Evidence map›Paper›PMID 39039441›Full record

ArticleBMC neurology2024

Primary diffuse large B-cell lymphoma of the central nervous system identified with CSF biomarkers.

Valentin Loser, Amandine Segot, Laurence de Leval, Bettina Bisig, Jean-Philippe Brouland, Ekkehard Hewer, Carmen Barcena, Andreas F Hottinger, Caroline Pot

Abstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Valentin LoserDepartment of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (CHUV)and, University of Lausanne , CHUV-BH07, Lausanne, Switzerland. valentin.loser@chuv.ch.ORCID http://orcid.org/0000-0002-2609-6843
Amandine SegotDepartment of Oncology, Service and Central Laboratory of Hematology, Lausanne University Hospital (CHUV)and, University of Lausanne , Lausanne, Switzerland.ORCID http://orcid.org/0000-0003-2408-3579
Laurence de LevalInstitute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV)and, University of Lausanne , Lausanne, Switzerland.ORCID http://orcid.org/0000-0003-3994-516X
Bettina BisigInstitute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV)and, University of Lausanne , Lausanne, Switzerland.ORCID http://orcid.org/0000-0002-6840-375X
Jean-Philippe BroulandInstitute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV)and, University of Lausanne , Lausanne, Switzerland.ORCID http://orcid.org/0000-0003-3475-0101
Ekkehard HewerInstitute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV)and, University of Lausanne , Lausanne, Switzerland.ORCID http://orcid.org/0000-0002-9128-0364
Carmen BarcenaInstitute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV)and, University of Lausanne , Lausanne, Switzerland.
Andreas F HottingerDepartment of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (CHUV)and, University of Lausanne , CHUV-BH07, Lausanne, Switzerland.ORCID http://orcid.org/0000-0001-7098-9414
Caroline PotDepartment of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital (CHUV)and, University of Lausanne , CHUV-BH07, Lausanne, Switzerland. caroline.pot-kreis@chuv.ch.ORCID http://orcid.org/0000-0002-1146-3129

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDiagnosis of primary diffuse large B-cell lymphoma of the central nervous system (PCNSL) is challenging and often delayed. MRI imaging, CSF cytology and flow cytometry have a low sensitivity and even brain biopsies can be misleading. We report three cases of PCNSL with various clinical presentation and radiological findings where the diagnosis was suggested by novel CSF biomarkers and subsequently confirmed by brain biopsy or autopsy. CASE PRESENTATIONS: The first case is a 79-year-old man with severe neurocognitive dysfunction and static ataxia evolving over 5 months. Brain MRI revealed a nodular ventriculitis. An open brain biopsy was inconclusive. The second case is a 60-year-old woman with progressive sensory symptoms in all four limbs, evolving over 1 year. Brain and spinal MRI revealed asymmetric T2 hyperintensities of the corpus callosum, corona radiata and corticospinal tracts. The third case is a 72-year-old man recently diagnosed with primary vitreoretinal lymphoma of the right eye. A follow-up brain MRI performed 4 months after symptom onset revealed a T2 hyperintense fronto-sagittal lesion, with gadolinium uptake and perilesional edema. In all three cases, CSF flow cytometry and cytology were negative. Mutation analysis on the CSF (either by digital PCR or by next generation sequencing) identified the MYD88 L265P hotspot mutation in all three cases. A B-cell clonality study, performed in case 1 and 2, identified a monoclonal rearrangement of the immunoglobulin light chain lambda (IGL) and kappa (IGK) gene. CSF CXCL-13 and IL-10 levels were high in all three cases, and IL-10/IL-6 ratio was high in two. Diagnosis of PCNSL was later confirmed by autopsy in case 1, and by brain biopsy in case 2 and 3.

conclusionsTaken together, 5 CSF biomarkers (IL-10, IL-10/IL-6 ratio, CXCL13, MYD88 mutation and monoclonal IG gene rearrangements) were strongly indicative of a PCNSL. Using innovative CSF biomarkers can be sensitive and complementary to traditional CSF analysis and brain biopsy in the diagnosis of PCNSL, potentially allowing for earlier diagnosis and treatment.

Indexed as

Lymphoma, Large B-Cell, DiffuseAgedBiomarkers, TumorBrainCentral Nervous System NeoplasmsFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedBiomarkers, TumorBiomarkerCerebrospinal fluidLymphomaPCNSL

Identifiers

PMID39039441
PMCPMC11265112

What Socratic holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.