DOI QR코드

DOI QR Code

Primary Central Nervous System Lymphoma: A Clinicopathological and Cytomorpholgical Study from A Tertiary Care Centre in Chennai, India

  • Ambroise, M. Moses (Department of Pathology, PIMS, Puducherry, Apollo Speciality Hospital) ;
  • Ghosh, Mitra (Department of Histopathology, Apollo Speciality Hospital) ;
  • Mallikarjuna, V.S. (Department of Histopathology, Apollo Speciality Hospital) ;
  • Annapurneswari, S. (Department of Histopathology, Apollo Speciality Hospital) ;
  • Kurian, Ann (Department of Histopathology, Apollo Speciality Hospital) ;
  • Chakravarthy, Ranjani (Department of Histopathology, Apollo Speciality Hospital)
  • Published : 2013.02.28

Abstract

Background: The aim of this study was to analyze the clinicopathological and immunohistochemical features of primary central nervous system lymphoma (PCNSL) cases occurring in Indian patients and also study the utility of the crush smear preparation in intraoperative diagnosis. Materials and Methods: The immune status, clinical, radiological details, immunohistochemical profile, histopathological findings and cytological features in smear preparation of 32 cases of PCNSL were analyzed. Patients with systemic NHL and skull-base lymphomas were excluded. Results: The mean age of our patients was 52 years with a male: female ratio 1:1. A periventricular location was found in 62.5% of patients. None of our PCNSL cases were associated with AIDS. All cases except one were diffuse large B-cell lymphomas. Intraoperative diagnosis using crush smears allowed correct prediction in 93% of cases. Conclusions: Our study shows that PCNSL is seen predominantly in immunocompetent patients in India. The age of presentation is relatively young as compared to the West. Our study also stresses the utility of crush smear preparation in establishing an intraoperative diagnosis.

