Diagnóstico de neurolinfomatosis como complicación tardía de linfoma no Hodgkin por 18F-FDG PET-CT / Diagnosis of neurolymphomatosis as a late complication of non-Hodgkin lymphoma through 18F-FDG PET-CT

Resumen La neurolinfomatosis (NL) es una condición poco frecuente que se caracteriza por la invasión de células B en los nervios craneales y las raíces nerviosas periféricas y generalmente está vinculada con leucemia o linfoma no Hodking (LNH). En el presente reporte se destacará la importancia de la sospecha diagnóstica en este grupo de pacientes y la importancia de 18F-FDG PET/CT en el diagnóstico diferencial con otras entidades causantes de síntomas similares. Se presenta el caso de una mujer de 63 años con diagnóstico de linfoma difuso de células B grandes, quien, en el tercer ciclo de quimioterapia DA-EPOCH-R, refiere dolor de tipo neuropático en miembro superior derecho, progresivo en severidad y en extensión con compromiso de la extremidad contralateral, convulsiones y parálisis facial periférica.

Abstract Neurolinfomatosis (LN) is a strange condition, defined as Invasion of cranial nerves and peripheral nerve roots by leukemia or lymphoma. Most of the cases are caused by non-Hodgkin's lymphoma of B cells (BHL). The present paper aims to emphasize the importance of suspecting this entity in patients with NHL and neuropathic pain and the role of 18F-FDG PET-CT in the diagnosis. We present the case of a 63-year-old woman diagnosed with diffuse large B-cell lymphoma, who in her third chemotherapy session DA-EPOCH-R of neuropathic pain in the right upper limb, with a poor clinical outcome, due to worsening pain, contralateral limb involvement, seizures and peripheral facial paralysis.

Feline lymphoma in the nervous system: pathological, immunohistochemical, and etiological aspects in 16 cats / Linfoma no sistema nervoso de felinos: aspectos patológicos, imuno-histoquímicos e etiológicos em 16 gatos

The pathological, immunohistochemical (IHC), and etiological features of lymphoma involving the nervous system (NS) in cats were analyzed through a retrospective study (2004-2017) in Rio Grande do Sul State, Brazil. The NS involvement was observed in 16 (12.2%) of 125 felines with lymphoma. Young cats were mainly affected, with a median of 24 months old. Most cases were secondary central NS lymphoma, whereas in three cats, the NS involvement was primary. IHC revealed 14 (87.5%) FeLV-positive, six FIV-positive, and one FeLV/FIV-negative cats. Distribution of feline lymphoma in the NS was 8/16 in the spinal cord, 7/16 in the brain, and 1/16 in the paravertebral nerves and ganglia (neurolymphomatosis). The lymphoma pattern in the spinal cord was exclusively extradural, often focal (6/8), and located in the lumbar (3/6), sacral (1/6), thoracic (1/6), and cervical segments (1/6). Brain neuroanatomical patterns were: leptomeningeal lymphomatosis (4/7), lymphomatous choroiditis (2/7), and intradural lymphoma (1/7). The feline with primary neurolymphomatosis presented a marked thickening of paravertebral nerves and ganglia from the sacral region. B-cell lymphoma (75%) was often diagnosed, and diffuse large B-cell lymphoma (DLBCL) (11/16) was the main subtype. T-cell lymphoma (25%) was less commonly observed and was classified as peripheral T-cell lymphoma (PTCL) (3/16) and T-cell lymphoblastic lymphoma (T-LBL) (1/16).(AU)

Os aspectos patológicos, imuno-histoquímicos (IHQ) e etiológicos do linfoma envolvendo o sistema nervoso de felinos foram analisados através de um estudo retrospectivo (período de 2004-2017) no Estado do Rio Grande do Sul, Brasil. O envolvimento do sistema nervoso foi observado em 16 (12,2%) dos 125 felinos com linfoma desse estudo e afetou principalmente, jovens com idade mediana de 24 meses. A grande maioria dos casos o linfoma era secundário no sistema nervoso central e somente em três gatos o linfoma foi primário do sistema nervoso. Na IHQ, 14 (87,5%) casos foram positivos para FeLV, seis (37,5%) para FIV, e um foi negativo para ambos. A distribuição do linfoma no sistema nervoso foi em 8/16 felinos na medula espinhal, 7/16 no encéfalo e em 1/16 em nervos e gânglios paravertebrais (neurolinfomatose). Na medula espinhal, o padrão do linfoma foi exclusivamente extradural e frequentemente focal (6/8), localizadas nos segmentos lombares (3/6), sacrais (1/6), torácicos (1/6) e cervicais (1/6). No encéfalo, os padrões neuroanatômicos observados foram: linfomatose leptomeningeal (4/7), coroidite linfomatosa (2/7), linfoma intradural (1/7). No felino diagnosticado com neurolinfomatose primária, foi observado acentuado espessamento dos nervos e gânglios paravertebrais da região sacral. Os linfomas de células de células B (75%) foram os mais frequentes e o principal tipo foi o linfoma difuso de grandes células B (11/16). Os linfomas de células T (25%), menos observados, foram classificados como linfomas de células T periférico inespecífico (3/16) e linfoma linfoblástico T (1/16).(AU)

