Primary central nervous system lymphoma: prognostication as per international extranodal lymphoma study group score and reactive CD3 collar.
BACKGROUND
Primary central nervous system (CNS) lymphoma is being increasingly recognized in immunosuppressed as well as immunocompetent individuals. It has a poor prognosis and the majority of these have diffuse large B-cell type of morphology.


OBJECTIVE
To categorize cases of primary CNS lymphoma according to the International Extranodal Lymphoma Study Group (IELSG) score and to correlate the score with reactive CD3 collar around blood vessels and necrosis.


METHODS
We reviewed the clinico-pathological, morphological and immuno-histochemical features of 30 cases of primary CNS lymphoma reported at our institute in the last nine years and categorized them according to the score given by IELSG.


RESULTS
All our cases were HIV-negative and had diffuse large cell histology. Twenty-seven of the 30 cases were associated with poor prognostic factors of intermediate to high risk according to the IELSG score. Reactive CD3 collar around the blood vessels was seen in seven cases which had low to intermediate IELSG score. However, no significant statistical difference of perivascular reactive CD3 collar and necrosis was seen with IELSG score.


CONCLUSIONS
Approximately 90% (27 cases) were associated with poor prognostic factors in the present study according to the IELSG score. Perivascular reactive CD3 collar was seen in cases with low to intermediate IELSG score. A larger study is required to further validate that the presence of reactive perivascular CD3 collar is associated with good prognosis. This histological marker could be supplemented with IELSG score to stratify the patients of primary CNS lymphoma according to their aggressiveness.
Kumari
N
N
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Krishnani
N
N
Rawat
A
A
Agarwal
V
V
Lal
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001402:B-Lymphocytes / Q000276:immunology / Q000473:pathology*; D014408:Biomarkers, Tumor / Q000378:metabolism; D017252:CD3 Complex / Q000276:immunology; D016543:Central Nervous System Neoplasms / Q000276:immunology / Q000473:pathology*; D005260:Female; D006801:Humans; D007194:India; D008223:Lymphoma / Q000276:immunology / Q000473:pathology*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
D014408:Biomarkers, Tumor; D017252:CD3 Complex