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60th Annual Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN)

German Society for Neuropathology and Neuroanatomy

26. - 28.08.2015, Berlin

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Pathological features of steroid mitigated CNS lymphoma mimicking inflammatory demyelination

Meeting Abstract

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  • corresponding author presenting/speaker Alonso Barrantes-Freer - Universtitaetsmedizin Goettingen, Institut fuer Neuropathologie, Goettingen, Germany
  • Aylin Sophie Handan Engel - Universtitaetsmedizin Goettingen, Institut fuer Neuropathologie, Goettingen, Germany
  • Odir Antonio Rodríguez-Villagra - Universidad de Costa Rica, Centro de Investigación en Neurociencias, San José, COSTA RICA
  • Markus Bergmann - Klinikum Bremen Mitte, Institut fuer Neuropathologie, Bremen, Germany
  • Christian Mawrin - Universitaetsklinikum Magdeburg, Institut fuer Neuropathologie, Magdeburg, Germany
  • Tania Kuempfel - LMU, Institut fuer klinische Neuroimmunologie, Muenchen, Germany
  • Hannah Pellkofer - Universtitaetsmedizin Goettingen, Institut fuer Neuropathologie, Goettingen, Germany
  • Imke Metz - Universtitaetsmedizin Goettingen, Institut fuer Neuropathologie, Goettingen, Germany
  • Annalen Bleckmann - Universitätsmedizin Göttingen, Hämatologie Onkologie, Göttingen, Germany
  • Sven Schippling - UniversitaetsSpital, Klinik fuer Neurologie, Zuerich, Switzerland
  • Elisabeth Jane Rushing - UniversitaetsSpital, Institut fuer Neuropathologie, Zuerich, Switzerland
  • Stephan Frank - Universitatsspital Basel, Neuropathologie, Basel, Switzerland
  • Markus Glatzel - Universtaetsklinikum Hamburg-Eppendorf, Institut fuer Neuropathologie, Hamburg, Germany
  • Jakob Matschke - Universtaetsklinikum Hamburg-Eppendorf, Institut fuer Neuropathologie, Hamburg, Germany
  • Christian Hartmann - Medizinische Hochschule Hannover, Institut fuer Pathologie, Hannover, Germany
  • Guido Reifenberger - Universitaetsklinikum Duesseldorf, Institut fuer Neuropathologie, Duesseldorf, Germany
  • Wolfgang Brueck - Universtitaetsmedizin Goettingen, Institut fuer Neuropathologie, Goettingen, Germany
  • author presenting/speaker Chrsitine Stadelmann - Universtitaetsmedizin Goettingen, Institut fuer Neuropathologie, Goettingen, Germany

Deutsche Gesellschaft für Neuropathologie und Neuroanatomie. 60th Annual Meeting of the German Society for Neuropathology and Neuroanatomy (DGNN). Berlin, 26.-28.08.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgnnNI3

doi: 10.3205/15dgnn19, urn:nbn:de:0183-15dgnn190

Published: August 25, 2015

© 2015 Barrantes-Freer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Histologically, the differential diagnosis of inflammatory demyelination encompasses a heterogeneous group of pathologies, of which multiple sclerosis (MS) represents the principal consideration. Nevertheless, the presence of inflammation and demyelination has also been described in patients with suspected primary central nervous system lymphoma (PCNSL), especially when steroids are administered prior to biopsy acquisition. In spite of the therapeutic relevance, it is still unknown whether inflammatory demyelination, as observed in MS lesions, can be reliably differentiated on a histological basis from steroid treated PCNSL (ST-PCNSL). Therefore, in the present study, we contrasted biopsy material from patients with inflammatory demyelination (and histologically confirmed PCNSL a posteriori) with early active multiple sclerosis lesions. Histological analysis of these groups revealed differences in the composition of the inflammatory infiltrate and the demyelination pattern. By analyzing bona fide PCNSL without previous steroid treatment, we further demonstrate that the histological changes of ST-PCNSL do not correspond to sampling artefacts or focal changes of untreated PCNSL. Finally, we determine that given a background of demyelination, the extent of lymphocytic inflammatory infiltration might suffice as a diagnostic criterion to adequately differentiate between MS and ST-PCNSL, thus allowing a timely and adequate therapeutic intervention.