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Revista Medica Del Instituto Mexicano... 2020El linfoma extranodal derivado de células NK/T (LNK/T) es una variedad de linfoma no Hodgkin; el tipo nasal constituye la presentación más común. Nuestro objetivo es...
INTRODUCCIÓN
El linfoma extranodal derivado de células NK/T (LNK/T) es una variedad de linfoma no Hodgkin; el tipo nasal constituye la presentación más común. Nuestro objetivo es presentar un caso de LNK/T con afección del sistema nervioso central (SNC) que simuló una tuberculosis meningea.
CASO CLÍNICO
Varón de 31 años con sensación de obstrucción nasal, cefalea, fiebre, panhipopituitarismo y mononeuropatía craneal múltiple, con lesión hipofisaria por imagen de resonancia magnética y engrosamiento dural, que evolucionó con pancitopenia y úlcera en el paladar blando. El diagnóstico se realizó mediante biopsia de cornete nasal compatible con infiltración por linfoma de estirpe T maduro NK.
CONCLUSIONES
La afección del LNK/T al SNC es una forma rara de presentación. El diagnóstico de LNK/T se puede ver retrasado por la presencia de síntomas heterogéneos. En nuestra población, la infección por Mycobacterium debe ser considerada como diagnóstico diferencial.
BACKGROUND
Lymphoma of NK/T cells (LNK/T) is a variety of non-Hodgkin lymphoma; the nasal type is the most common presentation. The aim of this article is to present a case of LNK/T with affection to central nervous system that imitates meningeal tuberculosis.
CASE REPORT
31 years old man with nasal blockage feeling, headache, fever, panhypopituitarism and multiple cranial mononeuropathy, with a pituitary injury demonstrated by magnetic resonance image and meningeal thickening, that progress with pancytopenia and soft palate ulcer. The diagnosis was made by nasal concha biopsy compatible with lymphoma infiltration, of LNK/T cell linage.
CONCLUSIONS
The affectation of LNK/T cell lymphoma in central nervous system is a rare presentation. the diagnosis could be delayed for the presence of heterogeneous symptoms. Mycobacterium infection must be considered as a differential diagnosis in our population.
PubMed: 34543560
DOI: 10.24875/RMIMSS.M20000079 -
Laboratory Medicine Jul 2022CNS involvement is a complication in hematologic malignant neoplasms. The advantage of multiparametric flow cytometry (MFC) over conventional cytology (CC) in detecting... (Review)
Review
BACKGROUND
CNS involvement is a complication in hematologic malignant neoplasms. The advantage of multiparametric flow cytometry (MFC) over conventional cytology (CC) in detecting occult leptomeningeal disease in CSF has been proven previously, as reported in the literature. In this study, we reviewed the experience of our laboratory in evaluating CSF specimens by MFC and CC after refinement of technical procedures.
METHODS
MFC analysis was performed in 159 specimens. In 91 specimens, simultaneous CC and MFC analysis was requested and results compared.
RESULTS
Neoplastic cells were identified in 27 (17.0%) of the total samples and in 17 (18.7%) of the paired specimens group by MFC, compared with 2 (2.2%) specimens with positive results as determined by CC. MFC enabled identification of malignant cells in low-cellularity specimens (<5 cells/μL) and all neoplasm categories.
CONCLUSION
MFC allowed the detection of minimal numbers of tumor cells in CSF specimens from individuals with leukemia and lymphoma in whom CC had not been able to identify those tumor cells.
Topics: Central Nervous System Neoplasms; Cytodiagnosis; Flow Cytometry; Hematologic Diseases; Humans; Meningeal Neoplasms
PubMed: 35212763
DOI: 10.1093/labmed/lmac004 -
Journal of Veterinary Internal Medicine Mar 2022Lymphoma is the most common spinal cord neoplasm and second most common intracranial tumor in cats, but description of specific magnetic resonance imaging (MRI) features...
BACKGROUND
Lymphoma is the most common spinal cord neoplasm and second most common intracranial tumor in cats, but description of specific magnetic resonance imaging (MRI) features is lacking.
OBJECTIVE
Describe the clinical and MRI features of lymphoma affecting the central (CNS) or peripheral (PNS) nervous system or both in cats.
ANIMALS
Thirty-one cats with confirmed cytological or histopathological diagnosis or both of lymphoma involving the CNS or PNS or both, and MRI findings of the lesions.
