(Primary) CNS Lymphomas

Dr. Prem Pillay , Singapore Brain Spine Nerves Center, Singapore

Senior Consultant Neurosurgeon with super speciality training in Neurosurgical Oncology

(Fellow at MD Anderson Cancer Center and Hospital, U of Texas, USA)

What Are Primary Central Nervous System (CNS) Lymphoma ?

Primary Central Nervous System (CNS) Lymphoma is a malignant, or high-grade brain tumor of B cell origin. A CNS Lymphoma can occur in both immuno-competent patients as well as patients with immunodeficiency (eg. HIV positive).

Who Gets Affected?

Age/Sex: The mean age is about 50 years except for HIV+ve or immuno-deficient patients who are mostly in the late 20s.

What Brings Them to the Clinic?

Presentation: Headaches, seizures, blurred vision, cranial neuropathy and focal neurological symptoms (hemiparesis, aphasia etc).

How is It Diagnosed?

Diagnosis:MRI is the diagnostic modality of choice. The tumor shows intense contrast enhancement with gadolinium. The lesions are usually cerebral and single in about 2/3rds of patients. HIV+ve patients usually have multiple lesions. The use of steroids prior to imaging may cause the lesion to temporarily disappear, hindering diagnosis. Stereotactic Biopsy or Image-guided craniotomy and biopsy is usually needed for histopathological diagnosis. The therapeutic role of aggressive surgical resection is limited.

What Are the Treatment Options?

Treatment: Image-guided /Computer-aided Craniotomy and aggressive tumor resection is rarely done as it can make patients worse and does not have a major impact on survival. The exception is for large tumors with mass effect and impending herniation. Radiation has an important role as primary CNS lymphoma is very radiosensitive. Stereotactic radiation and NeuroTomotherapy are more advanced forms of radiation. Chemotherapy especially intrathecal chemotherapy through an Ommaya reservoir is a mainstay of treatment. MTX (methothrexate) is the agent of choices.

Conclusion

Primary CNS lymphoma is a rare yet aggressive condition requiring timely diagnosis and specialised treatment. If you or a loved one experiences persistent neurological symptoms, it is crucial to seek medical attention immediately. At Singapore Brain Spine Nerves Center, our experienced team is dedicated to providing comprehensive and personalised care for patients with primary CNS lymphoma. Contact us today for expert consultation and compassionate support.