Lesions of the Central Nervous System in Leukemia: Pathologic and Magnetic Resonance Imaging (MRI) Features in 14 Patients

Abstract

Lesions of the central nervous system (CNS) were seen during and after treatment of leukemia. We aimed to characterize the specific pathology and MRI findings observed in leukemia patients with CNS lesions and to determine their value in the management of such patients. The data from stereotactic biopsy for pathology (12 patients) and MRI examinations (14 patients) were retrospectively evaluated. Factors that predisposed to the lesions of CNS were reviewed from the medical records. Among the 14 patients, 4 had a CNS infection, 2 had a neurodegenerative disorder, 8 had CNS leukemia. The clinical diagnosis based on clinical presentation and MRI features was not consistent with the pathological diagnosis in 2 patients: in one patient, the clinical diagnosis was a CNS infection, though the patient's pathological diagnosis was CNS leukemia; in the other patient, the clinical diagnosis was CNS leukemia, but the pathological diagnosis was glial cell hyperplasia. CNS lesions in leukemia have a wide range of causes. Apart from the relapse of leukemia in CNS, there are treatment related neurotoxicities and infections that are caused by immunocompromised states. Stereotactic biopsy for pathological confirmation has the advantages of minimal invasion and convenience, which remains the gold standard for diagnosing the nature of CNS lesions. Because many CNS lesions of leukemia are treatable, early correctly diagnosis is essential.Table 1Medical records of 14 leukemia patients with CNS lesionscaseAge, y /SexLeukemia typeA/I*Clinical presentationMRI findingsclinical diagnosisStereotactic biopsy for pathology diagnosisOutcome115/MAML (M5)14/3 d after CyclosporinSeizureMRI: The left occipital lobe, right frontal lobe low-density lesions with enhancement of capsule wall.InfectionFungal brain abscessesImproved238/MAML34/9 mo after allo-HSCTFeverMRI: Scattered lesions at the right frontal lobe. Short T1, long T2 signal.InfectionNot performedImproved320/MALL20/during 2nd course of chemoHeadache, limb ticMRI: Bilateral cerebral hemisphere cortex multiple long T1 and T2 signal nodular lesions.InfectionFungal brain abscessesImproved454/MAPL53/2 mo after Retinoic acidHeadache, limb numb, seizureMRI: Bilateral posterior parietal lobe showing patchy enhancement.LeukemiaLeukemiaImproved57/MALL (B cell)7/during the chemoHeadacheMRI: a cystic lesion in the right temporal lobe and cerebellum obvious edema.InfectionLeukemiaProgressed626/FAML (M4)25/during 4th course of chemoFever, ticMRI: Mixed signals at the left frontotemporal top border zone.InfectionBrain abscessesImproved725/MALL (T cell)21/3 y after immuno-suppressive agentHeadache, limb weaknessMRI: Mixed signals at right hemisphere, perilesional mild enhancement.LeukemiaT cell leukemia/lymphomaImproved816/MALL (T cell)16/ at the diagnosis of leukemiaHeadache, blurred visionMRI: Scattered, abnormal signal of sizes at the cerebellum.LeukemiaNot performedProgressed949/MALL (B cell)49/1 mo after chemononeMRI: Glial cell proliferation around lesion at right parietal lobe.LeukemiaGlial cell hyperplasiaImproved1060/MCMML57/4 y after allo-HSCTNausea, right limb weaknessMRI: a 2.5×2 cm2 lesion in left basal ganglia.LeukemiaChronic myelomonocytic leukemiaDied1126/MALL (B cell)20/9 mo after last course of chemoHeadacheMRI: lesions at the left temporal lobe, perilesional with obvious edema.LeukemiaB cell leukemia/lymphomaImproved1229/FAML (M5b)27/1 mo after last course of chemononeMRI: Bilateral cerebellum, left occipital lobe abnormal signal enhanced on T1 with Gd.LeukemiaLeukemiaImproved1342/MALL41/3 mo after allo-HSCTDizziness, Walking instabilityMRI: The left cerebellar hemisphere visible nodular enhancement lesions.LeukemiaLeukemiaImproved1423/FALL (B cell)23/1 mo after allo-ASCTheadacheMRI: The right paracele white matter lesions visible long T1, long T2 signal, the boundary is not clear, edema is not obvious, no enhancemen.Degenerative diseaseNerve cell degenerationImproved*A, the age when the diagnosis was made for leukemia.I, the interval between the last treatment and the onset of neurological symptoms. [Display omitted] [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.