|
|
|
|
|
|
||
|
|
||||
|
|
||||
|
||||
Medical Neuro-Oncology |
Department of Neurology and Neuroradiology (S.S., M.K., B.S.-H.) and Department of Pathology, Division of Neuropathology (S.Z., C.S.), University of Heidelberg, Heidelberg 69120, Germany
1 Address correspondence and reprint requests to Stefan Schwarz, Department of Neurology, Klinikum Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Abstract
We describe the clinical, radiologic, and postmortem findings of a 42-year-old man with intravascular lymphomatosis. The patient presented with a conus medullaris syndrome followed by progressive, disseminated spinal and cerebral symptoms. Disseminated encephalomyelitis was suspected due to the clinical, radiologic, and cerebrospinal fluid findings and the results of a stereotactic brain biopsy, all of which were compatible with inflammatory CNS disease. Treatment with methylprednisolone and cyclophosphamide led to a temporary remission of symptoms. The patient died 13 months after onset of symptoms. The diagnosis of disseminated intravascular lymphomatosis was established after death.
References
Baumann, T.P., Hurwitz, N., Karamitopolou-Diamantis, E., Probst,
A., Herrmann, R., and Steck, A.J. (2000) Diagnosis and treatment
of intravascular lymphomatosis. Arch. Neurol.
57,374
-377.
Chapin, J.E., Davis, L.E., Kornfeld, M., and Mandler, R.N. (1995) Neurologic manifestations of intravascular lymphomatosis. Acta Neurol. Scand. 91,494 -499.[ISI][Medline]
Demirer, T., Dail, D.H., and Aboulafia, D.M. (1994) Four varied cases of intravascular lymphomatosis and a literature review. Cancer 73,1738 -1745.[CrossRef][ISI][Medline]
Fredericks, R.K., Walker, F.O., Elster, A., and Challa, V. (1991) Angiotropic intravascular large-cell lymphoma (malignant angioendotheliomatosis): Report of a case and review of the literature. Surg. Neurol. 35,218 -223.[Medline]
Glass, J., Hochberg, F.H., and Miller, D.C. (1993) Intravascular lymphomatosis: A systemic disease with neurologic manifestations. Cancer 71,3156 -3164.[CrossRef][ISI][Medline]
Hamada, K., Hamada, T., Satoh, M., Tashiro, K., Katoh, I.,
Naganuma, M., Shima, K., Ogata, A., and Nagashima, K. (1991) Two
cases of neoplastic angioendotheliomatosis with myelopathy.
Neurology 41,1139
-1140.
Harris, C.P., Sigman, J.D., and Jaeckle, K.A. (1994) Intravascular malignant lymphomatosis: Amelioration of neurological symptoms with plasmapheresis. Ann. Neurol. 35,357 -359.[CrossRef][ISI][Medline]
Hartung, H.P., and Grossman, R.I. (2001) ADEM:
Distinct disease or part of the MS spectrum? Neurology
56,1257
-1260.
Isaacson, P.G. (1995) The revised European-American lymphoma (REAL) classification. Clin. Oncol. 7, 347-348.[CrossRef]
Kepes, J.J. (1993) Large focal tumor-like demyelinating lesions of the brain: Intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? A study of 31 patients. Ann. Neurol. 33,18 -27.[CrossRef][ISI][Medline]
Levin, K.H., and Lutz, G. (1996) Angiotropic
large-cell lymphoma with peripheral nerve and skeletal muscle involvement:
Early diagnosis and treatment. Neurology
47,1009
-1011.
Nakahara, T., Saito, T., Muroi, A., Sugiura, Y., Ogata, M.,
Sugiyama, Y., and Yamamoto, T. (1999) Intravascular lymphomatosis
presenting as an ascending cauda equina: Conus medullaris syndrome: Remission
after biweekly CHOP therapy. J. Neurol. Neurosurg.
Psychiatry 67,403
-406.
Ojeda, V.J. (1983) Neoplastic angioendotheliosis of the spinal cord. Acta Neuropathol. (Berl.) 62,164 -166.[Medline]
Ossege, L.M., Postler, E., Pleger, B., Müller, K.-M., and Malin, J.P. (2000) Neoplastic cells in the cerebrospinal fluid in intravascular lymphomatosis. J. Neurol. 247,656 -658.[Medline]
Schwarz, S., Mohr, A., Knauth, M., Wildemann, B., and
Storch-Hagenlocher, B. (2001) Acute disseminated
encephalomyelitis: A follow-up study of 40 adult patients.
Neurology 56,1313
-1318.
Tucker, T.J., Bardales, R.H., and Miranda, R.N. (1999) Intravascular lymphomatosis with bone marrow involvement. Arch. Pathol. Lab. Med. 123,952 -956.[Medline]
Wildemann, B., Jansen, O., Haas, J., Vogt-Schaden, M.E., and Storch-Hagenlocher, B. (2001) Rapid distinction of acute demyelinating disorders and central nervous system lymphoma by molecular analysis of cerebrospinal fluid cells. J. Neurol. 248,127 -130.[Medline]
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
