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. 2015 Jul 1;8(7):7798-808.
eCollection 2015.

Corticosteroid pre-treated primary CNS lymphoma: a detailed analysis of stereotactic biopsy findings and consideration of interobserver variability

Evrim Önder  1 , Ata T Arıkök  1 , Sevgen Önder  2 , Ünsal Han  1 , Mehmet Sorar  3 , Hayri Kertmen  3 , Engin D Yılmaz  1 , Ramazan Fesli  3 , Murat Alper  1
Affiliations

Corticosteroid pre-treated primary CNS lymphoma: a detailed analysis of stereotactic biopsy findings and consideration of interobserver variability

Evrim Önder et al. Int J Clin Exp Pathol. .

Abstract

Prior corticosteroid therapy presents a major challenge in the diagnosis of CNS lymphomas, particularly in stereotactic biopsies. In this study we analysed the cytological, histopathological and immunohistochemical features in stereotactic biopsies of 25 primary CNS lymphoma cases pre-treated with corticosteroids. We documented the extent and the frequency of each finding. We also investigated the significance of subjectivity in evaluation of these biopsies in 3 seperate sessions including the final diagnostic decision. In 48% of our cases the diagnosis was straightforward. These cases were characterized by prominent blasts either in diffuse paranchymal infiltrates or in perivascular regions. The remaining 52% demonstrated some degree of variability among pathologists. Lymphoid atypia other than the typical blastic morphology appeared as a subjective finding and this was more pronounced in cytology preparations. In our study, corticosteroid pre-treatment in primary CNS lymphoma was associated with a large spectrum of histopathological, immunohistochemical and cytological findings. Combined use of an extended immunohistochemical panel would increase the possibility of conclusive diagnosis. Nevertheless some of these findings and therefore the diagnosis are open to subjectivity.

Keywords: PCNSL; cytology; histopathology; immunohistochemistry; interobserver.

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Figures

Figure 1
Figure 1
A. Scattered lymphoid cells in non-neoplastic glial tissue; example for SL target. B. Scattered macrophages and lymphoid cells; SLM target. C. Perivascularly arranged lymphocytes; PVL target. D. Macrophages accompanying perivascular lymphocytes; PVLM target. E. PVL target noted to have suspicious lymphoid atypia by 2 observers. F. PVL target noted to have lymphoid atypia by 1 observer. G, H. Perivascular lymphoid cells with blasts; PVLB targets. J. Diffuse lymphoid infiltration with blasts; LB target.
Figure 2
Figure 2
Characteristics of lymphoid infiltration in HE slides.
Figure 3
Figure 3
A. Normal appearing lymphocytes; example for Lc slide. B. A preparation found to have suspicious lymphoid atypia by 2 out of 3 observer. C. Lymphoid cells with obvious blasts.
Figure 4
Figure 4
Characteristics of lymphoid infiltration in cytology slides.
Figure 5
Figure 5
A, B. Extensive CD20 positivity. C. Scattered CD3 positivity in a LB target.
Figure 6
Figure 6
Characteristics of lymphoid infiltration in IHC slides.
See this image and copyright information in PMC

References

    1. Louis D, Ohgaki H, Wiestler O, Cavenee W. WHO Classification of Tumours of the Central Nervous System. 4th edition. Lyon: IARC; 2007. pp. 188–192. - PMC - PubMed
    1. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Wardiman JW. WHO Classification of tumors of Haematopoietic and Lymphoid Tissues. 4th edition. Lyon: IARC; 2008. pp. 240–241.
    1. Doolittle ND, Abrey LE, Shenkier TN, Tali S, Bromberg JEC, Neuwelt EA, Soussain C, Jahnke K, Johnston P, Illerhaus G, Schiff D, Batchelor T, Montoto S, Kraemer DF, Zucca E. Brain parenchyma involvement as isolated central nervous system relapse of systemic non-Hodgkin lymphoma: an International Primary CNS Lymphoma Collaborative Group report. Blood. 2008;111:1085–1093. - PubMed
    1. Ferreri AJ, Blay JY, Reni M, Pasini F, Spina M, Ambrosetti A, Calderoni R, Rossi A, Vavassori V, Conconi A, Devizzi L, Berger F, Ponzoni M, Borish B, Tingulely M, Cerati M, Milani M, Orvieto E, Sanchez J, Chevreau C, Dell’ Oro S, Zucca E, Cavali F. Prognostic scoring system for primary CNS lymphomas: The International Extranodal Lymphoma Study Group experince. J. Clin. Oncol. 2003;21:266–272. - PubMed
    1. Haldorsen IS, Espeland A, Larson JL, Mella O. Diagnostic delay in primary central nervous system lymphoma. Acta Oncol. 2005;44:728–34. - PubMed

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