic resonance imaging showed a contrast-enhanced mass from C7 to Th2 and large, edematous lesions from the upper cervical to lower thoracic spinal cord. Elevated uptake of 18F-fluoro-2-deoxy-D-glucose (FDG) was identified in the enhanced regions on FDG-positron emission tomography (PET). Cerebrospinal fluid (CSF) analysis revealed highly elevated levels of β2-microglobulin (β2-MG). Steroid pulse therapy and therapeutic plasma exchange were performed for suspected myelitis, but symptoms did not improve. Spinal cord biopsy was, therefore, performed for treatment-resistant myelopathy. Histopathological examination revealed diffuse large B-cell lymphoma, which was diagnosed as PISCL because systemic examination showed no other findings suggestive of malignant lymphoma. Conclusion: In cases with poor response to treatment and a progressive course, PISCL should be considered, and spinal cord biopsy should be performed if PET shows increased 18F-FDG uptake and β2-MG is elevated in CSF.

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“…Given similarities of the clinical presentation and radiological findings among CNS lymphoma, gliomas and metastatic tumors, it is challenging to distinguish CNS lymphoma from other types of brain tumors solely based on MRI imaging (Nagashima et al 2018 ). Therefore, CSF B2M levels hold promise as an adjunctive diagnostic indicator for CNS lymphoma (Inoue et al 2023 ). Besides, in both univariate and multivariate Cox analyses, plasma B2M levels in CNS lymphoma patients was also found to be associated with prognosis (Wu et al 2023 ).…”

Section: Role Of B2m In Specific Cns Diseasesmentioning

confidence: 99%

The Role of Beta2-Microglobulin in Central Nervous System Disease

Liu,

Tang,

Yang

et al. 2024

Cell Mol Neurobiol

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Central nervous system (CNS) disorders represent the leading cause of disability and the second leading cause of death worldwide, and impose a substantial economic burden on society. In recent years, emerging evidence has found that beta2 -microglobulin (B2M), a subunit of major histocompatibility complex class I (MHC-I) molecules, plays a crucial role in the development and progression in certain CNS diseases. On the one hand, intracellular B2M was abnormally upregulated in brain tumors and regulated tumor microenvironments and progression. On the other hand, soluble B2M was also elevated and involved in pathological stages in CNS diseases. Targeted B2M therapy has shown promising outcomes in specific CNS diseases. In this review, we provide a comprehensive summary and discussion of recent advances in understanding the pathological processes involving B2M in CNS diseases (e.g., Alzheimer's disease, aging, stroke, HIV-related dementia, glioma, and primary central nervous system lymphoma).

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What is the Best Preoperative Quantitative Indicator to Differentiate Primary Central Nervous System Lymphoma from Glioblastoma?

Cited by 7 publications

References 14 publications

Primary central nervous system lymphoma: A mirror type presentation in an immunocompetent patient

Primary central nervous system lymphoma: A mirror type presentation in an immunocompetent patient

Essentials for early diagnosis of primary intramedullary spinal cord lymphoma. How to suspect primary intramedullary spinal cord lymphoma early and proceed to invasive biopsy? A case report and literature review

The Role of Beta2-Microglobulin in Central Nervous System Disease

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