Involvement of the central nervous system in non-Hodgkin's lymphoma.
Fifteen of 146 (10%) adult patients with non-Hodgkin's lymphoma showed clinical and pathologic evidence of involvement of the central nervous system (CNS): in 6 patients, the CNS lymphoma was present at the onset of disease, in 3 of them it was the only sign detected. In the remaining 9 cases, CNS involvement appeared during the course of systemic disease. In all cases symptoms related to infiltration of the CNS were associated with advanced disease (stage IV); bone marrow or bone involvement was found in 9 patients (60%). The histologic subtypes were mostly of high-grade malignancy according to the Kiel classification: immunoblastic (3), centroblastic (3), Burkitt type (2), lymphoblastic (1), LP immunocytoma in polymorphic variant (3), unclassifiable (3). The prominent signs and symptoms of CNS lymphoma are listed: the cranial nerve palsies are the most common finding. The principal means of detecting CNS involvement are discussed: cerebrospinal fluid cytology, brain scan and CAT scan were the most useful diagnostic procedures. The reported data allow identification of patients at high risk of CNS lymphoma: this includes histologies of high-grade malignancy, advanced stage of disease, and bone marrow or bone infiltration. Therefore, either intensive systemic chemotherapy or CNS prophylaxis are recommended for patients with high risk of CNS disease.
D000328:Adult; D000368:Aged; D001855:Bone Marrow Diseases / Q000209:etiology; D001859:Bone Neoplasms / Q000556:secondary; D001932:Brain Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D002648:Child; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*