The Clinical, Histopathological and Imaging Methods Characteristics of Non‑ Hodgkin Lymphomas in Patients with Brain Involvement

Česká verzia

Authors: S. Vokurka ¹; R. Tupý ²; L. Boudová ³; J. Mraček ⁴; P. Jindra ¹; J. Ferda ² ; M. Hrabětová ¹
Authors place of work: Hematologicko‑onkologické oddělení LF UK a FN Plzeň ¹; Klinika zobrazovacích metod LF UK a FN Plzeň ²; Patologicko‑anatomický ústav LF UK a FN Plzeň ³; Neurochirurgické oddělení LF UK a FN Plzeň ⁴
Published in the journal: Klin Onkol 2013; 26(5): 348-353
Category: Original Articles

Summary

Background:
The Non‑ Hodgkin‑lymphoma (NHL) brain infiltration carries a poor prognosis. Because of relatively rare incidence, we decided to share our experience.

Patients and Methods:
Retrospective analysis of patients with NHL brain infiltration diagnosed in 2001– 2011 at our university hospital.

Results:
Twenty‑ seven patients with median age of 61 (range 42– 82) years were analyzed. The primary diffuse large cell B‑ cell lymphoma of CNS was defined in 22/ 27 (81%) patients, in the others systemic NHL was present. Median positivity of the proliferative marker Ki‑ 67 was 80%, the number of NHL lesions 1 (1– 8), diameter 28 × 30 × 29 (11 × 16 × 20 to 85 × 76 × 65) mm. The fundamental finding in brain lymphoma MRI imaging was lesion with predominantly homogenous contrast enhancement, diffusion restriction and collateral edema. Thirteen out of 27 (48%) patients underwent lumbar puncture, and lymphoma presence in fluid was detected in only two of them. The most frequent symptoms were limb paresis or hemiparesis (55%), bradypsichysm (22%), expressive aphasia (22%), cephalea (18%). Corticosteroid therapy, as a primary treatment option, was indicated in 15% of patients with a median overall survival of one month, CNS radiotherapy in 37% with a median survival of three months, and chemotherapy in 48% patients with a median overall survival 10 (2– 45) months.

Conclusion:
The brain lymphomas are rare and prognostically very unfavorable affection. When specifying brain focal lesions on MRI, it is necessary to consider this etiology and to elect imaging protocols with contrast agents and diffusion weighted sequence. Biopsy should be performed prior to start of corticosteroid therapy. Intensive chemotherapy or radiotherapy indication must be individually considered, and proposed treatment should be initiated immediately with a potential for somewhat prolonged survival.

Key words:
lymphoma – brain – magnetic resonance imaging – neurosurgical procedures – cranial irradiation – chemotherapy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Submitted:
29. 2. 2013

Accepted:
11. 7. 2013

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