Primary intracerebral malignant lymphoma: a clinicopathological study of 89 patients

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✓ The authors report on a clinicopathological study of 89 surgical patients with histologically proven primary parenchymal brain lymphoma, all diagnosed between January 1975 and December 1990. The cohort included 60 men and 29 women whose median age at diagnosis was 60 years (range 14 to 84 years). The duration of symptoms was less than 8 weeks in 48% of the patients. Symptom groups included focal neurological deficit (73%), neuropsychiatric symptoms (28%), seizures (9%), and increased intracranial pressure (3%). A total of 132 tumors were seen in 89 patients: the most common sites were frontal (32 patients), temporoparietal (31 patients), and basal ganglia (17 patients); multiple lesions were reported in 23 patients. No patient had antecedent of human immunodeficiency virus positivity or acquired immunodeficiency syndrome. A family history of cancer was present in 33% of the patients, three-quarters of whom were first-degree relatives. Histological subtypes (National Cancer Institute Working Formulation) included 64 large cell (72%) and 13 immunoblastic (15%) tumors. Phenotype was determined in 66 patients: 63 were B-cell type and three were T-cell type. Surgical resection was performed in 47% of the cases, with the remainder undergoing biopsy only. All but six patients received radiation therapy. Thirty-one patients received chemotherapy, whereas 46 patients did not; data on the remaining 12 patients were unavailable. The end point of the study was death from any cause. At the time of last contact, 69 of the patients (78%) had died; the median survival time for this study group was 20.9 months. On univariate analysis, prognostic factors significantly associated with survival included age at diagnosis, family history of cancer, and focal neurological deficit. Multivariate analysis revealed four unfavorable prognostic factors: age greater than or equal to 60 years, history of cancer in first-degree relatives, focal deficit, and ependymal contact. After adjustment for these variables, clinical syndrome, size and number of lesions, extent of surgery, histological cell type, radiation dose, and use of chemotherapy were not significantly associated with survival.

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Address reprint requests to: Brian P. O'Neill, M.D., Department of Neurology, Mayo Clinic, 200 First Street, S.W., Rochester, Minnesota 55905.

© AANS, except where prohibited by US copyright law.

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Figures

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    Photomicrographs showing two malignant lymphomas. Left: Large noncleaved cell type, B-cell phenotype. The neoplastic cells are large with round nuclei, dispersed chromatin, multiple nucleoli apposed to nuclear membranes, and a modest amount of cytoplasm. Right: Immunoblastic type, B-cell phenotype. The neoplastic cells are large with round to irregular nuclear outlines, marginated heterochromatin, and single central prominent nucleoli. H & E, original magnification × 300.

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    Photomicrographs showing a malignant lymphoma, large noncleaved cell type, B-cell phenotype. The neoplastic cells are strongly immunoreactive for CD20 (left) and aberrantly coexpress CD43 (right). Immunoperoxidase stains on paraffin sections, aminoethyl carbazole chromogen and hematoxylin counterstain, original magnification × 350.

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    Photomicrographs showing a malignant lymphoma, pleomorphic small lymphocytic type, T-cell phenotype. Left: There is massive infiltration of the brain and expansion of the Virchow-Robins spaces by a monomorphous population of small lymphocytes with markedly irregular hyperchromatic nuclei and sparse cytoplasm. H & E, original magnification × 150. Right: The neoplastic cells are uniformly immunoreactive for CD45RO. Immunoperoxidase stain on paraffin sections, aminoethyl carbazole chromogen and hematoxylin counterstain, original magnification × 150.

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    Photomicrograph showing a case of large cell lymphoma that has a marked involvement of the brain parenchyma with expansion of the Virchow-Robins spaces. H & E, original magnification × 150.

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    Photomicrograph showing a case of large cell lymphoma in which the lymphomatous involvement was distinctly perivascular and infiltration of the cerebral cortical parenchyma was minimal. H & E, original magnification × 150.

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    Photomicrograph illustrating a diffuse mixed-cell lymphoma that involves the brain in a patchy fashion. Aggregates of neoplastic lymphocytes are associated with vascular proliferation, gliosis, and collections of foamy macrophages. H & E, original magnification × 150.

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