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Items 1-5 of 5 |
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CNS involvement in children with newly diagnosed non-Hodgkin's lymphoma.
Sandlund JT, Murphy SB, Santana VM, Behm F, Jones D, Berard CW, Furman WL, Ribeiro R, Crist WM, Greenwald C, Chen G, Walter A, Pui CH.
Departments of Hematology/Oncology, Radiation Therapy, Pathology and Laboratory Medicine, and Biostatistics, St Jude Children's Research Hospital, and University of Tennessee at Memphis, College of Medicine, Memphis, TN, USA. [email protected]
PURPOSE: To determine the frequency of CNS involvement at diagnosis of non-Hodgkin's lymphoma (NHL), to characterize its pattern of presentation, and to determine its prognostic significance. PATIENTS AND METHODS: We reviewed the records of 445 children (1975 through 1995) diagnosed with NHL (small noncleaved cell NHL/B-cell acute lymphoblastic leukemia [SNCC NHL/B-ALL], 201 patients; lymphoblastic, 113; large cell, 119; other, 12). Tumor burden was estimated by serum lactate dehydrogenase (LDH) measurement and reclassification of disease stage irrespective of CNS involvement (modified stage). RESULTS: Thirty-six of 445 children with newly diagnosed NHL had CNS involvement (lymphoma cells in the CSF [n = 23], cranial nerve palsy [n = 9], both features [n = 4]), representing 13%, 7%, and 1% of small noncleaved cell lymphoma, lymphoblastic lymphoma, and large-cell cases, respectively. By univariate analysis, CNS disease at diagnosis did not significantly impact event-free survival (P =. 095), whereas stage and LDH did; however, children with CNS disease at diagnosis were at 2.0 times greater risk of death than those without CNS disease at diagnosis. In a multivariate analysis, CNS disease was not significantly associated with either overall or event-free survival, whereas both serum LDH and stage influenced both overall and event-free survival. Among cases of SNCC NHL/B-ALL, CNS disease was significantly associated with event-free and overall survival (univariate analysis); however, in multivariate analysis, only LDH had independent prognostic significance. Elevated serum LDH or higher modified stage were associated with a trend toward poorer overall survival among children with CNS disease. CONCLUSION: A greater tumor burden at diagnosis adversely influences the treatment outcome of children with NHL and CNS disease at diagnosis, suggesting a need for ongoing improvement in both systemic and CNS-directed therapy.
PMID: 10944136 [PubMed - indexed for MEDLINE]
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Non-Hodgkin's lymphoma involving the central nervous system.
Wolf MM, Olver IN, Ding JC, Cooper IA, Liew KH, Madigan JP.
In 44 out of 758 patients (5.8%) with non-Hodgkin's lymphoma presenting between 1971 and 1982, the central nervous system (CNS) was involved. Patients with a diffuse histology had a 7.6% (34/449) incidence of CNS involvement compared to 3.9% (10/257) for patients with nodular lymphoma. In 63% of patients there was evidence of progressive systemic lymphoma at the time of diagnosis of CNS disease and in 23% CNS relapse occurred in clinical remission. Bone marrow was involved in 34% of patients at diagnosis and in 52% at some time prior to the onset of CNS complications. Cerebrospinal fluid cytology was positive in 63% and an elevated protein level was found in 95% of patients. The median length of survival of the 44 patients was only 3.2 months, but patients who responded to treatment of CNS lymphoma survived significantly longer than those who showed no response or progressed on therapy. Complete response to CNS treatment was achieved in five patients, of whom none relapsed in the CNS and two are long-term disease-free survivors. CNS prophylaxis appears justified for patients with lymphoblastic lymphoma, Burkitt's tumour, and diffuse undifferentiated lymphoma, who are at high risk of developing CNS complications. Patients with diffuse histiocytic, and diffuse poorly differentiated lymphocytic, lymphoma who have bone marrow involvement may also benefit from CNS prophylaxis.
PMID: 3859259 [PubMed - indexed for MEDLINE]
Improving the diagnostic accuracy of cytologic cerebrospinal fluid examinations in acute lymphoblastic leukemia using high-power microscopy and terminal deoxynucleotidyl transferase determinations.
Desai K, Fallon MA, Willard-Smith D, Wilbur DC.
Cytopathology Laboratory, University of Connecticut Health Center, Farmington 06030, USA.
