Department of Neurology, Knappschaftskrankenhaus University of Bochum, Bochum, Germany.
Department of Internal Medicine, Knappschaftskrankenhaus University of Bochum, Bochum, Germany.
Neuro Oncol. 2021 Dec 1;23(12):2076-2084. doi: 10.1093/neuonc/noab109.
In patients with presumed primary CNS lymphoma (PCNSL), a systemic manifestation is found only in a small minority. Although bone marrow biopsy (BMB) is recommended for staging, its diagnostic value is unclear.
A retrospective analysis of 392 patients with presumed PCNSL from 3 university hospitals and 33 patients with secondary CNS lymphoma (SCNSL) and initial CNS involvement from a multicenter Germany-wide prospective registry was performed.
A BMB was performed and documented in 320/392 patients with presumed PCNSL; 23 had pathologic results. One harbored the same lymphoma in the brain and bone marrow (BM), 22 showed findings in BM discordant to the histology of brain lymphoma; n = 12 harbored a low-grade lymphoma in the BM, the other showed B-cell proliferation but no proof of lymphoma (n = 5), monoclonal B cells (n = 3), or abnormalities not B-cell-associated (n = 2). In the group of SCNSL with initial CNS manifestation, 32/33 patients underwent BMB; 7 were documented with bone marrow involvement (BMI); 1 had concordant results in the brain and BM with no other systemic manifestation. Six had additional systemic lymphoma manifestations apart from the brain and BM.
In only 2 out of 352 (0.6%) patients with CNS lymphoma (320 presumed PCNSL and 32 SCNSL), BMB had an impact on diagnosis and treatment. While collected in a selected cohort, these findings challenge the value of BMB as part of routine staging in presumed PCNSL.
在疑似原发性中枢神经系统淋巴瘤（PCNSL）患者中，仅有一小部分存在全身表现。尽管骨髓活检（BMB）被推荐用于分期，但其诊断价值尚不清楚。
对 3 家大学医院的 392 例疑似 PCNSL 患者和来自德国一项多中心前瞻性登记研究的 33 例继发性中枢神经系统淋巴瘤（SCNSL）和初始中枢神经系统受累患者进行了回顾性分析。
对 392 例疑似 PCNSL 患者中的 320 例进行了 BMB 检查并记录；其中 23 例有病理结果。1 例患者的脑部和骨髓（BM）中存在相同的淋巴瘤，22 例患者的 BM 结果与脑淋巴瘤的组织学不一致；n=12 例患者的 BM 中存在低级别淋巴瘤，另 12 例患者表现为 B 细胞增殖，但未证实淋巴瘤（n=5）、单克隆 B 细胞（n=3）或与 B 细胞无关的异常（n=2）。在初始中枢神经系统受累的 SCNSL 组中，33 例患者中有 32 例接受了 BMB；7 例有骨髓受累（BMI）；1 例在脑和 BM 中具有一致的结果，无其他全身表现。6 例患者除了脑和 BM 外还有其他系统的淋巴瘤表现。
在仅有 2 例中枢神经系统淋巴瘤患者（320 例疑似 PCNSL 和 32 例 SCNSL）中，BMB 对诊断和治疗有影响。虽然这些发现是在一个选定的队列中收集的，但它们质疑了 BMB 作为疑似 PCNSL 常规分期一部分的价值。
