Abstract
BackgroundSecondary central nervous system lymphoma (SCNSL) is defined as secondary central nervous system (CNS) involvement in patients with systemic lymphoma. It is considered a profoundly adverse complication with inferior clinical outcome. Parenchymal involvement in the CNS in aggressive B-cell lymphoma is not frequently seen and remains a diagnostic dilemma.MethodsIn our study, we retrospectively analyzed the clinical and magnetic resonance imaging (MRI) features of 26 parenchymal SCNSL patients. In addition, we compared MRI features of SCNSL and primary CNS lymphoma (PCNSL) patients after 1:1 propensity score matching. Also we presented two SCNSL cases with atypical MRI appearance.ResultsAmong SCNSL patients, the median CNS relapse time was 3 months, and multiple lesions were found in 76.9% of the cases. In PCNSL, this percentage was 42.3% (p = 0.011). None of the SCNSL patients and 23.1% of the PCNSL patients had solitary infratentorial lesions (p = 0.003).ConclusionsThe majority of parenchymal involvement occurred within the first year of systemic lymphoma, in which mostly cases presenting with multiple and supratentorial locations, unlike what was found in PCNSL.
Highlights
Secondary central nervous system lymphoma (SCNSL) is defined as secondary central nervous system (CNS) involvement in patients with systemic lymphoma
Half of the SCNSL patients (n = 13) were older than 60 years old when diagnosed with systematic aggressive B cell lymphoma
Due to the rarity of parenchymal SCNSL, very few studies have summarized its characteristics on magnetic resonance imaging (MRI)
Summary
Secondary central nervous system lymphoma (SCNSL) is defined as secondary central nervous system (CNS) involvement in patients with systemic lymphoma. It is considered a profoundly adverse complication with inferior clinical outcome. CNS lymphoma (CNSL) is an aggressive brain neoplasm that can involve the brain, meninges, spinal cord, and eyes. Secondary CNS involvement, which affects approximately 5% of patients with DLBCL, is considered a profoundly adverse complication with a SCNSL can be generally divided into three conditions: systemic lymphoma combined with CNS involvement at presentation (combined disease), CNS involvement at the time of systemic relapse or progression (CNS with disease progression) and isolated CNS relapse despite systemic remission (isolated CNS disease) [4, 5]. Despite intrathecal injection and intravenous application of methotrexate for CNS prophylaxis, 5% of systematic DLBCL patients eventually present with involvement in the central nervous system [7]
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