METHODS
Multicenter retrospective descriptive study. Signalment and medical information were recorded. Magnetic resonance imaging findings were reviewed by 3 observers following a list of predefined criteria and consensus was sought. Frequency distributions of the different categorical data were reported.
RESULTS
Median duration of clinical signs at time of presentation was 14 days (range, 1-90). Neurological examination was abnormal in 30/31 cats. On MRI, lesions affecting the CNS were diagnosed in 18/31 cats, lesions in both CNS and PNS in 12/31, and lesions in the PNS only in 1/31. Intracranial lesions were diagnosed in 22 cats (extra-axial, 7/22; intra-axial, 2/22; mixed, 13/22), and spinal lesions were diagnosed in 12 (6/12 involving the conus medullaris and lumbosacral plexuses). Infiltration of adjacent extra-neural tissue was present in 11/31 cases. Contrast enhancement was seen in all lesions, being marked in 25/30. Meningeal enhancement was present in all but 2 cases. Several distinct MRI patterns were observed.
CONCLUSIONS AND CLINICAL IMPORTANCE
Nervous system lymphoma in cats has a wide range of MRI features, of which none is pathognomonic. However, together with clinical data and cerebrospinal fluid (CSF) analysis, MRI may provide a strong tentative antemortem diagnosis.
Topics: Animals; Cat Diseases; Cats; Lymphoma; Magnetic Resonance Imaging; Retrospective Studies; Spinal Cord
PubMed: 35048412
DOI: 10.1111/jvim.16350 -
British Journal of Neurosurgery Oct 2023Primary meningeal melanoma is a rare type of melanocytic cancer originating from the melanocytes of the leptomeninges. It commonly presents as a solitary mass, and... (Review)
Review
Primary meningeal melanoma is a rare type of melanocytic cancer originating from the melanocytes of the leptomeninges. It commonly presents as a solitary mass, and multifocal amelanotic lesions were scarcely reported. Diagnosis of multifocal melanoma is particularly challenging, clinically and diagnostically, especially in the absence of cutaneous nevi and melanin pigment. Surgical biopsy result is the gold standard. In this case study, we present an uncommon case of multifocal primary amelanotic meningeal melanomas mimicking lymphomas in the skull base and near the Sylvian fissure, which serves to provide reference value to the clinical diagnosis. Physicians should be aware of the existence of this special type in the clinical work.
Topics: Humans; Melanoma, Amelanotic; Lymphoma; Skin Neoplasms
PubMed: 33054413
DOI: 10.1080/02688697.2020.1834511 -
Veterinary Pathology Jan 2017Primary and secondary nervous system involvement occurs in 4% and 5%-12%, respectively, of all canine non-Hodgkin lymphomas. The recent new classification of canine...
Primary and secondary nervous system involvement occurs in 4% and 5%-12%, respectively, of all canine non-Hodgkin lymphomas. The recent new classification of canine malignant lymphomas, based on the human World Health Organization classification, has been endorsed with international acceptance. This histological and immunocytochemical classification provides a unique opportunity to study the histologic anatomic distribution patterns in the central and peripheral nervous system of these defined lymphoma subtypes. In this study, we studied a cohort of 37 dogs with lymphoma, which at necropsy had either primary (n = 1, 2.7%) or secondary (n = 36; 97.3%) neural involvement. These T- (n = 16; 43.2%) or B-cell (n = 21; 56.8%) lymphomas were further classified into 12 lymphoma subtypes, with predominant subtypes including peripheral T-cell lymphoma (PTCL) or diffuse large B-cell lymphoma (DLBCL), respectively. This systematic study identified 6 different anatomically based histologically defined patterns of lymphoma infiltration in the nervous system of dogs. Different and distinct combinations of anatomical patterns correlated with specific lymphoma subtypes. Lymphoma infiltration within the meningeal, perivascular, and periventricular compartments were characteristic of DLBCL, whereas peripheral nerve involvement was a frequent feature of PTCL. Similarly cell counts above 64 cells/μL in cerebrospinal samples correlated best with marked meningeal and periventricular lymphoma infiltration histologically. Prospective studies are needed in order to confirm the hypothesis that these combinations of histological neuroanatomic patterns reflect targeting of receptors specific for the lymphoma subtypes at these various sites.
