Search NEL Online

Case Reports 2015; 36(2): 124-126 PubMed PMID: 26071579 Citation  Keywords:  Central Nervous System Neoplasms:diagnosis, Demyelinating Diseases:diagnosis, Fatal Outcome, Female, Humans, Lymphoma, Non-Hodgkin:diagnosis, Middle Aged,.   

: We report a case of histopathologically-confirmed primary central nervous system lymphoma who was initially diagnosed as demyelinating encephalopathy. A 58-year-old woman was admitted with confusion and left hemiparesis. Head MR showed abnormal flaky hypointense T1 and hyperintense T2 signals at right thalamus, splenium of corpus callosum, bilateral cerebral peduncle, pons, medulla oblongata, basal ganglia and right corona radiata. Her mental status improved a little and she was discharged from hospital after neuroprotective treatment. 10 days after her discharge, her confusion appeared again with hallucination and unsteady walking. Pathological examination revealed non-Hodgkin's lymphoma (WHO classification: DLBCL). The patient continued to deteriorate after the surgery and died 10 days later....

Read abstract  Full text PDF

Journal Article 2014; 35(7): 613-618 PubMed PMID: 25617885 Citation  Keywords:  Adult, Aged, Aged, 80 and over, Biopsy:adverse effects, Brain Neoplasms:mortality, Female, Humans, Lymphoma:mortality, Magnetic Resonance Imaging:methods, Male, Middle Aged, Morbidity, Retrospective Studies, Risk Factors, Stereotaxic Techniques:adverse ef.   

OBJECTIVES: Stereotactic biopsy is a suitable method for sampling intrinsic brain lesions. Although this method is considered to be a safe procedure, some risk of complications still exists. The aim of the study was to retrospectively assess the morbidity and mortality of MRI-guided stereotactic biopsy of lesions which were histologically proven to be brain lymphoma.

METHODS: We retrospectively studied all accessible medical records for patients who had undergone MRI-guided stereotactic biopsy of brain lesions with histologically proven brain lymphoma from January 2007 to December 2012. Our cohort included 45 patients, 27 males and 18 females, aged 23-84 (63±14) years.

RESULTS: Forty-nine biopsies were carried out on 45 patients; the average number of tissue specimens was 3±1. The diagnostic yield of the stereotactic biopsy was 92%. Overall major morbidity directly related to stereotactic biopsy of brain lymphoma was 6.1% (3 cases) including 4.1% mortality (2 cases). Both deaths after the stereotactic procedure were due to intracranial hemorrhage and subsequent complications and both these patients had a history of treatment of systemic lymphomas. In one patient the stereotactic biopsy was complicated by a brain abscess which was successfully treated.

CONCLUSION: Stereotactic biopsy is still a mandatory diagnostic procedure for primary brain lymphomas, with an acceptable risk of complications. However, according to our results, the risk of complications can be higher in patients who have previously been treated for secondary lymphomas....

Read abstract  Full text PDF

Journal Article 2012; 33(5): 511-516 PubMed PMID: 23090269 Citation  Keywords:  Adenocarcinoma, Follicular:epidemiology, Adult, Aged, Biopsy, Fine-Needle:statistics & numerical data, Carcinoma, Medullary:epidemiology, Carcinoma, Papillary:epidemiology, Carcinoma, Squamous Cell:epidemiology, Female, Humans, Lymphoma, Non-Hodgkin:epide.   

OBJECTIVE: We aimed to evaluate the prognostic value of thyroid fine needle aspiration biopsy (FNAB) in the diagnosis of pathologic lesions.

METHODS: Data from 1 078 consecutive patients (female : male ratio, 9:1) who underwent thyroidectomy were retrospectively analyzed. All patients had preoperative thyroid FNAB. Unilateral and bilateral FNAB were performed in 872 and 206 patients, respectively, resulting in 1 284 cytologic aspirates, which were compared to postoperative histology. Risk factors for malignancy (age, sex, single nodule, or nodule in multinodular goiter) were evaluated.