In patients with acute lymphoblastic leukemia (ALL), cytologic examination of cerebrospinal fluid (CSF) is becoming increasingly important for clinical management. In order to enhance the diagnostic accuracy of CSF cytology results, the value of using terminal deoxynucleotidyl transferase (Tdt) and high-power (1,000x) light microscopy, together with conventional cytologic examination was assessed. In 33 CSF samples from ten multiply examined Tdt-positive ALL patients, original cytologic interpretations were compared to Tdt results. Cytology samples were reviewed by two pathologists (one with hematopathologic expertise). The cases in which cytologic interpretation did not correlate with Tdt result were first reviewed via 1,000x microscopy without knowledge of Tdt result, then re-reviewed with knowledge of Tdt result. Conventional cytology alone diagnosed 64% of cases accurately (Tdt representing the comparative standard). High-power microscopy increased the correlation to 82%. Use of high-power microscopy and knowledge of Tdt result together produced a total of 85% of cases with correlation of results. High-power microscopic examination therefore contributes significantly to the accurate diagnosis of ALL, and knowledge of the Tdt result at the time of cytologic examination produces an additional advantage in providing an objective measure for CSF involvement by leukemia. Using all three methods in conjunction is recommended in order to increase the overall accuracy of CSF examination for the detection of leukemic involvement in ALL patients.
PMID: 9143842 [PubMed - indexed for MEDLINE]
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Diagnosis of lymphoma, leukemia, and metastatic tumor involvement of the cerebrospinal fluid by cytology and immunocytochemistry.
Tani E, Costa I, Svedmyr E, Skoog L.
Department of Pathology, Karolinska Hospital, Stockholm, Sweden.
Fifty-five cerebrospinal fluid (CSF) specimens from 42 patients with suspected meningeal tumor involvement were reviewed. Cytology in conjunction with immunocytochemistry identified 26 CSF specimens as malignant. There were fifteen cases of lymphoma, four cases of leukemia, two cases of carcinoma, and two cases of melanoma. A monoclonal light chain expression was demonstrated in nine out of eleven B cell lymphomas. The three T-cell lymphomas all expressed pan T markers (CD 3) and two the T-helper antigen (CD 4). One patient had meningeal involvement of a true histiocytic lymphoma which was identified by its large atypical cells which were positive for alpha-1-anti-trypsin and muramidase. In four patients with a primary diagnosis of acute lymphoblastic leukemia, CSF involvement was confirmed by the demonstration of blasts with CD 10 (cALLA) or light chain restriction. Epithelial or melanocytic markers were demonstrated on the tumor cells in CSF from the remaining four patients. In 29 CSF specimens a diagnosis of reactive lymphocytosis was made using cytomorphology which mostly was characterized by macrophages mixed with small mature lymphoid cells. Immunologic evaluation showed that these mature cells were CD 10 negative T-cells and only few specimens contained polyclonal B-cells. The subsequent clinical course of these patients showed no evidence of CNS malignancy. It is concluded that cytology should be used in conjunction with immunocytochemistry to accurately evaluate CSF specimens from patients with possible malignant meningitis.
PMID: 7789240 [PubMed - indexed for MEDLINE]
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Diagnostic problems in the cytologic evaluation of cerebrospinal fluid for lymphoma and leukemia.
Borowitz M, Bigner SH, Johnston WW.
We reviewed 72 cerebrospinal fluid (CSF) specimens with abnormal hematopoietic cells and the clinical records of the 45 patients from whom they were obtained. Of the 72 specimens, 34 were originally diagnosed as positive for lymphoma or leukemia and the remaining 38 as "atypical cells present." Based on follow-up information of the patients, only three "atypical" specimens were from patients with CSF leukemia, but ten of the positive diagnoses were incorrect. Cases of acute lymphoblastic leukemia (ALL) produced cells with a characteristic morphology. Cells of five of the six false-positive specimens in this disorder were, in retrospect, markedly different from typical blasts. In contrast, two false-positive reactive cases from patients with no established malignancy had an infiltrate whose morphology was indistinguishable from that of many cases of diffuse histiocytic lymphoma (DHL). There were no cases of chronic lymphocytic leukemia (CLL) or nodular poorly differentiated lymphocytic lymphoma involving CSF, but two patients with CLL and infectious meningitis had false-positive cytologies. We conclude that in evaluating CSF specimens for lymphoma or leukemia, knowledge of the morphology and behavior of a patient's particular tumor can minimize incorrect diagnostic interpretations.
PMID: 6947670 [PubMed - indexed for MEDLINE]
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