Keywords

References

  1. Bataille B, Delwail V, Menet E, et al (2000). Primary intracerebral malignant lymphoma: Report of 248 cases. J Neurosurg, 92, 261-6. https://doi.org/10.3171/jns.2000.92.2.0261
  2. Buhring U, Herrlinger U, Krings T, et al (2001). MRI features of primary central nervous system lymphomas at presentation. Neurology, 57, 393-6. https://doi.org/10.1212/WNL.57.3.393
  3. Bessell EM, Dickinson P, Dickinson S, Salmon J (2011). Increasing age at diagnosis and worsening renal function in patients with primary central nervous system lymphoma. J Neurooncol, 104, 191-3. https://doi.org/10.1007/s11060-010-0457-5
  4. Corn BW, Marcus SM, Topham A, Hauck W, Curran WJ Jr (1997). Will primary central nervous system lymphoma be the most frequent brain tumor diagnosed in the year 2000? Cancer, 79, 2409-13. https://doi.org/10.1002/(SICI)1097-0142(19970615)79:12<2409::AID-CNCR17>3.0.CO;2-V
  5. Choi YL, Suh YL, Kim D, et al (2006). Malignant lymphoma of the central nervous system: difficult histologic diagnosis after glucocorticoid therapy prior to biopsy. Clin Neuropathol, 25, 29-36.
  6. Dolecek TA, Propp JM, Stroup NE ,Kruchko C (2012). CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005-2009. Neuro Oncol, 14, 1-49. https://doi.org/10.1093/neuonc/nor225
  7. Eichler AF, Batchelor TT (2006). Primary central nervous system lymphoma: presentation, diagnosis and staging. Neurosurg Focus, 21, 16.
  8. Fine HA, Mayer RJ (1993). Primary central nervous system lymphoma. Ann Intern Med, 119, 1093-104. https://doi.org/10.7326/0003-4819-119-11-199312010-00007
  9. Fischer L, Martus P, Weller M ,et al (2008). Meningeal dissemination in primary CNS lymphoma: prospective evaluation of 282 patients. Neurology, 71, 1102-8. https://doi.org/10.1212/01.wnl.0000326958.52546.f5
  10. Geppert M, Ostertag CB, Seitz G, Kiessling M (1990). Glucocorticoid therapy obscures the diagnosis of cerebral lymphoma. Acta Neuropathol, 80, 629-34. https://doi.org/10.1007/BF00307631
  11. Goplen AK, Dunlop O, Liestol K, et al (1997). The impact of primary central nervous system lymphoma in AIDS patients: a population-based autopsy study from Oslo. J Acquir Immune Defic Syndr Hum Retrovirol, 14, 351-4. https://doi.org/10.1097/00042560-199704010-00007
  12. Gelabert-Gonzalez M, Castro Bouzas D, Serramito-Garcia R, Frieiro Dantas C, Aran Echabe E (2012). Primary central nervous system lymphoma. Neurologia, June 13 [Epub ahead of print].
  13. Henry JM, Heffner RR Jr, Dillard SH, Earle KM, Davis RL (1974). Primary malignant lymphomas of the central nervous system. Cancer, 34, 1293-302. https://doi.org/10.1002/1097-0142(197410)34:4<1293::AID-CNCR2820340441>3.0.CO;2-P
  14. Hayabuchi N, Shibamoto Y, Onizuka Y, et al (1999). Primary central nervous system lymphoma in Japan: a nationwide survey. Int J Radiat Oncol Biol Phys, 44, 265-72. https://doi.org/10.1016/S0360-3016(98)00564-1
  15. Herrlinger U, Schabet M, Bitzer M, Petersen D, Krauseneck P (1999). Primary central nervous system lymphoma: from clinical presentation to diagnosis. J Neurooncol, 43, 219-26. https://doi.org/10.1023/A:1006298201101
  16. Haldorsen IS, Krakenes J, Goplen AK, et al (2008). AIDS-related primary central nervous system lymphoma: a Norwegian national survey 1989-2003. BMC Cancer, 8, 225 https://doi.org/10.1186/1471-2407-8-225
  17. Haldorsen IS, Krakenes J, Krossnes BK, Mella O, Espeland A (2009). CT and MR imaging features of primary central nervous system lymphoma in Norway, 1989-2003. AJNR Am J Neuroradiol, 30, 744-51. https://doi.org/10.3174/ajnr.A1447
  18. Haldorsen IS, Espeland A, Larsson EM (2011). Central nervous system lymphoma: characteristic findings on traditional and advanced imaging. AJNR Am J Neuroradiol, 32, 984-92. https://doi.org/10.3174/ajnr.A2171
  19. Johnson BA, Fram EK, Johnson PC, Jacobowitz R (1997). The variable MR appearance of primary lymphoma of the central nervous system: comparison with histopathologic features. AJNR Am J Neuroradiol, 18, 563-72.
  20. Koeller KK, Smirniotopoulos JG, Jones RV (1997). Primary central nervous system lymphoma: Radiologic-pathologic correlation. Radiographics, 17, 1497-526. https://doi.org/10.1148/radiographics.17.6.9397461
