Skip to main content
  • Brain Lesions in Patients with a History of Hematologic Malignancy: How Often is it a Second Pathology?

    Final Number:

    Kendall Snyder MD; Joshua David Hughes MD; Michael J. Link MD; Ian F. Parney MD, PhD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Patients with a history of hematologic malignancy can develop new or recurrent brain lesions. When CSF or ocular studies cannot determine whether the lesion represents recurrent lymphoma or a second pathology, brain biopsy is often utilized. No study has examined how frequently a recurrent or second pathology is encountered.

    Methods: Electronic medical records were searched from 2000-2016 for patients with a prior diagnosis of systemic or CNS hematologic malignancy that developed a new or recurrent CNS lesion and underwent cranial biopsy.

    Results: Fifty patients were found; forty-nine biopsies were diagnostic. Regarding patient history, forty-eight had systemic and 1 primary CNS lymphoma. Forty-four(90%) patients had a non-Hodgkin’s(NHL) lymphoma sub-type; the majority were diffuse large B-cell lymphoma[DLBCL,n=34,(77%)]. Other hematologic malignancies included Hodgkin’s lymphoma(HL,n=3), acute promyleocytic leukemia(APL,n=1), and low-grade B-cell lymphoprolifereative disorder(LG-BCLD,n=1). Thirty-four patients(69%) had a brain biopsy consistent with their prior lymphoma; all had a history of DLBCL, except one with a history of small lymphocytic lymphoma. Eleven patients(22%) had a biopsy different than their prior lymphoma. All patients had non-DLBCL, except for one patient. Four (8%) patients had transition from a non-DLBCL type to DLBCL. Comparing patients with a history of DLBCL vs non-DLBCL, there was a statistically significant difference for a brain biopsy showing a second or transitional pathology in patients with non-DLBCL (p=0.001).

    Conclusions: In our cohort of patients with a history of hematologic malignancy, we found the rate of a different or transitional brain pathology was 31%. All patients, except one, with a second pathology had a history of non-DLBCL types. All patients, except one, with a history of DLBCL had a brain lesion consistent with their lymphoma history. Patients with a history of DLBCL were likely to have a brain lesion consistent with their prior history.

    Patient Care: This research improves our understanding of the need for brain biopsy in patients with known lymphoma who develop a brain lesion.

    Learning Objectives: Describe the frequency of which a recurrent or second brain pathology is encountered in patients with a history of hematologic malignancy.


We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy