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BioRxiv : the Preprint Server For... Dec 2023Leptomeningeal disease (LMD) occurs when tumors seed into the leptomeningeal space and cerebrospinal fluid (CSF), leading to severe neurological deterioration and poor...
Leptomeningeal disease (LMD) occurs when tumors seed into the leptomeningeal space and cerebrospinal fluid (CSF), leading to severe neurological deterioration and poor survival outcomes. We utilized comprehensive multi-omics analyses of CSF from patients with lymphoma LMD to demonstrate an immunosuppressive cellular microenvironment and identified dysregulations in proteins and lipids indicating neurodegenerative processes. Strikingly, we found a significant accumulation of toxic branched-chain keto acids (BCKA) in the CSF of patients with LMD. The BCKA accumulation was found to be a pan-cancer occurrence, evident in lymphoma, breast cancer, and melanoma LMD patients. Functionally, BCKA disrupted the viability and function of endogenous T lymphocytes, chimeric antigen receptor (CAR) T cells, neurons, and meningeal cells. Treatment of LMD mice with BCKA-reducing sodium phenylbutyrate significantly improved neurological function, survival outcomes, and efficacy of anti-CD19 CAR T cell therapy. This is the first report of BCKA accumulation in LMD and provides preclinical evidence that targeting these toxic metabolites improves outcomes.
PubMed: 38187773
DOI: 10.1101/2023.12.18.572239 -
Iranian Journal of Microbiology Dec 2023Cryptococcosis, a relatively uncommon infection in cancer patients is often associated with delayed diagnosis and high fatality rate due to its highly heterogeneous and...
Cryptococcosis, a relatively uncommon infection in cancer patients is often associated with delayed diagnosis and high fatality rate due to its highly heterogeneous and protean manifestations. Early recognition and initiation of appropriate antifungal therapy might have a favourable outcome in such cases. Here we report three cases of Cryptococcosis among cancer patients in a tertiary care cancer centre in South India. All three patients were males of different ages at presentation with immunosuppression in the form of solid organ or hematologic malignancy and were using immunosuppressive medications like steroids or chemotherapeutic agents. They presented with cryptococcemia and cryptococcal meningitis. Patients with microbiologically proven cryptococcosis had poor outcome in this subgroup of patients.
PubMed: 38156297
DOI: 10.18502/ijm.v15i6.14163 -
Cancer Reports (Hoboken, N.J.) Jan 2024Lifestyle is associated with meningioma risk in the general population.
BACKGROUND
Lifestyle is associated with meningioma risk in the general population.
AIMS
We assessed longitudinal associations between lifestyle-associated factors and subsequent meningiomas in childhood cancer survivors.
METHODS AND RESULTS
Childhood cancer survivors age ≥18 years in the St. Jude Lifetime Cohort Study were evaluated for body composition, self-reported physical activity, cardiopulmonary fitness, muscle strength, smoking, and alcohol consumption at baseline. Time to first meningioma analyses were performed, adjusted for sex, age at diagnosis and baseline assessment, treatment decade, and childhood cancer treatment exposures. The study included 4,072 survivors (47% female; [mean (SD)] 9 (6) years at diagnosis; 30 (8.5) years at the start of follow-up, with 7.0 (3.3) years of follow-up). 30% of the participants were survivors of acute lymphoblastic leukemia and 29% of the participants had received cranial radiation. During follow-up, 90 participants developed ≥1 meningioma, of whom 73% were survivors of acute lymphoblastic leukemia, with cranial radiation being the strongest risk factor (relative risk [RR] 29.7, 95% confidence interval [CI] 10.6-83.2). Muscle strength assessed by knee extension was associated with a lower risk of developing a meningioma in the adjusted analyses (RR 0.5, 95% CI 0.2-1.0, p = 0.04 for quartiles 3-4 vs. 1). No other lifestyle-associated variable was associated with subsequent meningioma.
CONCLUSION
Independent of cranial radiation, muscle strength was associated with a lower risk of developing a subsequent meningioma in childhood cancer survivors.
Topics: Humans; Child; Female; Adolescent; Male; Meningioma; Cohort Studies; Cancer Survivors; Life Style; Meningeal Neoplasms; Precursor Cell Lymphoblastic Leukemia-Lymphoma
PubMed: 38009808
DOI: 10.1002/cnr2.1944 -
International Journal of Surgery Case... Dec 2023Sphenoid sinuses, air-filled cavities in the sphenoid bone, develop between the 3rd and 4th year and mature by 12 to 16 years. Understanding their anatomy is vital for...
INTRODUCTION
Sphenoid sinuses, air-filled cavities in the sphenoid bone, develop between the 3rd and 4th year and mature by 12 to 16 years. Understanding their anatomy is vital for safe transsphenoidal surgeries because of nearby vital structures. They exhibit variable pneumatization and often have an intersinus septum. This case emphasizes the importance of understanding sphenoid sinus anatomy, particularly in the context of transsphenoidal surgeries. It also introduces a novel case involving a congenital roof defect, previously unreported in medical literature.
