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MeSH term: Central Nervous System Neoplasms
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This list of publications is regularly updated (Source: PubMed).
A rare case of Primary Central Nervous System Lymphoma initially diagnosed as demyelinating encephalopathy.
Neuro Endocrinol Lett. 2015; 36(2):123-126 [PubMed] Related Publications
Multifocal lateral and fourth ventricular primary central nervous system lymphoma: case report and literature review.
Turk Neurosurg. 2015; 25(3):493-5 [PubMed] Related Publications
Primary central nervous system lymphoma: is absence of intratumoral hemorrhage a characteristic finding on MRI?
Radiol Oncol. 2015; 49(2):128-34 [PubMed] Free Access to Full Article Related Publications
PATIENTS AND METHODS: A retrospective cohort of brain tumors from August 2008 to March 2013 was searched, and 58 patients (19 with primary central nervous system lymphoma, 39 with glioblastoma multiforme) satisfied the inclusion criteria. Absence of gross intratumoral hemorrhage was examined on T2WI, and an intratumoral susceptibility signal was graded using a 3-point scale on susceptibility-weighted imaging. Results were compared between primary central nervous system lymphoma and glioblastoma multiforme, and values of P < 0.05 were considered significant.
RESULTS: Gross intratumoral hemorrhage on T2WI was absent in 15 patients (79%) with primary central nervous system lymphoma and 23 patients (59%) with glioblastoma multiforme. Absence of gross intratumoral hemorrhage could not differentiate between the two disorders (P = 0.20). However, intratumoral susceptibility signal grade 1 or 2 was diagnostic of primary central nervous system lymphoma with 78.9% sensitivity and 66.7% specificity (P < 0.001), irrespective of gross intratumoral hemorrhage.
CONCLUSIONS: Low intratumoral susceptibility signal grades can differentiate primary central nervous system lymphoma from glioblastoma multiforme. However, specificity in this study was relatively low, and primary central nervous system lymphoma cannot be excluded based solely on the presence of an intratumoral susceptibility signal.
CSF neopterin level as a diagnostic marker in primary central nervous system lymphoma.
Neuro Oncol. 2015; [PubMed] Related Publications
METHODS: We retrospectively reviewed the characteristics of 124 patients with brain tumor (n = 82) or an inflammatory CNS disorder (n = 42) in whom CSF neopterin levels were assessed. Twenty-eight patients had PCNSL, 54 patients had another type of brain tumor (glioma n = 36, metastasis n = 13, other n = 5), and 13 patients had a pseudotumoral inflammatory brain lesion.
RESULTS: CSF neopterin levels were significantly higher in the patients with PCNSL than in those with other brain tumors (41.8 vs 5.1 nmol/L, P < .001), those with pseudotumoral inflammatory brain lesions (41.8 vs 4.3 nmol/L, P < .001), and those with nontumefactive inflammatory CNS disorders (41.8 vs 3.8 nmol/L, P < .001). In the 95 patients with space-occupying brain lesions, at a cutoff of 10 nmol/L, the sensitivity of this approach was 96% and the specificity was 93% for the diagnosis of PCNSL. The positive and negative predictive values were 84% and 98%, respectively.
CONCLUSION: Assessing CSF neopterin levels in patients with a suspected brain tumor might be helpful for the positive and differential diagnosis of PCNSL. A prospective study is warranted to confirm these results.
(P040) Radiosurgery for primary central nervous system lymphoma.
Oncology (Williston Park). 2015; 29(4 Suppl 1) [PubMed] Related Publications
Unusual primary central nervous system lymphoma location involving the fourth ventricle and hypothalamus.
Neuroradiol J. 2015; [PubMed] Related Publications
[Clinical and prognostic analysis of 30 cases of primary central nervous system lymphoma].
Zhonghua Xue Ye Xue Za Zhi. 2015; 36(4):282-5 [PubMed] Related Publications
METHODS: Retrospective analysis, Kaplan-Meier analysis and Log-rank test were conducted on 30 PCNSL patients from 2006 to 2014 in our hospital.
