Kim Hye Ok, Kim Jae Seung, Kim Seon-Ok, Chae Sun Young, Oh Seung Jun, Seo Minjung, Lee Suk Hyun, Oh Jungsu S, Ryu Jin-Sook, Huh Joo-Ryung, Kim Jeong Hoon
Department of Nuclear Medicine, College of Medicine, Ewha Womans University.
Department of Nuclear Medicine.
Medicine (Baltimore). 2020 May;99(20):e20140. doi: 10.1097/MD.0000000000020140.
Primary central nervous system lymphoma (PCNSL) typically shows a strong uptake of F-fludeoxyglucose (FDG) imaged by positron emission tomography (PET). Uncommonly, PCNSL demonstrates a low uptake on FDG PET. We investigated the clinicopathological characteristics of the unusual cases of PCNSL with low FDG uptake.We retrospectively enrolled 104 consecutive patients with newly diagnosed PCNSL who underwent baseline brain FDG PET. The degree of FDG uptake of PCNSL was visually scored by 4 grades (0, ≤contralateral white matter; 1, >contralateral white matter and <contralateral gray matter; 2, = contralateral gray matter; 3, >contralateral gray matter). Grades 0-2 were considered as PCNSL with low uptake. We investigated association of low uptake of PCNSL with the following clinicopathological factors: age, sex, steroid treatment, lactate dehydrogenase level, cerebrospinal fluid protein level, condition of PET scanning, immunohistochemical markers (cluster of differentiation 10 [CD10], B-cell lymphoma 6 [BCL-6], B-cell lymphoma 2 [BCL-2], multiple myeloma oncogene 1 [MUM1], Epstein-Barr virus [EBV] protein, and Ki67), location of lesions, tumor size, multiplicity of lesions, involvement of deep brain structures, and cystic or necrotic appearance of lesions.Of the 104 patients with PCNSL, 14 patients (13.5%) showed PCNSL with low FDG uptake on PET. Among various clinicopathological factors, MUM1 negativity was the only factor associated with low FDG uptake PCNSL by univariate (P = .002) and multivariate analysis (P = .007).This study suggests that the different clinicopathological characteristics between patients with high uptake and low uptake of PCNSL on FDG PET is closely associated with lack of MUM1, a protein known to be a crucial regulator of B-cell development and tumorigenesis.
原发性中枢神经系统淋巴瘤（PCNSL）在正电子发射断层扫描（PET）成像中通常表现出对F-氟脱氧葡萄糖（FDG）的强烈摄取。罕见的是，PCNSL在FDG PET上表现为低摄取。我们研究了FDG摄取低的PCNSL不寻常病例的临床病理特征。我们回顾性纳入了104例连续的新诊断PCNSL患者，这些患者接受了基线脑FDG PET检查。PCNSL的FDG摄取程度通过4个等级进行视觉评分（0，≤对侧白质；1，>对侧白质且<对侧灰质；2，=对侧灰质；3，>对侧灰质）。0-2级被视为FDG摄取低的PCNSL。我们研究了PCNSL低摄取与以下临床病理因素的关联：年龄、性别、类固醇治疗、乳酸脱氢酶水平、脑脊液蛋白水平、PET扫描情况、免疫组化标志物（分化簇10 [CD10]、B细胞淋巴瘤6 [BCL-6]、B细胞淋巴瘤2 [BCL-2]、多发性骨髓瘤癌基因1 [MUM1]、爱泼斯坦-巴尔病毒 [EBV] 蛋白和Ki67）、病变位置、肿瘤大小、病变数量、深部脑结构受累情况以及病变的囊性或坏死外观。在104例PCNSL患者中，14例（13.5%）在PET上表现为FDG摄取低的PCNSL。在各种临床病理因素中，MUM1阴性是单因素分析（P = 0.002）和多因素分析（P = 0.007）中与FDG摄取低的PCNSL相关的唯一因素。本研究表明，FDG PET上PCNSL高摄取和低摄取患者之间不同的临床病理特征与MUM1的缺乏密切相关，MUM1是一种已知对B细胞发育和肿瘤发生起关键调节作用的蛋白质。