RESULTS: 203 (15.81%) aspirates were non-diagnostic. 768 (59.81%) were benign; 112 (8.72%) were atypical; 170 (13.24%) were follicular neoplasms, 5 (0.4%) had suspicion of malignancy; and 26 (2.02%) were malignant tumors on FNAB. The calculated risk of malignancy in each group was: 1.97%, 1.84%, 7.15%, 12.35%, 60%, and 100%. There were 2.02% false negative and 0.15% false positive results. Diagnostic discrepancies occurred in the follicular neoplasm group, of 86 biopsies (0.15%).

CONCLUSION: FNAB is the primary method of preoperative diagnostics of thyroid tumors, as it allows many patients to avoid thyroidectomy. In addition, it helps the operating surgeon to decide the extent of surgical resection....

Read abstract  Full text PDF

Case Reports 2008; 29(6): 867-870 PubMed PMID: 19112415 Citation  Keywords:  Adult, Brain Neoplasms:complications, Central Nervous System Neoplasms:complications, Humans, Lymphoma, B-Cell:complications, Magnetic Resonance Imaging, Male, Multiple Sclerosis, Relapsing-Remitting:complications,.   

: We present the patient with the diagnosis of multiple sclerosis (MS), relapsing-remitting form with long lasting remission. Unexpectedly, this patient presented dramatical clinical deterioration and revealed clinical symptoms such as bradypsychia, cognitive symptoms, central vestibulare syndrome, spastic quadruparesis. Clinical findings suggested secondary progressive MS, but MRI called in question this diagnosis. The MRI appearance suggested, that MS had been complicated by a different brain pathological lesion, and the brain biopsy was indicated. A histological examination confirmed primary CNS lymphoma (PCNSL). This case exemplifies important aspects of clinical neurology. A re-evaluation of the diagnosis of MS should always be performed in a patient when new symptoms are presented that are unusual or could be due to other pathological processes. MRI offers the highly sensitive way to detect the coexistence of MS and other brain disease. Primary goal of imaging modalities is differential diagnosis between demyelinating diseases, such as MS and other brain lesions. Advanced focus demand contrast- enhancing and mass- effect lesions. It is important to realize, that contrast-enhancement and brain edema may be mitigated by treatment with corticosteroids. In some cases a brain biopsy is needed....

Read abstract  Full text PDF

Clinical Trial 2005; 26(2): 136-142 PubMed PMID: 15855885 Citation  Keywords:  Adult, Aged, Alcohol Drinking:urine, Body Mass Index, Circadian Rhythm:physiology, Electromagnetic Fields, Female, Humans, Lymphoma:urine, Male, Melatonin:analogs & derivatives, Middle Aged, Reference Values, Statistics, Nonparametric,.   

OBJECTIVES: Exposure to extremely low frequency electromagnetic fields (ELF-EMF) has been suggested to suppress melatonin secretion, which might result in higher cancer risks because of its missing oncostatic action. We investigated the effects of residential exposure to ELF-EMF on the excretion of urinary 6-sulfatoxymelatonin (6-OHMS), the major melatonin metabolite, as an indicator of nocturnal melatonin secretion.

METHODS: 6-OHMS was measured in two spot urine samples, collected at 22.00 h and 08.00 h, in 29 men and 22 women. Spot ELF-EMF measurements were conducted at the centre and the four angles of the living room, the bedroom, and the kitchen of study subjects at low current configuration (all lights and appliances turned off), and they were repeated immediately at high current configuration (all lights and appliances turned on).

RESULTS: Risk of a reduced 6-OMHS nocturnal secretion was elevated for daily alcohol intake (OR = 6.4; 95%C.I. 1.4,33.1), and body mass index (BMI) above the median (OR = 2.2; 95%C.I. 0.5,9.6). Risk of disrupted rhythm of 6-OHMS excretion was moderately elevated for domestic ELF-EMF exposure above the upper tertile at low current configuration (OR = 2.6; 95%C.I. 0.4,15.7).

CONCLUSION: Alcohol consumption, BMI, and gender seem to affect nocturnal melatonin secretion, while an effect of residential exposure to ELF-EMF is uncertain. Future studies should properly account for the effect of such variables, when addressing the hypothesis of disturbances in melatonin secretion as a plausible explanation for the reported excess risk of several tumoral diseases associated with low level ELF-EMF exposure....

Read abstract  Full text PDF