Corticosteroid-associated Changes Resembling a Demyelinating Brain Lesion in Diffuse Large B-cell Lymphoma (DLBCL)
A Case Report
DOI:
https://doi.org/10.21141/PJP.2021.14Keywords:
corticosteroids, demyelination, diffuse large B-cell, lymphomaAbstract
Biopsies of suspected lymphoma cases with history of pre-biopsy corticosteroid therapy present several diagnostic issues, such as the inability to demonstrate the neoplastic hematolymphoid cells, the similarity of post-corticosteroid changes with inflammatory demyelinating lesions, and the possibility of a demyelinating lesion preceding a central nervous system lymphoma. This report presents the case of a 51-year-old immunocompetent male with a solitary callosal mass, with immunomorphologic features suggestive of a demyelinating lesion on initial biopsy, and upon re-biopsy after three months revealed a diffuse large B-cell lymphoma. Awareness of these issues in post-corticosteroid stereotactic biopsy specimens, together with adequate clinical and radiologic data, is important for proper diagnosis and further therapeutic guidance.
Downloads
Download data is not yet available.
References
1. Deckert M, Paulus W, Kluin PM, Ferry JA. Lymphomas. In: Louis DN, Ohgaki H, Wiestier OD, et al. WHO classification of tumours of the central nervous system. Lyon: International Agency for Research on Cancer (IARC); 2016.
2. Paulus W, Perry A. Lymphomas and histiocytic tumors. In: Perry A, Brat DJ. Practical Surgical Neuropathology: A diagnostic approach. Philadelphia: Elsevier; 2010.
3. Deckert M. Lymphomas and Haemopoietic Neoplasms. In: Love S, Perry A, Ironside J, Budka H. Greenfield’s Neuropathology, 9th ed. USA: CRC Press; 2015.
4. Patrij K, Reiser M, Wätzel L, et al. Isolated central nervous system relapse of systemic lymphoma (SCNSL): clinical features and outcome of a retrospective analysis. Ger Med Sci. 2011; 9:Doc11. https://pubmed.ncbi.nlm.nih.gov/21698087. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118693. https://doi.org//10.3205/000134.
5. Gascoyne RD, Campo E, Jaffe ES, et al. Diffuse large B- cell lymphoma, NOS. In: Swerdlow SH, Campo E, Harris NL, et al. WHO classification of tumors of hematopoietic and lymphoid tissues. Lyon: International Agency for Research on Cancer (IARC); 2017.
6. Schmidt RE. White matter and myelin disorders. In: Perry A, Brat DJ. Practical surgical neuropathology: a diagnostic approach. Philadelphia: Elsevier; 2010.
7. Barrantes-Freer A, Engel AS, Rodriguez-Víllagra OA, et al. Diagnostic red flags: steroid-treated malignant CNS lymphoma mimicking autoimmune inflammatory demyelination. Brain Pathol. 2018; 28(2):225-33. https://pubmed.ncbi.nlm.nih.gov/28213912. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028373. https://doi.org/10.1111/bpa.12496.
8. Giannini C, Dogan A, Salomão D. CNS Lymphoma: a practical diagnostic approach. J Neuropathol Exp Neurol. 2014;73(6):478-94.
https://pubmed.ncbi.nlm.nih.gov/24806301. https://doi.org/10.1097/NEN.0000000000000076.
9. Kvarta MD, Sharma D, Castellani RJ, et al. Demyelination as a harbinger of lymphoma: a case report and review of primary central nervous system lymphoma preceded by multifocal sentinel demyelination. BMC Neurol. 2016;16:72. https://pubmed.ncbi.nlm.nih.gov/27206499. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875602. https://doi.org/10.1186/s12883-016-0596-1.
10. Alderson L, Fetell MR, Sisti M, Hochberg F, Cohen M, Louis DN. Sentinel lesions of primary CNS lymphoma. J Neurol Neurosurg Psychiatry. 1996;60(1):102-5.
https://pubmed.ncbi.nlm.nih.gov/8558135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC486201. https://doi.org/10.1136/jnnp.60.1.102.
11. Husseini L, Saleh A, Reifenberger G, Hartung H, Kieseier BC. Inflammatory demyelinating brain lesions heralding primary CNS lymphoma. Can J Neurol Sci. 2012;39(1):6-10. https://pubmed.ncbi.nlm.nih.gov/22384490. https://doi.org/10.1017/s0317167100012610.
12. Brück W, Brunn A, Klapper W, et al. Differential diagnosis of lymphoid infiltrates in the central nervous system: experience of the network lymphomas and lymphomatoid lesions in the nervous system. Pathologe. 2013;34(3):186-97. https://pubmed.ncbi.nlm.nih.gov/23471726. https://doi.org/10.1007/s00292-013-1742-9.
13. Yim E, Umemura Y, Sun Y, Junck L. EPID-27. The vanishing tumor phenomenon in the diagnosis of primary CNS lymphoma. Neuro-Oncol. 2020;22(2):ii84. https://doi.org/10.1093/neuonc/noaa215.345
14. Porter AB, Giannini C, Kaufmann T, et al. Primary central nervous system lymphoma can be histologically diagnosed after previous corticosteroid use: a pilot study to determine whether corticosteroids prevent the diagnosis of primary central nervous system lymphoma. Ann Neurol. 2008;63(5):662-7. https://pubmed.ncbi.nlm.nih.gov/18481293. https://doi.org/10.1002/ana.21366.
