2005, Number 6
<< Back Next >>
Gac Med Mex 2005; 141 (6)
Primary central nervous system lymphoma in immunocompetent patients.
Guinto-Balanzar G, Félix-Espinoza I, De Anda PS, Aréchiga-Ramos NC, Arteaga-Larios V, Kovacs K
Language: Spanish
References: 42
Page: 469-476
PDF size: 127.95 Kb.
ABSTRACT
Primary central nervous system lymphoma has been traditionally described in patients with immunodeficiency syndromes; however, there is an increasing number of immunocompetent patients with this type of tumor that have been reported recently.
In this paper we have retrospectively analyzed 22 immunocompetent patients with a confirmed diagnosis of primary lymphoma of the brain. The mean age in this group was 65 years with a similar male/female ratio. The time of evolution of the clinical course was 80.4 days and it was mainly characterized by headache and focal neurological deficit. In four patients multiple lesions were observed, while the remaining presented single lesions mainly located in the periventricular area of the cerebral hemispheres. All patients were initially administered steroids and a stereotactic biopsy was performed. The majority of tumors were histologically classified as diffuse large cells and all of them showed a positive reaction to B-cells antigens on immunohistochemistry. All patients were treated with radiotherapy and in 10 of them, chemotherapy with methotrexate was also indicated. The mean survival rate was 11 months among patients treated with radiotherapy alone and increased to 36 months when chemotherapy was added.
REFERENCES
Bailey P. Intracranial sarcomatous tumors of leptomeningeal origin Arch Surg 1929;18:1359-1402.
2. Henry JM, Heffiner RRJ, Drillard SH Earle KM, Davis RL. Primary malignant lymphomas of the central nervous system. Cancer 1974;34:1293-1302.
3. Guinto G, Félix I, Aréchiga N, Arteaga V, Kovacs K. Primary central nervous system lymphomas in immunocompetent patients. Histol Histopathol 2004;19:963-972.
4. DeAngelis LM. Primary central nervous system lymphoma. J Neurol Neurosurg Psychiatry 1999;66:699-701.
5. Postler E, Bornemann A, Skalej M, Krober S, Kaiserling E, Wickboldt J, Meyermann R. Intracranial inflammatory tumors: a survey of their various etiologies by presentation of 5 cases. J Neurooncol 1999;43:209-217.
6. Paulus W, Jellinger K, Morgello S, Dekert-Schlüter. Malignant lymphomas. En: Pathology and genetics of tumours of the nervous system. Kleihves P, Cavenee WK (Eds). International Agency for Reserch on Cancer. Lyon, France 2000. p. 198-203.
7. Basso U, Brandes A. Diagnostic advances and new trend of the treatment of primary central nervous system lymphoma. Eur J Cancer 2002;38:1298-1312.
8. Kadan-Lottick NS, Skluzacek MC, Gurney JG. Decreasing incidence rates of primary central nervous system lymphpma. Cancer 2002;95:193-202.
9. Bataille B, Delwail V, Menet E, Vandermarcq P, Ingrand P, Wager M, Guy G, Lapierre F. Primary intracerebral malignant lymphoma: report of 248 cases. J Neurosurg 2000;92:261-266.
Geddes JF, Bhattacharjee MB, Savage K, Scaravalli F, McLaughlin JE. Primary cerebral lymphoma: a study of 47 cases probed for Epstein-Barr virus genome. J Clin Pathol 1992;45: 587-590.
Chang KL, Flaris N, Hickey WF, Johnson RM, Meyer JS, Weiss LM. Brain lymphomas of immunocompetent and immunocompromised patients: study of the association with Epstein-Barr virus. Mod Pathol 1993;6:427-432.
Remick SC, Diamond C, Migliozzi JA, Solis O, Wagner H, Haase RF, et al. Primary central nervous system lymphoma in patients with and without acquired immune deficiency syndrome. A retrospective analysis and review of the literature. Medicine (Baltimore) 1990;69:345-360.
Jellinger KA, Paulus W. Primary central nervous system lymphomas-an update. J Cancer Res Clin Oncol 1992;119:7-27.
Adams J, Howatson AG. Cerebral lymphomas: review of 70 cases. J Clin Pathol 1990;43:544-547.
O'Neill BP, Kelly PJ, Earle JD, Scheithauer B, Banks PM. Computer assisted stereotaxic biopsy for the diagnosis of primary central nervous system lymphoma. Neurology 1987;37:1160-1164.
Ashby MA, Bowen D, Bleehen NM, Barber PC, Freer CE. Primary lymphoma of the central nervous system: experience at Addenbrooke's Hospital, Cambridge. Clin Radiol 1988;39:173-181.
Kepes JJ. Astrocytomas: old and newly recognized variants, their spectrum and morphology and antigen expression. Can J Neurol Sci 1987;14:109-121.
Murray K, Kun L, Cox J. Primary malignant lymphoma of the central nervous system. Results of treatment of 11 cases and review of the literature. J Neurosurg 1986;65:600-607.