Topics: Animals; Dog Diseases; Dogs; Female; Lymphoma; Lymphoma, B-Cell; Lymphoma, T-Cell; Male; Nervous System Neoplasms; Retrospective Studies
PubMed: 27511313
DOI: 10.1177/0300985816658101 -
Indian Journal of Cancer Nov 2019In leptomeningeal metastasis (LM), malignant lung cancer cells reach the sanctuary site of the leptomeningeal space through haematogenous or lymphatic route and thrive... (Review)
Review
In leptomeningeal metastasis (LM), malignant lung cancer cells reach the sanctuary site of the leptomeningeal space through haematogenous or lymphatic route and thrive in the leptomeninges because of restricted access of chemotherapeutic agents across the blood brain barrier. The incidence of LM is 3%-5% in non-small cell lung cancer (NSCLC) patients; the incidence is higher in patients with anaplastic lymphoma kinase (ALK) gene rearrangement or epidermal growth factor receptor (EGFR) mutations. However, the real-world burden of undiagnosed cases may be higher. LM diagnosis is based on clinical, radiological, and cytological testing. Disease management remains a challenge because of low central nervous system penetration of drugs. The prognosis of NSCLC patients with LM is poor with an overall survival (OS) of 3 months with contemporary treatment and <11 months with novel therapies. Therapy goals in this patient population are to improve or stabilize neurologic status, improve quality of life, and prolong survival while limiting the toxicity of chemotherapeutic regimens. We reviewed therapeutic options for management of LM in NSCLC patients with or without genetic mutations. Radiotherapy, systemic, or intrathecal chemotherapy, and personalized molecularly targeted therapy prolong the OS in patients with LM. Newer third generation EGFR-tyrosine kinase inhibitors have considerable brain penetration property and have been vital in increasing the OS especially in patients with EGFR mutations. Sequential or combination therapy third generation EGFR agents with radiotherapy or chemotherapy might be effective in increasing the quality of life and overall survival.
Topics: Blood-Brain Barrier; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Meningeal Carcinomatosis; Prognosis; Protein Kinase Inhibitors
PubMed: 31793437
DOI: 10.4103/ijc.IJC_74_19 -
Oncotarget Jan 2016There is limited data on the impact of specific patient characteristics, tumor subtypes or treatment interventions on survival in breast cancer LM. (Review)
Review
BACKGROUND
There is limited data on the impact of specific patient characteristics, tumor subtypes or treatment interventions on survival in breast cancer LM.
METHODS
A systematic review was conducted to assess the impact of hormone receptor and HER-2 status on survival in breast cancer LM. A search for clinical studies published between 1/1/2007 and 7/1/2012 and all randomized-controlled trials was performed. Survival data from all studies are reported by study design (prospective trials, retrospective cohort studies, case studies).
RESULTS
A total of 36 studies with 851 LM breast cancer subjects were identified. The majority (87%) were treated with intrathecal chemotherapy. Pooled median overall survival ranged from 14.9-18.1 weeks depending on study type. Breast cancer LM survival (15 weeks) was longer than other solid tumor LM 8.3 weeks and lung cancer LM 8.7 weeks, but shorter than LM lymphoma (15.4 versus 24.2 weeks). The impact of hormone receptor and HER-2 status on survival could not be determined.
CONCLUSIONS
A median overall survival of 15 weeks in prospective studies of breast cancer LM provides a historical comparison for future LM breast cancer trials. Other outcomes including the impact of molecular status on survival could not be determined based on available studies.
Topics: Breast Neoplasms; Female; Humans; Meningeal Neoplasms
PubMed: 26543235
DOI: 10.18632/oncotarget.5911 -
Expert Review of Hematology Nov 2016Making the diagnosis of secondary CNS involvement in lymphoma can be difficult due to unspecific signs and symptoms, limited accessibility of brain/myelon parenchyma and... (Review)
Review
Making the diagnosis of secondary CNS involvement in lymphoma can be difficult due to unspecific signs and symptoms, limited accessibility of brain/myelon parenchyma and low sensitivity and/or specifity of imaging and cerebrospinal fluid (CSF) examination currently available. Areas covered: MRI of the total neuroaxis followed by CSF cytomorphology and flow cytometry are methods of choice when CNS lymphoma (CNSL) is suspected. To reduce the numerous pitfalls of these examinations several aspects should be considered. New CSF biomarkers might be of potential diagnostic value. Attempts to standardize response criteria are presented. Expert commentary: Diagnosing CNSL remains challenging. Until diagnostic methods combining high sensitivity with high specifity are routinely introduced, high level of awareness and optimal utilization of examinations currently available are needed to early diagnose this potentially devastating disease.
