Abstract Details

Title Clinical Characteristics of Primary T-cell Lymphoma of the Central Nervous System

Topic Neuro-oncology

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-016

Objective To characterize clinical presentation, imaging, and laboratory characteristics of patients with primary central nervous system (CNS) T-cell lymphoma (TCL).

Background Primary CNS TCL is a rare subset of an uncommon condition, as most primary CNS lymphomas are B-cell in origin. The rarity of literature creates diagnostic dilemmas in patients presenting with undifferentiated brain lesions, often delaying diagnosis.

Design/Methods This is a descriptive study of primary CNS TCL cases evaluated within Mayo Clinic between 1/1/2005 and 6/30/2023, highlighting demographics, clinical presentation, neuroimaging, and laboratory features. Pathologically confirmed diagnosis was required for inclusion.

Results

Thirteen patients with primary CNS TCL were identified. Ten (77%) were male with a median age of 43 (IQR 32 – 52) at initial presentation. Presenting symptoms included seizure (5), focal neurologic deficit (4), headache (3), and cognitive impairment (1). Ten (77%) developed seizures during their course. All patients had enhancing lesions and supratentorial involvement, with corpus callosum infiltration in 5 (38%). Nine (69%) had blooming artifact on susceptibility weighted imaging. Eight (62%) had multiple lesions at presentation.

Eleven patients had cerebrospinal fluid testing, with 1 having cytology demonstrating nonspecific non-hematolymphoid malignant cells. Prior to biopsy confirmation, 6 patients received alternative diagnoses: chronic Lyme, chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS), CNS vasculitis, demyelinating disease, and encephalitis. All patients were diagnosed via brain biopsy, with 4 (31%) requiring two biopsies for diagnosis. Those requiring a second biopsy received an incorrect diagnosis following initial biopsy. Median time from presentation to diagnosis was 63 days (IQR 24 – 180).

Conclusions Primary CNS TCL should be considered for patients with enhancing brain lesions. A high index of suspicion is necessary, and over 30% of our patients required repeat brain biopsy for diagnosis. Diagnostic clues include supratentorial location, multiple lesions, callosal involvement, and intralesional blooming artifact on susceptibility weighted imaging.

Authors/Disclosures
Hannah Padilla PRESENTER	Miss Padilla has nothing to disclose.
Kim Griffin, MD (Mayo Clinic)	Dr. Griffin has nothing to disclose.
Derek Johnson, MD (Mayo Clinic)	Dr. Johnson has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Telix.
Reece Hass, DO (Mayo Clinic, Rochester)	Dr. Hass has nothing to disclose.
Tony Zhang, MBChB	Dr. Zhang has nothing to disclose.
Ivan D. Carabenciov, MD (Mayo Clinic)	Dr. Carabenciov has nothing to disclose.
Rafid Mustafa, MD (Mayo Clinic, Department of Neurology)	Dr. Mustafa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon Therapeutics. Dr. Mustafa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for PicnicHealth. Dr. Mustafa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Annexon Biosciences. Dr. Mustafa has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Annexon Biosciences.
Michel Toledano, MD (Mayo Clinic)	Dr. Toledano has nothing to disclose.

��ɫ��

��ɫ��