CASE PRESENTATION
A 52-year-old male presented with left cheek swelling that progressed to the eyelid, accompanied by low visual acuity, nasal symptoms, and a high temperature. Clinical examination revealed purulent discharge. A CT scan indicated opacity in the left maxillary sinus and a roof defect in the left sphenoid sinus. However, endoscopic surgery revealed the sphenoid sinus to be normal. This indicates that the defect is congenital. A biopsy from the maxillary sinus lesion confirmed lymphoma, and he was sent to the oncology hospital. There was no extension of the maxillary sinus lesion into the sphenoid sinus. This unique case had no history of drainage, taste issues, meningitis, or pituitary surgery.
DISCUSSION
The complete absence of the sphenoid sinus roof is a unique and rare anatomical anomaly with significant implications for surgical procedures. Transsphenoidal surgery, which benefits from endoscopic advancements, provides enhanced visualization but also poses risks due to the proximity to critical structures. Pneumatization of the sphenoid sinus typically reaches maturity during adolescence, with individual variations in extent, Septations, extensions, and asymmetry are common in sphenoid sinus anatomy. This underscores the need for surgeon awareness and adjusted surgical approaches in such rare instances.
CONCLUSIONS
We emphasize the importance of a thorough anatomical understanding through precise radiological study before any sinus surgery due to the possibility of unexpected anatomical abnormalities.
PubMed: 38006739
DOI: 10.1016/j.ijscr.2023.109089 -
Neurology India 2023Acute lymphoblastic leukaemia/lymphoma (ALL) is a systemic disease which primarily involves bone marrow or lymphoid organs. Extranodal presentation of ALL is uncommon,... (Review)
Review
Acute lymphoblastic leukaemia/lymphoma (ALL) is a systemic disease which primarily involves bone marrow or lymphoid organs. Extranodal presentation of ALL is uncommon, and ALL presenting as a dural mass is exceedingly rare. Here we present a case of primary dural B-cell ALL which was preoperatively diagnosed as meningioma on clinico-radiological grounds. A 27-year-old female patient presented with left hemicranial headache for one month's duration along with progressive vision loss of in both eye and altered behaviour. Contrast enhanced magnetic resonance imaging (CE-MRI) suggest dural based mass with dural tail sign. Histopathological examination of the resected specimen revealed B-cell ALL. Further systemic investigations didn't suggest any peripheral blood, bone marrow or lymph node involvement. To the best of our knowledge, only two cases of primary dural ALL have been reported in the literature so far. This report highlights the diagnostic difficulty in extramedullary precursor lymphoid neoplasm.
Topics: Female; Humans; Adult; Meningioma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Lymphoma; Radiography; Meningeal Neoplasms
PubMed: 37929440
DOI: 10.4103/0028-3886.388108 -
Neurology(R) Neuroimmunology &... Nov 2023Persistent impaired immunity is possible even years after B-cell depleting therapies. This may favor the occurrence of infections, including infectious meningitis and...
OBJECTIVES
Persistent impaired immunity is possible even years after B-cell depleting therapies. This may favor the occurrence of infections, including infectious meningitis and encephalitis. In this study, we report a case of chronic enterovirus meningoencephalitis in prolonged B-cell depletion years after rituximab therapy.
METHODS
This is a case report from a German academic hospital. In addition to repeated clinical examinations, repeated brain MRI and extended CSF and laboratory diagnostics were performed. We used the CARE checklist when writing our report.
RESULTS
A 38-year-old man presented with high fever (>40°C), severe headache, and progressive neurologic and cognitive deficits. As result of previous lymphoma therapy with rituximab years ago, prolonged B-cell aplasia was detected. To restore humoral immunity, the patient received repeated infusions of immunoglobulins. In the end, a complete restitution of the physical and mental condition was achieved with the established therapy.
DISCUSSION
This case report should emphasize the importance of assessing humoral immunity even years after B-cell depletion therapy, especially in case of opportunistic infections.
Topics: Male; Humans; Adult; Rituximab; Enterovirus; Enterovirus Infections; Meningoencephalitis; B-Lymphocytes
PubMed: 37813597
DOI: 10.1212/NXI.0000000000200171 -
ACG Case Reports Journal Oct 2023Intestinal T-cell lymphomas are an uncommon type of gastrointestinal malignancy, primarily found in the stomach and small bowel. The liver represents the most common...
Intestinal T-cell lymphomas are an uncommon type of gastrointestinal malignancy, primarily found in the stomach and small bowel. The liver represents the most common distant organ for metastasis in gastrointestinal malignancies, followed by the lungs. Brain and muscular metastases are rare. We present intestinal T-cell lymphoma with a primary site in the sigmoid colon and metastasis to the brain, meninges, and psoas muscle. Biopsy of the malignant mass confirmed intestinal T-cell lymphoma. To our knowledge, this is the first colon T-cell lymphoma with primary brain and meningeal metastasis with another uncommon site of muscular metastasis.
PubMed: 37811364
DOI: 10.14309/crj.0000000000001172 -
Annals of Medicine and Surgery (2012) Oct 2023Cerebral lymphoma is a rare and aggressive brain tumor. It accounts for 1% of all non-Hodgkin's lymphomas (NHL) and 2% of all brain tumors. Untreated brain lymphoma has...
