Primary central nervous system lymphomas with massive intratumoral hemorrhage: Clinical, radiological, pathological, and molecular features of six cases.

Abstract

Primary central nervous system lymphomas (PCNSLs) rarely exhibit intratumoral hemorrhage. The differential diagnosis of hemorrhagic neoplasms of the central nervous system (CNS) currently includes metastatic carcinomas, melanomas, choriocarcinomas, oligodendrogliomas, and glioblastomas. Here we present the clinical, radiological, pathological, and molecular genetic features of six cases of PCNSL associated with intratumoral hemorrhage. The median age of patients was 75 years, with male predominance. While conventional PCNSLs were associated with low cerebral blood volume (CBV), perfusion magnetic resonance imaging (MRI) revealed elevated CBV in three cases, consistent with vascular proliferation. All six cases were diagnosed pathologically as having diffuse large B-cell lymphoma (DLBCL) with a non-germinal center B-cell-like (non-GCB) phenotype; marked histiocytic infiltrates and abundant non-neoplastic T-cells were observed in most cases. Expression of vascular endothelial growth factor and CD105 in the lymphoma cells and the small vessels, respectively, suggested angiogenesis within the neoplasms. Neoplastic cells were immunohistochemically negative for programmed cell death ligand 1 (PD-L1), while immune cells in the microenvironment were positive for PD-L1. Mutations in the MYD88 gene (MYD88) (L265P) and the CD79B gene (CD79B) were detected in five and one case, respectively. As therapeutic modalities used for PCNSLs differ from those that target conventional hemorrhagic neoplasms, full tissue diagnoses of all hemorrhagic CNS tumors are clearly warranted.

• Authors: Seiji Yamada, Jun Muto, Sachiko Iba, Kazuya Shiogama, Yuta Tsuyuki, Akira Satou, Shigeo Ohba, Kazuhiro Murayama, Yasuo Sugita, Shigeo Nakamura, Hideaki Yokoo, Akihiro Tomita, Yuichi Hirose, Tetsuya Tsukamoto, Masato Abe
• Journal: Neuropathology : official journal of the Japanese Society of Neuropathology (Neuropathology) Vol. 41 Issue 5 Pg. 335-348 (Oct 2021) ISSN: 1440-1789 [Electronic] Australia
• PMID: 34254378 (Publication Type: Journal Article)
• Copyright: © 2021 Japanese Society of Neuropathology.

Chemical References

• Vascular Endothelial Growth Factor A

Topics

• Aged
• Central Nervous System
• Central Nervous System Neoplasms (complications, diagnostic imaging, genetics)
• Hemorrhage
• Humans
• Lymphoma, Large B-Cell, Diffuse (complications, diagnostic imaging, genetics)
• Male
• Tumor Microenvironment
• Vascular Endothelial Growth Factor A