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Conceptualization: S.-M.R., M.A.B. and V.B.; validation: M.A.B., V.B., B.M., D.-M.T., M.P., S.-I.S. and I.-A.C.; writing—original draft preparation: S.-M.R., M.-M.P., A.-Ș.S., T.-I.P. and D.M.M.; writing—review and editing: V.B.; data curation: S.-M.R. All authors have read and agreed to the published version of the ma... |
## Institutional Review Board Statement |
Not applicable. |
## Informed Consent Statement |
Not applicable. |
## Data Availability Statement |
The data presented in this study are available on request from the corresponding authors. |
## Conflicts of Interest |
The authors declare no conflicts of interest. |
## Funding Statement |
The Article Processing Charges were funded by the University of Medicine and Pharmacy of Craiova. |
## Footnotes |
## References |
## Associated Data |
### Data Availability Statement |
The data presented in this study are available on request from the corresponding authors. |
fd0a4fe6a913d1f2213c34c524c1195496a5399ea0e3ee241b675a1cff7fcfbe pmc13116887.txt |
PMCID: PMC13260794 |
TITLE: Primary central nervous system lymphoma and tumefactive demyelinating lesions in multiple sclerosis: a retrospective observational cohort study |
LICENSE: https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the or... |
ABSTRACT: BackgroundDifferentiating primary central nervous system lymphoma (PCNSL) from tumefactive demyelinating lesions (TDLs) remains a major diagnostic challenge.ObjectiveOur study aimed to compare the differences in clinical observations, neuroimaging data, and pathological features between the PCNSL and TDLs, as... |
## Introduction |
Primary central nervous system lymphoma (PCNSL) is a rare non-Hodgkin lymphoma with high malignancy, accounting for 3% of primary brain tumors (1). PCNSL does not affect lymph nodes outside the central nervous system (2), and it has a poorer prognosis than peripheral lymphoma (3). The clinical features of PCNSL are mos... |
The demyelinating inflammatory lesions in the central nervous system are also called demyelinating pseudotumor (DPT) or tumefactive demyelinating lesion (TDLs), exhibiting space-occupying lesions on neuroimaging, which are similar to those of brain tumors (6). The clinical and pathological aspects of sentinel demyelina... |
In the present study, we collected data from patients with PCNSL and TDLs and reported the differences between PCNSL and TDLs in clinical features, neuroimaging and pathological characteristics, and biomarkers. |
## Methods |
### Patients |
A total of 97 patients with PCNSL and 86 patients with TDL, treated in the Zhangzhou Affiliated Hospital of Fujian medical University from 2012 to 2022, were included in the present study. The research was approved by the ethics committee of Zhangzhou Affiliated Hospital of Fujian medical University. All the patients c... |
The inclusion criteria were as follows (1): patient age≥18 (2). PCNSL confirmed by pathology (3). TDL diagnosed by pathology or the corresponding criteria: demyelinating lesions measuring ≥20 mm in diameter, or lesions of 5–20 mm with mass effect that mimic tumor-like space-occupying lesions and exhibit characteristic ... |
### Neuroimaging |
Magnetic resonance imaging (MRI) diagnosis: The patient was diagnosed with a 3.0 superconducting MR machine (General Electric, Milwaukee, WI, USA). The parameters are set as previously described (15) with minor modification. For T1-weight imaging (T1WI), the repetition time (TR) was set to 2,415 ms, echo time (TE) to 1... |
### Histopathological study |
The tumors removed from surgery or biopsy were collected in formalin. The tissue was embedded in paraffin. For hematoxylin-eosin (HE) staining, the prepared tissue slices were dewaxed, hydrated, and stained in hematoxylin solution for 5 min. After differentiated by 1% hydrochloric alcohol for 15s, the slices were washe... |
### Cerebrospinal fluid and serum analyses |
Blood of the patients were drawn from elbow venous at a volume, following with centrifugation (3,000 r/min, 10 min) to obtain the serum. CSF was collected at through the lumbar puncture. After centrifuging at 500r/min for 10min, the supernatant was placed in the frozen tube and stored in -80°C refrigerator. The protein... |
### Statistical analyses |
All statistical analyses were performed using GraphPad (version 9.3.1) and SPSS (version 28.0). The normality of continuous variables was assessed using the Kolmogorov–Smirnov test. Continuous variables are presented as mean ± standard deviation (SD) and were compared between groups using the independent-samples Studen... |
## Results |
### Clinical features of PCNSL and TDLs |
The clinical features of PCNSL and TDLs are shown in Table 1. The onset age of PCNSL patients (59 males and 38 females) was 59.28 ± 10.23 years, with an insidious or slow onset. The initial symptoms of PCNSL included headache in 26 cases (26.8%), weakness in 17 cases (17.5%), numbness in 10 cases (10.3%), reduced visio... |