  21. Kadan-Lottick NS, Skluzacek MC, Gurney JG (2002). Decreasing incidence rates of primary central nervous system lymphoma. Cancer, 95, 193-202. https://doi.org/10.1002/cncr.10643
  22. Kadoch C, Treseler P, Rubenstein JL (2006). Molecular pathogenesis of primary central nervous system lymphoma. Neurosurg Focus, 21, 1.
  23. Loureiro C, Gill PS, Meyer PR, et al (1988). Autopsy findings in AIDS-related lymphoma. Cancer, 62, 735-9. https://doi.org/10.1002/1097-0142(19880815)62:4<735::AID-CNCR2820620416>3.0.CO;2-E
  24. Lanjewar DN, Jain PP, Shetty CR (1998). Profile of central nervous system pathology in patients with AIDS: an autopsy study from India. AIDS, 12, 309-13. https://doi.org/10.1097/00002030-199803000-00009
  25. Newell ME, Hoy JF, Cooper SG, et al (2004). Human immunodeficiency virus-related primary central nervous system lymphoma: factors influencing survival in 111 patients. Cancer, 100, 2627-36. https://doi.org/10.1002/cncr.20300
  26. Olson JE, Janney CA, Rao RD, et al (2002). The continuing increase in the incidence of primary central nervous system non-Hodgkin lymphoma: a surveillance, epidemiology, and end results analysis. Cancer, 95, 1504-10. https://doi.org/10.1002/cncr.10851
  27. Plesec TP, Prayson RA (2007). Frozen section discrepancy in the evaluation of central nervous system tumors. Arch Pathol Lab Med, 131, 1532-40.
  28. Porter AB, Giannini C, Kaufmann T, et al (2008). Primary central nervous system lymphoma can be histologically diagnosed after previous corticosteroid use: a pilot study to determine whether corticosteroids prevent the diagnosis of primary central nervous system lymphoma. Ann Neurol, 63, 662-7. https://doi.org/10.1002/ana.21366
  29. Pasricha S, Gupta A, Gawande J, Trivedi P, Patel D (2011). Primary central nervous system lymphoma: a study of clinicopathological features and trend in western India. Indian J Cancer, 48, 199-203. https://doi.org/10.4103/0019-509X.82890
  30. Schabet M (1999). Epidemiology of primary CNS lymphoma. J Neurooncol, 43, 199-201. https://doi.org/10.1023/A:1006290032052
  31. Satishchandra P, Nalini A, Gourie-Devi M, et al (2000). Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989-96). Indian J Med Res, 111, 14-23.
  32. Sarkar C, Sharma MC, Deb P, et al (2005). Primary central nervous system lymphoma - a hospital based study of incidence and clinicopathological features from India (1980-2003). J Neurooncol, 71, 199-204. https://doi.org/10.1007/s11060-004-1385-z
  33. Shibamoto Y, Ogino H, Suzuki G, et al (2008). Primary central nervous system lymphoma in Japan: changes in clinical features, treatment, and prognosis during 1985-2004. Neuro Oncol, 10, 560-8. https://doi.org/10.1215/15228517-2008-028
  34. Schultz CJ, Bovi J (2010). Current management of primary central nervous system lymphoma. Int J Radiat Oncol Biol Phys, 76, 666-78. https://doi.org/10.1016/j.ijrobp.2009.10.011
  35. Shiels MS, Pfeiffer RM, Hall HI, et al (2011). Proportions of Kaposi sarcoma, selected non-Hodgkin lymphomas, and cervical cancer in the United States occurring in persons with AIDS, 1980-2007. JAMA, 305, 1450-9. https://doi.org/10.1001/jama.2011.396
  36. Sutherland T, Yap K, Liew E, et al (2012). Primary central nervous system lymphoma in immunocompetent patients: a retrospective review of MRI features. J Med Imaging Radiat Oncol, 56 , 295-301. https://doi.org/10.1111/j.1754-9485.2012.02366.x
  37. Tilgner J, Herr M, Ostertag C, Volk B (2005). Validation of intraoperative diagnoses using smear preparations from stereotactic brain biopsies: intraoperative versus final diagnosis- influence of clinical factors. Neurosurgery, 56, 257-65. https://doi.org/10.1227/01.NEU.0000148899.39020.87
  38. Weller M (1999). Glucocorticoid treatment of primary CNS lymphoma. J Neurooncol, 43, 237-9. https://doi.org/10.1023/A:1006254518848
  39. Yeole BB (2008). Trends in the Brain Cancer Incidence in India. Asian Pac J Cancer Prev, 9, 267-70.
  40. Zhang D, Hu LB, Henning TD, et al (2010). MRI findings of primary CNS lymphoma in 26 immunocompetent patients. Korean J Radiol, 11, 269-77. https://doi.org/10.3348/kjr.2010.11.3.269