Progress in research on neurolymphomatosis / 中国肿瘤临床

Neurolymphomatosis is a malignant disease that occurs primary or secondary to non-Hodgkin's lymphoma and leukemia. It is mainly caused by lymphoma cells directly infiltrating peripheral nerves, and the incidence is low. The clinical manifestations vary ac-cording to the involved nerves and mainly present as decreased strength in the muscles innervated by the affected plexus/root. It is of-ten misdiagnosed as a polyneuropathy such as Guillain-Barre syndrome or chronic inflammatory demyelinating polyneuropathy. With combined treatment using immunoglobulins or steroids, the symptoms are temporarily improved but the disease still progresses rapid-ly, eventually requiring the attention of a physician. This paper will discuss clinical reports and research on neurolymphomatosis in re-cent years from the aspects of pathogenesis, clinical manifestations, differential diagnosis, diagnostic methods, treatment, and progno-sis, and will provide a theoretical basis for clinical diagnosis and treatment.

Modern techniques of magnetic resonance in the evaluation of primary central nervous system lymphoma: contributions to the diagnosis and differential diagnosis

Abstract In addition to findings from conventional magnetic resonance imaging, modern magnetic resonance imaging techniques have provided important information about tumor metabolism, in vivo metabolite formation, water molecule diffusion, microvascular density, and blood-brain barrier permeability, all of which have improved the in vivo diagnostic accuracy of this method in the evaluation of primary central nervous system lymphoma. These nonconventional magnetic resonance techniques are useful in the clinical practice because they enhance conventional magnetic resonance imaging by reinforcing the possibility of a diagnosis and by allowing the early detection of disease recurrence. This report is a review of the most relevant contributions of nonconventional magnetic resonance techniques to the imaging diagnosis of primary central nervous system lymphoma, the differential diagnosis of this disease, and the prognosis of patients. This paper aims to describe a wide range of presentations of primary central nervous system lymphoma, their appearance in imaging, and the differential diagnoses of this disease.

Neurolymphomatosis Involving Antebrachial Cutaneous Nerve / 대한정형외과학회잡지

The term neurolymphomatosis has included infiltration of the peripheral nervous system by lymphoma. In generally, direct invasion of the peripheral nervous system is rare. The difficulty in treatment of neurolymphomatosis is due to unclassified characteristic symptoms and diagnosis. We performed excision of mass on the antebrachial cutaneous nerve with no specific symptoms. After diagnosis of diffuse large B cell lymphoma, further treatment and observation were followed. However, recurrence of the lymphoma was found in the ipsilateral forearm ulnar nerve, therefore we described a case of neurolymphomatosis with a brief review of the literature.

The Diagnostic Dilemma of Neurolymphomatosis

Neurolymphomatosis (NL) defined as infiltration of the central nervous system or the peripheral nervous system (PNS) by malignant lymphoma cells is a rare clinical entity. However, the increasing use of fluorodeoxyglucose positron-emission tomography (FDG-PET) and magnetic resonance imaging in evaluating PNS disorders is resulting in; this condition being recognized more frequently. Here; we report five NL patients and review the current literature. We report five patients with non-Hodgkin's lymphoma (NHL) and NL, all of whom were men aged 47-69 years. The clinical presentation varied from symmetrical peripheral neuropathy to mononeuropathy. Peripheral neuropathy was the presenting manifestation of a systemic lymphoma in two patients (40%). Neuroimaging as well as whole-body FDG-PET helped in determining the correct diagnosis in all of the patients. NL is an unusual presentation of NHL resulting from infiltration of the PNS by malignant lymphomatous cells. While evaluating peripheral neuropathy, a high degree of suspicion of NL is required since the presenting symptoms vary, conventional radiology has only modest sensitivity, and a pathological diagnosis is often difficult. FDG-PET helps in the early diagnosis and treatment of this condition.

