Nodular intracerebral lesions can reveal an asymptomatic systemic lymphoma

To investigate whether a systemic workup is useful to assess the primary or secondary nature of brain lymphoma in immunocompetent patients suffering from nodular intracerebral lesions.

We retrospectively studied a consecutive series of 62 immunocompetent patients suffering from non-Hodgkin's brain lymphoma and analyzed two parameters: (1) the results of a partial systemic workup and (2) the pattern of relapse for all patients who are currently followed up or were so until death.

The workup was conducted with chest X-ray and blood analysis in all cases, total body CT scan in 31 cases, bone marrow biopsy in 30 and serum lactate dehydrogenase in 29. Asymptomatic systemic lymphomatous lesions were found in 9.6% of the cases (n=6/62). Two were nodal lymphomas and four were extranodal (maxillary sinus, testis, cutaneous and osseous). No systemic localization was observed during the follow-up of patients in whom the primary nature of the lymphoma was assessed after their initial negative workup (56/62). In this group, all relapses occurred within the central nervous system, even in those exclusively treated with cerebral radiotherapy (29/56).

Our results indicate that nodular intracerebral lesions can reveal asymptomatic systemic lymphoma. When brain lymphoma is suspected or diagnosed, systemic workup including clinical, biological and radiological examinations is mandatory before assessing the primary or secondary nature of the disease. Node areas, skin, testis, Waldeyer's ring and adjacent structures are of special interest and should be carefully explored.