15. Önder E, Arikök AT, Önder S, et al. Corticosteroid pre-treated primary CNS lymphoma: a detailed analysis of stereotactic biopsy findings and consideration of interobserver variability. Int J Clin Exp Pathol. 2015;8(7):7798-808. https://pubmed.ncbi.nlm.nih.gov/26339344. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555672..
2. Paulus W, Perry A. Lymphomas and histiocytic tumors. In: Perry A, Brat DJ. Practical Surgical Neuropathology: A diagnostic approach. Philadelphia: Elsevier; 2010.
3. Deckert M. Lymphomas and Haemopoietic Neoplasms. In: Love S, Perry A, Ironside J, Budka H. Greenfield’s Neuropathology, 9th ed. USA: CRC Press; 2015.
4. Patrij K, Reiser M, Wätzel L, et al. Isolated central nervous system relapse of systemic lymphoma (SCNSL): clinical features and outcome of a retrospective analysis. Ger Med Sci. 2011; 9:Doc11. https://pubmed.ncbi.nlm.nih.gov/21698087. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118693. https://doi.org//10.3205/000134.
5. Gascoyne RD, Campo E, Jaffe ES, et al. Diffuse large B- cell lymphoma, NOS. In: Swerdlow SH, Campo E, Harris NL, et al. WHO classification of tumors of hematopoietic and lymphoid tissues. Lyon: International Agency for Research on Cancer (IARC); 2017.
6. Schmidt RE. White matter and myelin disorders. In: Perry A, Brat DJ. Practical surgical neuropathology: a diagnostic approach. Philadelphia: Elsevier; 2010.
7. Barrantes-Freer A, Engel AS, Rodriguez-Víllagra OA, et al. Diagnostic red flags: steroid-treated malignant CNS lymphoma mimicking autoimmune inflammatory demyelination. Brain Pathol. 2018; 28(2):225-33. https://pubmed.ncbi.nlm.nih.gov/28213912. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8028373. https://doi.org/10.1111/bpa.12496.
8. Giannini C, Dogan A, Salomão D. CNS Lymphoma: a practical diagnostic approach. J Neuropathol Exp Neurol. 2014;73(6):478-94.
https://pubmed.ncbi.nlm.nih.gov/24806301. https://doi.org/10.1097/NEN.0000000000000076.
9. Kvarta MD, Sharma D, Castellani RJ, et al. Demyelination as a harbinger of lymphoma: a case report and review of primary central nervous system lymphoma preceded by multifocal sentinel demyelination. BMC Neurol. 2016;16:72. https://pubmed.ncbi.nlm.nih.gov/27206499. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4875602. https://doi.org/10.1186/s12883-016-0596-1.
10. Alderson L, Fetell MR, Sisti M, Hochberg F, Cohen M, Louis DN. Sentinel lesions of primary CNS lymphoma. J Neurol Neurosurg Psychiatry. 1996;60(1):102-5.
https://pubmed.ncbi.nlm.nih.gov/8558135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC486201. https://doi.org/10.1136/jnnp.60.1.102.
11. Husseini L, Saleh A, Reifenberger G, Hartung H, Kieseier BC. Inflammatory demyelinating brain lesions heralding primary CNS lymphoma. Can J Neurol Sci. 2012;39(1):6-10. https://pubmed.ncbi.nlm.nih.gov/22384490. https://doi.org/10.1017/s0317167100012610.
12. Brück W, Brunn A, Klapper W, et al. Differential diagnosis of lymphoid infiltrates in the central nervous system: experience of the network lymphomas and lymphomatoid lesions in the nervous system. Pathologe. 2013;34(3):186-97. https://pubmed.ncbi.nlm.nih.gov/23471726. https://doi.org/10.1007/s00292-013-1742-9.
13. Yim E, Umemura Y, Sun Y, Junck L. EPID-27. The vanishing tumor phenomenon in the diagnosis of primary CNS lymphoma. Neuro-Oncol. 2020;22(2):ii84. https://doi.org/10.1093/neuonc/noaa215.345
14. Porter AB, Giannini C, Kaufmann T, et al. Primary central nervous system lymphoma can be histologically diagnosed after previous corticosteroid use: a pilot study to determine whether corticosteroids prevent the diagnosis of primary central nervous system lymphoma. Ann Neurol. 2008;63(5):662-7. https://pubmed.ncbi.nlm.nih.gov/18481293. https://doi.org/10.1002/ana.21366.
15. Önder E, Arikök AT, Önder S, et al. Corticosteroid pre-treated primary CNS lymphoma: a detailed analysis of stereotactic biopsy findings and consideration of interobserver variability. Int J Clin Exp Pathol. 2015;8(7):7798-808. https://pubmed.ncbi.nlm.nih.gov/26339344. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555672..
Published
09/07/2021
How to Cite
de la Cruz, G. E., & Uy, J. A. (2021). Corticosteroid-associated Changes Resembling a Demyelinating Brain Lesion in Diffuse Large B-cell Lymphoma (DLBCL): A Case Report. PJP, 6(2), 41–46. https://doi.org/10.21141/PJP.2021.14
Issue
Section
Case Reports
License
The Philippine Journal of Pathology is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Based on works made open access at http://philippinejournalofpathology.org
@philippinepathologyjournal