The Diagnostic Dilemma of Neurolymphomatosis

Neurolymphomatosis (NL) defined as infiltration of the central nervous system or the peripheral nervous system (PNS) by malignant lymphoma cells is a rare clinical entity. However, the increasing use of fluorodeoxyglucose positron-emission tomography (FDG-PET) and magnetic resonance imaging in evaluating PNS disorders is resulting in; this condition being recognized more frequently. Here; we report five NL patients and review the current literature. We report five patients with non-Hodgkin's lymphoma (NHL) and NL, all of whom were men aged 47-69 years. The clinical presentation varied from symmetrical peripheral neuropathy to mononeuropathy. Peripheral neuropathy was the presenting manifestation of a systemic lymphoma in two patients (40%). Neuroimaging as well as whole-body FDG-PET helped in determining the correct diagnosis in all of the patients. NL is an unusual presentation of NHL resulting from infiltration of the PNS by malignant lymphomatous cells. While evaluating peripheral neuropathy, a high degree of suspicion of NL is required since the presenting symptoms vary, conventional radiology has only modest sensitivity, and a pathological diagnosis is often difficult. FDG-PET helps in the early diagnosis and treatment of this condition.

Cervical Nerve Root Neurolymphomatosis Detected on F-18 FDG PET/CT / 계명의대학술지

A 65-year-old woman was treated with chemotherapy for diffuse large B-cell lymphoma (DLBCL) after presenting with sharp pain of the left arm. She had complete remission of the DLBCL, and symptoms disappeared. One year after treatment, she developed sharp pain in the first through third fingers that extended to the left arm. F-18 FDG PET/CT showed linear increased FDG uptake along the cervical nerve roots and plexus at the C4-C7 levels, suggesting neurolymphomatosis. Gadolinium-enhanced MRI showed enhancement and enlargement of the cervical nerve root and plexus. Fine needle aspiration biopsy of the left cervical nerve confirmed DLBCL.

Neurolymphomatosis in a patient with T-cell non-Hodgkin's lymphoma / 대한내과학회지

Neurolymphomatosis, defined as a selective infiltration of lymphoma cells into cranial nerves, peripheral nerves and nerve roots, is a rarely recognized manifestation of lymphoma. Its characteristic symptoms are often overlooked or mistaken for other conditions, such as a peripheral polyneuropathy, due to chemotherapeutic agents or clinical findings of metastatic lesions in the central nervous system. Recently, neurolymphomatosis has been increasingly recognized using magnetic resonance imaging and positron emission tomography-computed tomography. We present a case of neurolymphomatosis manifesting as peripheral mononeuropathy in a patient with T-cell non-Hodgkin's lymphoma.

Neurolymphomatosis Involving Sciatic Nerve: A Case Report / 대한정형외과학회잡지

The term "Neurolymphomatosis" includes the infiltration of the peripheral nervous system by lymphoma and nontumor lymphocytes. A neurolymphomatosis has not been classified as a distinct entity. Hence, its characteristic symptoms are often missed, and oncologists or neurological consultants fail to obtain an accurate diagnoses. We encountered a case of non-Hodgkins lymphoma involving the sciatic nerve, which has never been reported in the orthopedic literature in Korea. We report a case of neurolymphomatosis with a brief review of the literature.

A Case of Neurolymphomatosis Involving Cranial Nerve Diagnosed by PET-CT Imaging

Neurolymphomatosis is rare neurologic manifestation, that usually develops in patients with wide spread non-Hodgkin's lymphoma. Cranial neuropathy is an unusual syndrome of neurolymphomatosis that is sometimes difficult to diagnose using conventional imaging modalities. We report a 63 year-old man with non-Hodgkin's lymphoma with progressive multiple cranial nerve palsy. He complained progressive cranial nerve palsy. We performed conventional magnetic resonance imaging and cerebrospinal fluid(CSF) exam. But no any abnormality showed in conventional imaging and CSF study. We report a patient who presented with cranial neuropathy in neurolymphomatosis.

A Case of Neurolymphomatosis Relapsed as Mononeuropathy Multiplex after Hematologic Remission

Neurolymphomatosis, which is defined as a peripheral nerve infiltration of lymphoma, is an infrequent complication of systemic lymphoma and the isolated involvement of the peripheral nerve as a sign of recurrence is very rare. Here, we report a case with neurolymphomatosis presented as a mononeuropathy multiplex and is the first reported case in Korea. With potent chemotherapy, the blood-nerve barrier may have a critical role in the isolated recurrence of lymphoma in the peripheral nervous system.

A Case of Neurolymphomatosis Originated from Nasal Type CD56+ NK/T Cell Lymphoma

10~25% of all cases of lymphoma involves the nervous system. Neurolymphomatosis, one of the complications of lymphoma, is rare clinical disorder with signs of peripheral neuropathy. It is also a rare cause of painful neuropathy and usually presents with sensorimotor polyneuropathy in nerve conduction studies. We report a case of neurolymphomatosis that had originated from a nasal type NK/T cell lymphoma with clinical and electrophysiological evidences of peripheral neuropathy, confirmed by histopathologic evidences of lymphomatous infiltration.