INTRODUCTION
Cerebral lymphoma is a rare and aggressive brain tumor. It accounts for 1% of all non-Hodgkin's lymphomas (NHL) and 2% of all brain tumors. Untreated brain lymphoma has a very poor prognosis, with an overall life expectancy of around 1.5 months.
CASE PRESENTATION
The authors report the case of a 35-year-old patient, with no previous pathological history, who presented for 3 weeks with deafness and recently aggravated otalgia. In MRI, brain imaging revealed a formation initially suggestive of an aggressive meningioma, and the histological study of the operative specimen was in favor of a diffuse large-cell non-germ-center B NHL.
CLINICAL DISCUSSION
Primary central nervous system lymphoma is an extra-nodal NHL localized to the brain, meninges, spinal cord, and eyes. In 90% of cases, these are diffuse large B-cell lymphomas, the other types being poorly characterized low-grade lymphomas, T-cell lymphomas, and Burkitt's lymphomas. MRI with gadolinium contrast is the gold standard for diagnosis which enhancement is homogeneous and well-limited, frequently associated with perilesional vascular edema. In T2-weighted sequences, there is a weak signal with restricted diffusion on diffusion-weighted imaging. The management of brain lymphoma is currently based on chemotherapy with high-dose methotrexate combined with the other agents, mainly rituximab.
CONCLUSION
Cerebral lymphoma remains a non-negligible entity of central nervous system tumors, which can be confused with several other tumors, mainly glial and meningioma.
PubMed: 37811052
DOI: 10.1097/MS9.0000000000001126 -
Heliyon Sep 2023Diffuse large B-cell lymphoma (DLBCL) is a highly aggressive B-lymphocyte-derived malignant proliferative disease that is currently one of the leading causes of death in...
Diffuse large B-cell lymphoma (DLBCL) is a highly aggressive B-lymphocyte-derived malignant proliferative disease that is currently one of the leading causes of death in HIV patients. The incidence of lymphoma in HIV patients is 60-200 times higher than in the general population compared to the non-HIV population, and diffuse large B-cell lymphoma can cause numerous disease manifestations, especially in severely immunocompromised individuals. We treated a case of HIV-associated splenic diffuse large B-cell lymphoma combined with hepatitis C and tuberculous meningitis. In this case, diffuse large B-cell lymphoma of the spleen was difficult to diagnose. Second, simultaneous treatment of multiple diseases requires consideration of drug interactions. Our case highlights the diagnostic value of early tissue biopsy and the importance of avoiding drug interactions during treatment, and the selection of appropriate CART, anti-hepatitis C, and anti-tuberculosis protocols to reduce mortality from diffuse large B-cell lymphoma comorbidification.
PubMed: 37809999
DOI: 10.1016/j.heliyon.2023.e20073 -
Exploration of Targeted Anti-tumor... 2023The aim of this study was to investigate the feasibility of developing a deep learning (DL) algorithm for classifying brain metastases from non-small cell lung cancer...
AIM
The aim of this study was to investigate the feasibility of developing a deep learning (DL) algorithm for classifying brain metastases from non-small cell lung cancer (NSCLC) into epidermal growth factor receptor () mutation and anaplastic lymphoma kinase () rearrangement groups and to compare the accuracy with classification based on semantic features on imaging.
METHODS
Data set of 117 patients was analysed from 2014 to 2018 out of which 33 patients were positive, 43 patients were positive and 41 patients were negative for either mutation. Convolutional neural network (CNN) architecture efficient net was used to study the accuracy of classification using T1 weighted (T1W) magnetic resonance imaging (MRI) sequence, T2 weighted (T2W) MRI sequence, T1W post contrast (T1post) MRI sequence, fluid attenuated inversion recovery (FLAIR) MRI sequences. The dataset was divided into 80% training and 20% testing. The associations between mutation status and semantic features, specifically sex, smoking history, mutation and rearrangement status, extracranial metastasis, performance status and imaging variables of brain metastasis were analysed using descriptive analysis [chi-square test (χ)], univariate and multivariate logistic regression analysis assuming 95% confidence interval (CI).
RESULTS
In this study of 117 patients, the analysis by semantic method showed 79.2% of the patients belonged to positive were non-smokers as compared to double negative groups ( = 0.03). There was a 10-fold increase in positivity as compared to positivity in ring enhancing lesions patients ( = 0.015) and there was also a 6.4-fold increase in positivity as compared to double negative groups in meningeal involvement patients ( = 0.004). Using CNN Efficient Net DL model, the study achieved 76% accuracy in classifying rearrangement and mutations without manual segmentation of metastatic lesions. Analysis of the manually segmented dataset resulted in improved accuracy of 89% through this model.
CONCLUSIONS
Both semantic features and DL model showed comparable accuracy in classifying mutation and rearrangement. Both methods can be clinically used to predict mutation status while biopsy or genetic testing is undertaken.
PubMed: 37745691
DOI: 10.37349/etat.2023.00158