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Updated: Feb 2, 2026
09:02
Immunoglobulin Gene Sequence Analysis In Chronic Lymphocytic Leukemia: From Patient Material To Sequence Interpretation
Published on: November 26, 2018
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Brain invasion by chronic lymphocytic leukemia.
Ryohei Otani1,2, Takeo Uzuka1, Hadzki Matsuda1
1Department of Neurosurgery, Dokkyo Medical University, Mibu-machi, Japan.
Summary
Rare brain invasion by chronic lymphocytic leukemia (CLL) occurred in a patient with progressive mental disturbance. MRI showed lesions mimicking demyelination, but biopsy confirmed CLL infiltration, highlighting diagnostic challenges.
Area of Science:
- Neurology
- Hematology
- Oncology
Background:
- Chronic lymphocytic leukemia (CLL) rarely invades the central nervous system.
- Brain invasion by CLL presents diagnostic challenges, often mimicking other neurological conditions.
Observation:
- A 61-year-old woman with a 14-year history of CLL presented with progressive mental disturbance.
- Brain MRI revealed discontinuous ring-enhancing lesions with an "open ring" sign, initially suggesting a demyelinating disorder.
- Histological examination of a biopsied specimen confirmed infiltration by CLL cells (CD5, CD20, CD23 positive).
Findings:
- CLL cells infiltrated the Virchow-Robin space and brain parenchyma, compressing and occluding arterioles.
- CD163-positive cells were observed in the brain parenchyma.
- Myelin staining revealed myelinoclasis in the affected brain tissue, correlating with MRI findings.
Implications:
- The MRI "open ring" sign in this case likely represented myelinoclasis due to CLL brain invasion.
- This case underscores the importance of considering lymphoma, specifically CLL, in the differential diagnosis of atypical brain lesions, even with non-specific MRI findings.
- Accurate diagnosis requires integrating imaging with histopathological confirmation.
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