Artikel
Pathological features of steroid mitigated CNS lymphoma mimicking inflammatory demyelination
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Veröffentlicht: | 25. August 2015 |
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Gliederung
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.