RESULTS: The median age of this cohort (14 males and 16 females) was 57.4 years old. 18 cases had single tumor, 12 cases multiple. 17 cases presentd with intracranial hypertension and 13 cases focal neurological deficits. 13 cases (62%) were diffuse large B cell lymphoma. About 60% patients received combination therapy including surgery, radiotherapy or chemotherapy. 63.3% complete remission rate (CR) was achieved for all patients. Kaplan-Meier analysis and Log-rank test showed the median overall survival (OS) was 24 months, the rates of 2-year survival, 5-year survival, 6-month progression-free survival(PFS) and 1-year free-progressed survival (PFS) were as of 46.7%, 13.3%, 60.0% and 43.3% respectively. The median OS of 11 patients received whole brain radiotherapy(WBRT)combined with chemotherapy was 48 months. The median OS of 7 patients treated with stereotactic radiosurgery(SRS) combined with chemotherapy had no significant difference when compared to the former (P=0.233). Survive analysis showed that age was prognostic factor for PCNSL patients(P=0.030).
CONCLUSION: Diffuse large B cell lymphoma was the main type of PCNSL, single or multiple location, presented with increased intracranial hypertension or focal neurological deficits. Age was the key prognostic factor for patients. Surgery was suitable for patients with supertentorial and superficial tumor or with acute intracranial hypertension syndrome. SRS was a feasible local therapy which alleviated the symptoms and led to less toxicity. PCNSL patients might benefit from multimode therapy.
Autoimmune Hemolytic Anemia preceding the Diagnosis of Primary Central Nervous System Lymphoma.
Iran J Ped Hematol Oncol. 2015; 5(1):65-9 [PubMed] Free Access to Full Article Related Publications
Stereotactic radiosurgery in combination with up-front high-dose methotrexate as a first-line treatment for newly diagnosed primary central nervous system lymphoma.
J Neurooncol. 2015; 123(2):237-44 [PubMed] Related Publications
Primary central nervous system lymphoma in a rheumatoid arthritis patient treated with methotrexate: a case report.
BMC Res Notes. 2015; 8:88 [PubMed] Free Access to Full Article Related Publications
CASE PRESENTATION: A Japanese female patient of between 60 and 70 years of age with rheumatoid arthritis was admitted to our hospital because of sudden convulsion and impaired consciousness. Just before admission, she was treated with adalimumab and methotrexate. Contrast-enhanced computed tomography scan showed a densely stained mass with surrounding edema in both frontal lobes and the left nucleus basalis, and enlarged lymph nodes in the right supraclavicular fossa. We performed a biopsy of the right cervical lymph node, but could not establish a histopathological diagnosis. In situ hybridization showed the presence of Epstein Barr virus, therefore we diagnosed this case as methotrexate-associated lymphoproliferative disorders mediated by Epstein Barr virus after considering the drug history of the patient. After we discontinued methotrexate, patient symptoms gradually improved. The masses at both frontal lobes and the left nucleus basalis were gradually regressed.
CONCLUSION: Since the frequency of methotrexate use and the maximum dosage has been increasing, particular attention should be paid to the development of methotrexate-associated lymphoproliferative disorders in rheumatoid arthritis patients who are treated with methotrexate.
Outcomes for HIV-positive patients with primary central nervous system lymphoma after high-dose chemotherapy and auto-SCT.
Bone Marrow Transplant. 2015; 50(7):999-1000 [PubMed] Related Publications
New approaches in primary central nervous system lymphoma.
Chin Clin Oncol. 2015; 4(1):11 [PubMed] Related Publications
Neurocognitive features distinguishing primary central nervous system lymphoma from other possible causes of rapidly progressive dementia.
Cogn Behav Neurol. 2015; 28(1):1-10 [PubMed] Article available free on PMC after 01/03/2016 Related Publications
BACKGROUND: PCNSL can present as an RPD. Differentiating PCNSL from other RPDs is critical because lymphomatous dementia may be reversible, and untreated PCNSL is fatal.
