Lymphomas
Systemic Lymphoma
Metastasis to CNS much more common with non-Hodgkin lymphoma (NHL) than with Hodgkin disease.
Nervous system sites involved in NHL: meninges (10%), epidural space (3% to 5%), brain (<1%, vs. primary CNS lymphoma, where >90% have brain parenchyma tumor).
Factors predisposing to CNS involvement: older age, bone marrow or retroperitoneal involvement, high serum lactic dehydrogenase (LDH).
Meningeal Lymphoma
4% to 11% of patients with NHL.
Clinical features: headache, nausea, vomiting, back pain, confusion, behavioral changes, cranial nerve palsies (commonly 3rd, 6th, 7th), limb weakness, sensory changes.
Diagnosis: MRI; CSF with lymphoma cells or elevated β2 microglobulin (tumor marker).
Treatment and prognosis: focal radiotherapy and intrathecal chemotherapy. Median survival 4 months; highly variable.
Epidural Spinal Cord Compression
5% of NHL patients. Usually direct extension from vertebral body metastases. Thoracic cord most common site; 5–10% have multifocal epidural tumor so entire spine should be imaged (noncontrast MRI sufficient).
Treatment: focal radiotherapy.
Primary CNS Lymphoma
Immunocompetent Patients
Epidemiology
3% of all intracranial neoplasms, 7% of all malignant lymphomas. Incidence rising in people >60, peak incidence age 40 to 60; M:F ratio 3:2.
Clinical Features
Behavioral changes and lateralizing symptoms (hemiparesis, aphasia, visual field deficits) common. Occasionally: seizures, ataxia, cranial nerve palsies. 20% have ocular disease (blurred vision, floaters, visual loss due to retinal detachment).
Diagnosis
CT or MRI: single or multiple contrast-enhancing lesions with mild to moderate surrounding edema. (In immunocompetent patients, ring enhancement, calcification, hemorrhage rare). Typically periventricular, often frontal. Small number of patients have leptomeningeal disease only. Differential diagnosis: high-grade gliomas, metastasis, abscess, sarcoid, TB, active demyelination.Related posts:
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