O'Niell BP, Illig JJ. Primary central nervous system lymphoma. Mayo Clin Proc 1989; 64: 1005-1020.
Nelson DF, Martz KL, Bonner H, Nelson JS, Newall J, Kerman HD, et al. Non-Hodgkin's lymphoma of the brain: can high dose, large volume irradiation therapy improve survival? Report on a prospective trial by the Radiation Therapy Oncology Group (RTOG): RTOG 8315. Int J Radiat Oncol Biol Phys 1992;23:9-17.
Blay JY, Ongolo-Zogo C, Sebban C, Thiesse P, Biron P. Primary cerebral lymphomas: unsolved issues regarding first line treatment, follow-up, late neurological toxicity and treatment of relapses. Ann Oncol 2000;11:39-44.
DeAngelis LM, Yahalom J, Thaler HT, Kher U. Combined modality therapy for primary CNS lymphoma. J Clin Oncol 1992;10:635-643.
Abrey LE, DeAngelis LM, Yahalom J. Long-term survival in primary CNS lymphoma. J Clin Oncol 1998;16:859-863.
Blay JY, Conroy T, Chevreau C, Thyss A, Quesnel N, Eghbali H, et al. High dose methotrexate for the treatment of primary central nervous system lymphomas: analysis of survival and late neurological toxicity in a retrospective series. J Clin Oncol 1998;16:864-871.
Nasir S, DeAngelis LM. Update on the management of primary CNS lymphoma. Oncology (Williston Park) 2000;14:228-234.
Karnofsky DA, Abelman WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma with particular reference to bronchogenic carcinoma. Cancer 1948;1:634-656.
Harris Nl, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML,et al. A revised European-American Classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood 1994; 84:1361-1392.
Tomlinson FH, Kurtin PJ, Suman VJ, Scheithauer BW, O'Fallon JR, Kelly PJ, et al. Primary intracerebral malignant lymphoma: a clinicopathological study of 89 patients. J Neurosurg 1995;82:558-566.
Hayabuchi N, Shibamoto Y, Onizuka Y. Primary central nervous system lymphoma in Japan: a nationwide survey. Int J Radiat Oncol Biol Phys 1999;44:265-272.
Pirotte B, Levevier M, Golmann S, Brucher JM, Brotchi J, Hildebrand J. Glucocorticoid-induced long term remission in primary cerebral lymphoma: case report and review of the literature. J Neurooncol 1997;32:63-69.
Filla A, De Michele G, D'Armiento FP, Di Salle F, Cirillo S, Marano E, et al. Steroid-induced disappearance of primary central nervous system lymphoma. Clinical, neuroradiological and pathological findings. Acta Neurol (Napoli) 1989;11:400-407.
Bühring U, Herrlinger U, Krings T, Thiex R, Weller M, Küker W. MRI features of primary central nervous system lymphomas at presentation. Neurology 2001;57:393-396.
Namasivayam J, Teasdale E. The prognostic importance of CT features in primary intracranial lymphoma. Br J Radiol 1992;65:761-765.
Kim DG, Nam DH, Jung HW, Choi KS, Han DH. Primary central nervous system lymphoma: variety of clinical manifestations and survival. Acta Neurochir (Wien) 1996;138:280-289.
Ferreri AJ, Blay JY, Reni M, Pasini F, Spina M, Ambrosetti A, et al. Prognostic scoring system for primary CNS lymphomas: the International Extranodal Lymphoma Study Group experience. J Clin Oncol 2003;15:266-272.
Balmaceda C, Gaynor JJ, Sun M, Gluck JT, DeAngelis LM. Leptomeningeal tumor in primary central nervous system lymphoma: recognition, significance and implications. Ann Neurol 1995;38:202-209.
Watanabe M, Tanaka R, Takeda N, Wakabayashy K, Takahashi H. Correlation of computed tomography with the histology of primary malignant lymphoma of the brain. Neuroradiology 1992;34:36-42.
Johnson BA, Fram EK, Johnson PC, Jacobowitz R. The variable MR appearance of primary lymphoma of the central nervous system: comparison with histopathologic features. Am J Neuroradiol 1997;18:563-572.
Erdag N, Bhorade RM, Alberico RA, Yousuf N, Patel MR. Primary lymphoma of the central nervous system: Typical and atypical CT and MR imaging appearances. Am J Roentgenol 2001;176:1319-1326.
Paulus W, Jellinger K. Comparison of integrin adhesion molecules expressed by primary brain lymphomas and nodal lymphomas. Acta Neuropathol (Berl)1993;86:360-364.
Murphy JK, O'Brien CJ, Ironside JW. Morphologic and immunophenotypic characterization of primary brain lymphomas using paraffin-embedded tissue. Histopathology 1989;15:449-460.
McCue MP, Sandrock AW, Lee JM, Harris NL, Hedley-Whyte ET. Primary T-cell lymphoma of the brainstem. Neurology 1993;43:377-381.