Craniocerebral involvement in lymphoma

Infiltración linfomatosa craneocerebral

Jorge D. Correale^I; David A. Monteverde^I; José A. Bueri^I; Edgardo G. Reich^I; Néstor Lucatelli^II

^IFrom the Division of Neurology - osé Maria Ramos Mejia Hospital, Buenos Aires

^IIDivision of Pathology - José Maria Ramos Mejia Hospital, Buenos Aires

SUMMARY

Nine-hundred-eighty-nine patients with lymphoma were studied. Fifty-three cases (5.3%) had lymphomatous craniocerebral infiltration. The principal factors of risk for this complication were: advanced stage of the lymphoma (III or IV), diffuse histiocytic, diffuse poorly differentiated lymphocytic, or mixed cellularity lymphoma histological type, bone marrow involvement, and previous systemic chemotherapy. Thirty-two per cent of the cases of meningeal lymphomatous infiltration were asymptomatic and represented autopsy findings. CT-scan was an useful test to detect brain focal parenchymatous infiltration, as opposed to meningeal infiltration. Mean survival time in patients with lymphomatous meningeal infiltration was 4.3 months, following the combined use of systemic chemotherapy, radiation therapy and intrathecal methotrexate. Two cases had primary cerebral lymphoma, although without associated immunodeficiency Twenty patients (2%) had intracranial hemorrhage, in clear relationship with platelet alterations. Fifteen patients (1.5%) had CNS infection, caused by common bacteriae or opportunistic agents. In 7 cases, the diagnosis was made at autopsy. Thirty-six autopsies were performed. In 8 cases (22%), pathologic findings such as, demyelination, microcalcificat ons, coagulative necrosis, or gliosis, suggested complications from treatment.

RESUMEN

Fueron estudiados 989 pacientes con linfoma. Tuvieron infiltración linfomatosa craneocerebral 53 casos (5.3%). Los principales factores de riesgo para esta complicación fueron: a. estado avanzado del linfoma (III o IV); b. las formas difusas histiocíticas, difusa pobremente diferenciada o celularidad mixta; c. el compromiso de la medula osea y de la quimioterapia sistêmica previa. En el 32% de los casos la infiltración meníngea linfomatosa fué asintomática y represento hallazgos de autópsia. La tomografía cerebral fué de utilidad para detectar infiltraciones parenquimatosas focales, no así para Ias infiltraciones meníngeas. El tiempo medio de sobrevida en pacientes con infiltración meníngea linfomatosa fué de 4.3 meses, siguientes al uso combinado de terapia radiante a craneo total, quimioterapia sistêmica y/o intratecal con methotrexate. Dos casos con linfoma cerebral primário no estuvieron asociados con inmunodeficiencia. Hemorragias intracraniales se observaron en 20 pacientes (2%), en relaciõn con alteraciones plaquetarias. En 15 casos hubo infección del SNC (1.5%), causada uor bactérias comunes o por agentes oportunistas. En 7 de esos casos el diagnóstico se hizo por autópsia. En 8 de 36 casos autopsiados (22%) se observaron desmielinización, microcalcificaciones, necrosis coagulativa o gliosis, sugestivas de complicaciones por los tratamientos efectuados.

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Dr. David A. Mimteverde - Division Neurologia Hospital José Maria Ramos Mejia . Urquiza 609 - 1221 Buenos Aires - Argentina.

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Craniocerebral involvement in lymphoma

Infiltración linfomatosa craneocerebral

Publication Dates

• Publication in this collection
  26 May 2011
• Date of issue
  Sept 1990