METHODS: We performed a meta-analysis of case reports of dementia from PCNSL (between 1950 and 2013); 20 patients (14 with lymphomatosis cerebri) met our criteria. We compared these patients to a case series of patients with RPD from Creutzfeldt-Jakob disease and other non-PCNSL etiologies (Sala et al, 2012. Alzheimer Dis Assoc Disord. 26:267-271).
RESULTS: Median age was 66 years (range 41 to 81); 70% were men. Time from symptom onset to evaluation was <6 months in 65%. No patients had seizures; 5% had headaches; 45% had non-aphasic speech difficulty. There was significantly more memory impairment in patients with PCNSL than other RPDs and significantly less myoclonus and parkinsonism. Behavioral changes and cerebellar signs were not significantly different. Significantly more patients with PCNSL than other RPDs had white matter changes; significantly fewer had atrophy. Elevated CSF protein and pleocytosis were more frequent in PCNSL; patients with other RPDs tended to have normal CSF±14-3-3 protein.
CONCLUSIONS: Unlike patients with RPD from other causes, those with PCNSL commonly present with impaired memory, apathy, and abnormal speech and gait, without headache, seizure, or myoclonus. White matter changes and CSF abnormalities predominate. Improved clinical awareness of PCNSL can prompt earlier diagnosis and treatment.
Primary central nervous system lymphoma mimicking recurrent depressive disorder: A case report.
Oncol Lett. 2015; 9(4):1819-1821 [PubMed] Article available free on PMC after 01/03/2016 Related Publications
Diagnosis and treatment of primary central nervous system lymphoma: A report of nine cases and literature review.
Oncol Lett. 2015; 9(4):1795-1801 [PubMed] Article available free on PMC after 01/03/2016 Related Publications
[Positron emission tomography in primary brain lymphoma: Diagnostic and prognostic significance].
Med Clin (Barc). 2015; 144(11):501-2 [PubMed] Related Publications
Clinicopathological correlates of primary central nervous system lymphoma: experience from a tertiary care center in South India.
Neurol India. 2015 Jan-Feb; 63(1):77-82 [PubMed] Related Publications
AIM: To study the clinical and immunophenotypic profile of patients with a PCNSL who presented between the years 2000 and 2013 in a tertiary care center in South India.
MATERIALS AND METHODS: This was a retrospective study. Demographic and clinical data were obtained from the clinical case records.
INCLUSION CRITERIA: Cases of PCNSL involving brain.
EXCLUSION CRITERIA: Cases of PCNSL involving the spinal cord, meninges and orbit as well as intravascular large B-cell lymphoma, lymphomas with evidence of systemic disease or secondary lymphomas. Archived slides and tissue blocks were retrieved. All cases had hematoxylin and eosin stained sections and immunohistochemistry for CD20, CD3, and MIB-1. Additional immunohistochemistry was performed for CD10, BCL6, and MUM1 on paraffin blocks with sufficient tissue.
RESULTS: There were a total of 73 cases with the mean age of presentation being 45.9 years (range 8-71 years) and with a male predominance (male: female (M:F) = 2.3:1). Headache was the commonest presenting complaint. The mean duration of symptoms was 10.6 weeks. All patients were immunocompetent. Most tumors were supratentorial in location. Out of 73 cases, 70 presented with a diffuse large B-cell lymphoma (DLBCL), two with a Burkitt's lymphoma, and one with a lymphomatoid granulomatosis. Only 51 of the DLBCL cases had sufficient tissue for additional studies. Non-germinal center was the most common phenotype seen in 65.7% (33/51) of cases. Germinal center B-cell (GCB) phenotype was seen in 18/51 cases (34.3%).
CONCLUSION: DLBCL constituted the majority of PCNSLs and although non-germinal center was the predominant phenotype, more than a third of the cases were of the GCB phenotype. As the germinal center phenotype is known to have a better prognosis, further studies to explore its relevance in the Asian population are indicated.
Randomized phase III study of whole-brain radiotherapy for primary CNS lymphoma.
