Posttransplant primary CNS lymphoma

The records and neuro-imaging studies of 8 cases of posttransplant primary CNS lymphoma (PT-PCNSL) diagnosed at Mayo Clinic Rochester between 1970 and 1998 were reviewed retrospectively. All patients received organ transplant ation, Patients who had hematologic transplantation were not included in th e analysis. The median and mean age of the 4 men and 4 women was 45 years ( range, 34 to 50 years). The median duration of symptoms before diagnosis wa s 36 days (range, 5 to 98 days). At diagnosis, the neurologic examination w as focally abnormal in 6 of 8 patients. Compared with the initial computed tomographic study, MRI showed 25 additional brain lesions. Only 43.7% of le sions enhanced with contrast agent; of those that did, all but one were het erogeneous. Ependymal contact occurred in 5 patients. MRT lesion burden inc reased proportionally to the interval between scans. Diagnostic tissue was obtained by stereotactic biopsy from 6 patients and by open biopsy from 2, Hemorrhage occurred in the biopsy area in 4 patients who had stereotactic b iopsy and 2 died tall had normal coagulation studies). Slides available for review (7 patients) showed that the tumors were of CD20-positive lineage a nd were positive for Epstein-Barr virus, using in situ hybridization. Six p atients died. Median survival for the cohort was 13 weeks. PT-PCNSL has cli nical and imaging features distinct from typical PCNSL, In our series, (1) PT-PCNSL presented nonspecifically and progressed rapidly, (2) stereotactic brain biopsy had significant morbidity, and (3) despite multimodal therapy , survival was poor.