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.