Neurology. 2015; 84(12):1242-8 [PubMed] Related Publications
METHODS: Patients with newly diagnosed PCNSL were randomized to high-dose methotrexate (HDMTX)-based chemotherapy alone or followed by WBRT. We hypothesized that the omission of WBRT would not compromise overall survival (OS; primary endpoint), using a noninferiority design with a margin of 0.9.
RESULTS: In the per-protocol population (n = 320), WBRT nonsignificantly prolonged progression-free survival (PFS) (median 18.2 vs 11.9 months, hazard ratio [HR] 0.83 [95% confidence interval (CI) 0.65-1.06], p = 0.14) and significantly PFS from last HDMTX (25.5 vs 12.0 months, HR 0.65 [95% CI 0.5-0.83], p = 0.001), but without OS prolongation (35.6 vs 37.1 months, HR 1.03 [95% CI 0.79-1.35], p = 0.82). In the intent-to-treat population (n = 410), there was a prolongation by WBRT of both PFS (15.4 vs 9.9 months, HR 0.79 [95% CI 0.64-0.98], p = 0.034) and PFS from last HDMTX (19.4 vs 11.9 months, HR 0.72 [95% CI 0.58-0.89], p = 0.003), but not of OS (32.4 vs 36.1 months, HR 0.98 [95% CI 0.79-1.26], p = 0.98).
CONCLUSION: Although the statistical proof of noninferiority regarding OS was not given, our results suggest no worsening of OS without WBRT in primary therapy of PCNSL.
CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that in PCNSL HDMTX-based chemotherapy followed by WBRT does not significantly increase survival compared to chemotherapy alone. The study lacked the precision to exclude an important survival benefit or harm from WBRT.
First-line treatment and outcome of elderly patients with primary central nervous system lymphoma (PCNSL)-a systematic review and individual patient data meta-analysis.
Ann Oncol. 2015; 26(7):1305-13 [PubMed] Related Publications
PATIENTS AND METHODS: A systematic review of studies about first-line therapy in immunocompetent patients ≥60 years with PCNSL until 2014 and a meta-analysis of individual patient data from eligible studies and international collaborators were carried out.
RESULTS: We identified 20 eligible studies; from 13 studies, we obtained individual data of 405 patients, which were pooled with data of 378 additional patients (N = 783). Median age and Karnofsky Performance Score (KPS) was 68 years (range: 60-90 years) and 60% (range: 10%-100%), respectively. Treatments varied greatly, 573 (73%) patients received high-dose methotrexate (HD-MTX)-based therapy. A total of 276 patients received whole-brain radiotherapy (median 36 Gy, range 28.5-70 Gy). KPS ≥ 70% was the strongest prognostic factor for mortality [hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.41-0.62]. After a median follow-up of 40 months, HD-MTX-based therapy was associated with improved survival (HR 0.70, 95% CI 0.53-0.93). There was no difference between HD-MTX plus oral chemotherapy and more aggressive HD-MTX-based therapies (HR 1.39, 95% CI 0.90-2.15). Radiotherapy was associated with an improved survival, but correlated with an increased risk for neurological side-effects (odds ratio 5.23, 95% CI 2.33-11.74).
CONCLUSIONS: Elderly PCNSL patients benefit from HD-MTX-based therapy, especially if combined with oral alkylating agents. More aggressive HD-MTX protocols do not seem to improve outcome. WBRT may improve outcome, but is associated with increased risk for neurological side-effects. Prospective trials for elderly PCNSL patients are warranted.
Antithrombin III is probably not a suitable biomarker for diagnosis of primary central nervous system lymphoma.
Ann Hematol. 2015; 94(7):1167-74 [PubMed] Article available free on PMC after 01/03/2016 Related Publications
Population-based Incidence and Survival for Primary Central Nervous System Lymphoma in Korea, 1999-2009.
Cancer Res Treat. 2015; [PubMed] Related Publications
Materials and Methods: Using the Korea National Cancer Incidence Database, 1,062 cases of PCNSL newly diagnosed from 1999 to 2009 were analyzed. The crude rate, age-standardized rate (ASR), and annual percent change were calculated. To estimate the observed survival, we restricted the data to between 1999 and 2007 and followed the cases until December 2010. The overall survival was estimated using the Kaplan-Meier method, and piecewise Poisson regression model.