[TABLE] The clinical features of PCNSL and TDLs. |
Parameter | PCNSL | TDLs | p |
Number of subjects | 97 | 86 | |
Age(years) | 59.28 ± 10.23 | 36.28 ± 8.11 | p<0.01 |
Gender | | | p>0.05 |
Male | 59 | 42 | |
Female | 38 | 44 | |
Initial symptoms | | | p>0.05 |
Headache | 26 (26.8%) | 28 (32.6%) | |
Cognitive dysfunction | 17 (17.5%) | 10 (11.6%) | |
Numbness | 10 (10.3%) | 12 (14.0%) | |
Reduced vision | 8 (8.3%) | 10 (11.6%) | |
Limb movement disorder | 8 (8.3%) | 5 (5.8%) | |
### Neuroimaging of PCNSL and TDL |
Upon MRI scans, most brain lesions of TDLs and PCNSL showed hypointense on T2WI and T1WI sequences. On diffusion-weighted imaging (DWI) sequences, brain lesions in PCNSL showed U-shaped hyperintense, while lesions in TDLs showed mild diffuse hyperintense. Both PCNSL and TDLs lesions presented hypointense on apparent di... |
### Pathological features of PCNSL and TDL |
We also investigated the differences in the pathological features between PCNSL and TDLs. Immunohistochemical (IHC) staining for CD3 and CD20, along with hematoxylin–eosin (HE) staining, was performed on surgical/biopsy specimens from all 97 PCNSL and 86 TDLs patients included in this study, with no missing samples. Th... |
### Cerebrospinal fluid and serum analyses |
IL-6 and IL-10 are known to be closely associated with lymphocyte immunology, and their abnormal expression has been linked to poor prognosis in non-Hodgkin lymphoma (17, 18). Elevated CSF IL−10 levels have also been reported in multiple sclerosis and neuromyelitis optica spectrum disorder (19). Increased CSF IL−6 leve... |
Then we constructed ROC curves to discriminate the potential use of CSF IL-6 and IL-10 levels for the diagnosis of PCNSL (Figure 3F). CSF IL-10 showed excellent (p < 0.001) discriminator power for the diagnosis of PCNSL (cut-off ≥ 9.095 pg/mL; sensitivity 84.54%, specificity 86.05%; Youden index = 0.706) as the AUC was... |
## Discussion |
PCNSL is a relatively rare type of non-Hodgkin lymphoma affecting the central nervous system, which mostly occurs in immunocompromised patients (23, 24). The clinical symptoms of the disease are insidious, making it difficult to make a differential diagnosis based on clinical characteristics alone. TDL is a rare demyel... |
PCNSL often occurs in elderly patients (28), while TDLs often occur in middle age (29). In a study of 480 patients with TDLs, PCNSL, tumefactive primary angiitis of the central nervous system, and brain gliomas, the average age of PCNSL patients is significantly higher than that of TDLs patients (57.60 ± 13.39 vs 37.29... |
Neuroimaging features of PCNSL on MRI can be very variable. In the present study, brain lesions of TDLs and PCNSL mainly showed hypointense on T2WI, T1WI, and ADC images, making no room for differentiating between PCNSL and TDLs on these points. PCNSL shows hypointense or isointense on T1WI, and hypointense, isointense... |
Typical histopathological characteristics of PCNSL include diffuse infiltrative and highly proliferating lymphoma cells with angiocentric growth patterns (31), and EBV-positive PCNSL often exhibits larger areas of necrosis (48). The basic histopathologic features of active-stage TDLs consist of demyelinated areas with ... |
Diagnosis of PCNSL is challenging, and although brain biopsy remains the gold standard, finding a less invasive source of lymphomatous biomarkers is still of vital importance. Serum IL-10 and IL-6 levels have been reported to correlate with prognosis in non-Hodgkin’s lymphoma (52). However, no statistical differences w... |
## Conclusion |
Distinguishing sentinel lesions of PCNSL and TDLs at an early disease stage remains challenging. In this observational study, we reported the differences between PCNSL and TDLs in clinical features, neuroimaging, pathological characteristics, and the biomarkers. Specifically, variations in onset age, MRI findings on DW... |
8bc94f4045742e5efe748adac0d817b05ccbc6d3edfd9f0c758e838dbcb9e7c9 pmc13260794.txt |
PMCID: PMC13301885 |
TITLE: Confocal Laser Endomicroscopy in Brain Metastasis Surgery: A Systematic Review of the Evidence at the Tumor–Brain Interface |
LICENSE: https://creativecommons.org/licenses/by/4.0/ Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. |
ABSTRACT: AbstractBackground: Brain metastases are the most common intracranial tumors in adults and are traditionally considered well-demarcated lesions amenable to complete surgical resection. Nonetheless, increasing histopathological evidence demonstrates that metastatic cells may infiltrate beyond the contrast-enha... |
## 1. Introduction |
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