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Inflammatory Demyelinating Brain Lesions Heralding Primary CNS Lymphoma

Published online by Cambridge University Press:  02 December 2014

Leila Husseini ,
Andreas Saleh ,
Guido Reifenberger ,
Hans-Peter Hartung  and
Bernd C. Kieseier
Leila Husseini
Affiliation:
Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany
Andreas Saleh
Affiliation:
Department of Radiology, Heinrich-Heine University, Düsseldorf, Germany
Guido Reifenberger
Affiliation:
Department of Neuropathology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
Hans-Peter Hartung
Affiliation:
Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany
Bernd C. Kieseier*
Affiliation:
Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany
*
Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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Abstract

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Brain biopsy plays a crucial role in the exploration of suspect white matter lesions in the differential diagnosis of primary central nervous system lymphoma (PCNSL) and inflammatory demyelination. We present the case of a previously healthy, immunocompetent woman, aged fifty-nine, who developed a histologically confirmed demyelinating white matter lesion months prior to the manifestation of a PCNSL. Similar cases of “sentinel lesions” preceding a PCNSL have been reported. In a literature review, we compared the diagnostic features that may be useful to differentiate a PCNSL from inflammatory demyelinating disease in older age. We conclude that the occurrence of large, contrast-enhancing cerebral lesions in older patients with a relapsing-remitting disease course and steroid-resistant vision disorders should lead to the consideration of a PCNSL.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 1 , January 2012 , pp. 6 - 10
Copyright
Copyright © The Canadian Journal of Neurological 2012

References

1Raizer, JJ, Koutcher, JA, Abrey, LE, et al.Proton magnetic resonance spectroscopy in immunocompetent patients with primary central nervous system lymphoma. J Neurooncol. 2005;71:173–80.CrossRefGoogle ScholarPubMed
2Alderson, L, Fetell, MR, Sisti, M, Hochberg, F, Cohen, M, Louis, DN.Sentinel lesions of primary CNS lymphoma. J Neurol Neurosurg Psychiatry. 1996;60:102–5.Google Scholar
3Brecher, K, Hochberg, FH, Louis, DN, de la Monte, S, Riskind, P.Case report of unusual leukoencephalopathy preceding primary CNS lymphoma. J Neurol Neurosurg Psychiatry. 1998;65: 917–20.CrossRefGoogle ScholarPubMed
4Kuhlmann, T, Schroter, A, Dechent, P, et al.Diagnosis of a multifocal B cell lymphoma with preceding demyelinating central nervous system lesions by single voxel proton MR spectroscopy. J Neurol Neurosurg Psychiatry. 2001;70:259–62.Google Scholar
5Schultz, CJ, Bovi, J.Current management of primary central nervous system lymphoma. Int J Radiat Oncol Biol Phys. 2010;76: 666–78.Google Scholar
6Kis, B, Rumberg, B, Berlit, P.Clinical characteristics of patients with late-onset multiple sclerosis. J Neurol. 2008;255:697–702.Google Scholar
7Hochberg, FH, Baehring, JM, Hochberg, EP.Primary CNS lymphoma. Nat Clin Pract Neurol. 2007;3:24–35.Google Scholar
8Herrlinger, U.Primary CNS lymphoma: findings outside the brain. J Neurooncol. 1999;43:227–30.CrossRefGoogle ScholarPubMed
9Roos, DE, O’Brien, PC, Crompton, JL.Ocular involvement in primary central nervous system lymphoma: an increasing clinical problem? Australas Radiol. 1993;37:372–4.Google Scholar
10Pels, H, Schlegel, U.Primary central nervous system lymphoma. Curr Treat Options Neurol. 2006;8:346–57.CrossRefGoogle ScholarPubMed
11Chan, CC, Wallace, DJ.Intraocular lymphoma: update on diagnosis and management. Cancer Control. 2004;11:285–95.Google Scholar
12Peterson, K, Gordon, KB, Heinemann, MH, DeAngelis, LM.The clinical spectrum of ocular lymphoma. Cancer. 1993;72:843–9.Google Scholar
13DeAngelis, LM.Primary central nervous system lymphoma. Curr Opin Neurol. 1999;12:687–91.Google Scholar
14Herrlinger, U, Schabet, M, Bitzer, M, Petersen, D, Krauseneck, P.Primary central nervous system lymphoma: from clinical presentation to diagnosis. J Neurooncol. 1999;43:219–26.Google Scholar
15Kuker, W, Nagele, T, Thiel, E, Weller, M, Herrlinger, U.Primary central nervous system lymphomas (PCNSL): MRI response criteria revised. Neurology. 2005;65:1129–31.Google Scholar
16Davie, CA, Hawkins, CP, Barker, GJ, et al.Serial proton magnetic resonance spectroscopy in acute multiple sclerosis lesions. Brain. 1994;117:49–58.Google Scholar
17Barkhof, F, van Walderveen, M.Characterization of tissue damage in multiple sclerosis by nuclear magnetic resonance. Philos Trans R Soc Lond B Biol Sci. 1999;354:1675–86.Google Scholar
18Kuker, W, Nagele, T, Korfel, A, et al.Primary central nervous system lymphomas (PCNSL): MRI features at presentation in 100 patients. J Neurooncol. 2005;72:169–77.Google Scholar
19Deangelis, LM, Iwamoto, FM. An update on therapy of primary central nervous system lymphoma. Hematology Am Soc Hematol Educ Program. 2006:311-16.Google Scholar