Results: The ASR for PCNSL between 1999 and 2009 was 0.17 per 100,000, and the annual percent change from 1999 to 2009 was 8.8% (p < 0.001). The ASR of males was higher than that of females, and the older groups (60s or over) showed the largest increase in incidence rates. For all ages, the five-year survival from PCNSL was 29.9% between 1999 and 2007. Survival from PCNSL is known to show strong association with age at diagnosis.
Conclusion: These results are similar to those of previous studies. Our findings may be helpful to clinicians and patients in determining long-term prognoses for PCNSL.
[Clinical characteristics and prognosis of 20 cases of primary central nervous system lymphoma].
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2015; 23(1):111-8 [PubMed] Related Publications
METHODS: The clinical and pathological features, diagnosis and treatment, curative efficacy and survival rate of 20 cases of primary central nervous system lymphoma were retrospectivaly analyzed.
RESULTS: The indicated that the clinical manifestations included headache, paralysis, seizures, dizziness and mental acuity, etc. There were 7 cases with single focus of lesion, 13 cases with multiple foci of lesions. The pathologic examimation showed 1 case of peripheral T-cell lymphoma and 19 cases of diffuse large B cell lymphoma, they all were from non-germinal center. Out of 20 cases, 11 cases with Ki-67>75%,6 cases with Ki-67 50%-75%, 2 cases with Ki-67 25%-50% and 1 case with Ki-67 10%. Therapeutic evaluation were as follows: 10 cases with CR, 2 cases with PR, 6 cases with PD in 18 patients recieved treatment. The use of ritusimab in treatment or no use and number of lesion foci in cranium were related to survival time (P < 0.05) . The survival time in group with Ki-67(+)<75% was longer than that in group with Ki-67(+)>75% (P = 0.042). Age and CSF-TP level were related to curative effect (P < 0.05) .
CONCLUTION: There is no specific clinical manifestation. The physical examination and imageological diagnosis of PCNSL, as well as pathological biopsy are necessary for diagnose of PCNSL. The factors for poor prognosis include age > 60 years, CSF-TP > 600 mg/L, multiple lesions and Ki-67(+)>75%. PCNSL has high malignancy and poor prognosis. The chemotherapy based on high dose of MTX (among which MTX combined with rituximab) and HSCT after CR are the best treatment regimen for DLBCL.
Absence of CXCR4 mutations but high incidence of double mutant in CD79A/B and MYD88 in primary central nervous system lymphoma.
Br J Haematol. 2015; 170(2):285-7 [PubMed] Related Publications
Cytomegalovirus meningoencephalitis after rituximab treatment for primary central nervous system lymphoma.
Neurologist. 2015; 19(2):35-7 [PubMed] Related Publications
Epstein-Barr virus-positive diffuse large B-cell primary central nervous system lymphoma associated with organized chronic subdural hematoma: a case report and review of the literature.
Pathol Int. 2015; 65(3):138-43 [PubMed] Related Publications
Oncology scan--primary central nervous system lymphoma.
Int J Radiat Oncol Biol Phys. 2014; 90(4):721-4 [PubMed] Related Publications
R-MPV followed by high-dose chemotherapy with TBC and autologous stem-cell transplant for newly diagnosed primary CNS lymphoma.
Blood. 2015; 125(9):1403-10 [PubMed] Article available free on PMC after 26/02/2016 Related Publications
Erratum: Hyperosmolar and methotrexate therapy avoiding surgery in the acute presentation of primary central nervous system lymphoma: Erratum.
Surg Neurol Int. 2014; 5:165 [PubMed] Article available free on PMC after 26/02/2016 Related Publications
Primary central nervous system lymphoma.
J Neurosci Rural Pract. 2015; 6(1):2-3 [PubMed] Article available free on PMC after 26/02/2016 Related Publications