Topics: Biomarkers; Central Nervous System Neoplasms; Cytodiagnosis; Diagnosis, Differential; Early Detection of Cancer; Humans; Lymphoma; Multimodal Imaging; Outcome Assessment, Health Care; Phenotype; Reproducibility of Results; Sensitivity and Specificity
PubMed: 27677656
DOI: 10.1080/17474086.2016.1242405 -
Pediatric Neurosurgery 2022Following cranial irradiation, there is an increased risk of developing secondary neoplasms, especially meningiomas. Despite childhood cancer survivors who have... (Review)
Review
INTRODUCTION
Following cranial irradiation, there is an increased risk of developing secondary neoplasms, especially meningiomas. Despite childhood cancer survivors who have undergone cranial irradiation having an increased risk of acquiring radiation-induced meningioma (RIM), there is no widely used standard guideline for meningioma screening.
METHODS
At a single institution, we reviewed three adult survivors of childhood cancer who were treated for RIM between 2010 and 2020. We recorded age at diagnosis for the primary lesion, the radiation dose, age at RIM diagnosis, and tumor characteristics including treatment, pathology, and outcome. Two had had T-cell acute lymphocytic leukemia and one a rhabdomyosarcoma. The age of diagnosis of the RIM ranged from 20 to 40 years, with latencies ranging from 18 to 33 years. All lesions were classified as WHO Grade I meningiomas, and only 1 patient had a subsequent recurrence. A literature search identified articles that address RIM: a total of 684 cases were identified in 36 publications.
RESULTS
Mean radiation doses ranged from 1.4 gray to 70 gray. Mean age of diagnosis for secondary meningioma ranged from 8 to 53.4 years old, with latency periods ranging from 2.8 to 44 years. Given variability in the way that investigators have published their results, it is difficult to make a single recommendation for RIM screening. Using our experience and the literature, we devised two different screening protocols and calculated their expense.
CONCLUSIONS
We recommend that data be standardized in a registry to provide greater insight into the clinical and resource allocation questions, especially as long-term survival of children with pediatric cancer into full adulthood becomes more commonplace worldwide.
Topics: Child; Adult; Humans; Adolescent; Young Adult; Middle Aged; Meningioma; Neoplasms, Radiation-Induced; Cranial Irradiation; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Meningeal Neoplasms
PubMed: 36252549
DOI: 10.1159/000527565 -
Current Problems in Diagnostic Radiology 2017Primary central nervous system lymphoma (PCNSL) is an uncommon variant of extranodal non-Hodgkin lymphoma, which involves the brain, leptomeninges, eyes, or spinal cord... (Review)
Review
Primary central nervous system lymphoma (PCNSL) is an uncommon variant of extranodal non-Hodgkin lymphoma, which involves the brain, leptomeninges, eyes, or spinal cord without evidence of systemic disease. In addition to a detailed history and physical examination, the evaluation of patients suspected of having a PCNSL should include a contrast-enhanced magnetic resonance imaging. Occassionaly, PCNSL shows peculiarities on magnetic resonance imaging, which delay the diagnosis and thus the start of treatment. It is essential that radiologists be aware of these less common presentations such as isolated spine or meningeal lymphoma, angiocentric lymphoma, ocular lymphoma, and Epstein-Barr virus-associated lymphoma. Advanced neuroimaging (diffusion and perfusion sequences, spectroscopy-magnetic resonance, and positron emission tomography metabolic imaging) are useful techniques for the differential diagnosis of PCNSL with processes such as brain glioblastoma, multiple sclerosis, and metastases and brain abscesses, especially in atypical presentations. In this article, a review of unusual radiological findings for PCNSL in immunocompetent patients is made, highlighting the usefulness of functional and metabolic imaging for establishing an early presumptive diagnosis, which reduces delays in treatment.
Topics: Central Nervous System Neoplasms; Humans; Lymphoma; Magnetic Resonance Imaging
PubMed: 27475832
DOI: 10.1067/j.cpradiol.2016.04.004