| Identifier |
primary_cns_lymphoma_lee |
| Title |
Primary CNS Lymphoma |
| Creator |
Andrew G. Lee, MD; Anirudh Mukhopadhyay |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (AM) Class of 2023, Baylor College of Medicine, Houston, Texas |
| Subject |
Lymphoma; Cancer; Central Nervous System |
| Description |
Summary: • Most of the primary CNS lymphoma is diffuse large non-Hodgkin's B cell lymphoma • Primary CNS lymphoma can be anywhere in the central nervous system (brain, peri-ventricular white matter, etc.) o Lots of surrounding peritumoral edema can be seen on MRI • Most patients with primary CNS lymphoma are asymptomatic. Symptomatic patients will usually have bilateral disease. • If the primary CNS lymphoma is in the eye, pars plana vitrectomy (PPV) can be used to get the diagnosis rather than brain biopsy o Useful since we want to have directed ocular therapy if we have eye involvement |
| Transcript |
All right, today I'm going to be telling you what an ophthalmologist needs to know about primary CNS lymphoma. We're only talking about primary today because there are secondary CNS lymphomas that come from elsewhere. Today's topic is primary, primary. And most of the primary CNS lymphoma is a very specific type, which is diffuse large non Hodgkin's B cell lymphoma. So it's diffuse large B cell, non Hodgkin's lymphoma. And the way this comes to us is it can be anywhere in the central nervous system, and that means it can be in your brain and it's usually peri-ventricular in the white matter adjacent to the ventricle. There's a mass, there's usually a lot of surrounding peritumoral edema on the MRI scan and it enhances and in the eye that can be primary also, which is primary intraocular lymphoma. But the intraocular lymphoma is probably a subset of CNS lymphoma. So that's why it's sometimes referred to as CNS and eye even though the eye is CNS. And so when we see a patient who's referred for primary CNS lymphoma, what are we looking for is those cells in the anterior chamber or the cells might be in the vitreous cells or the lymphoma can be under the retina or in the choroid. So it can be vitreoretinal or it can be uveal tract. So the diffuse large B cell lymphoma is infiltrating neoplasm that it can be in the brain, in the front of the eye, or in the back of the eye. And so when we are called to look at primary CNS lymphoma patients, the patient may or may not have symptoms. In fact, most of them don't have symptoms. But if they do have symptoms, the disease is usually bilateral and usually very vague symptoms like floaters or the vitreous cell, or they might just have blurry vision. And we're going to be looking in the anterior and the poster segment because what we're looking for is that intraocular lymphoma. And the reason this is important is if we see it in the eye, we might be able to do a diagnostic pars plana vitrectomy (PPV) to get the diagnosis rather than biopsying the brain lesion, especially if the brain lesion is in a bad place, eloquent brain or difficult to access so we can get the diagnosis. The other reason to do it is when we treat the brain lesion, we want to have directed ocular therapy if we have eye involvement. So the eyes involved, we want to treat the eye. If the eye is not involved, we don't have to do external beam radiation therapy or do intra-vitriol methotrexate, we can just do treatment of the brain, intravenous or intrathecal methotrexate and external beam radiation therapy to the brain lesion. And then the last reason to do it is it helps make the diagnosis because we see it in the eye and in the brain and it's diffuse large, B cell lymphoma. You really don't know whether it's primary or secondary. So they're going to be looking elsewhere, of course, but in the primary form, it's confined to the eye and the CNS. In the secondary forms that comes from elsewhere. So that can be extra nodal or nodal that can be from anywhere where there's lymph nodes. And so you really need to know about intraocular lymphoma, both for diagnostic purposes to help with the treatment and also change the treatment even if the patient is asymptomatic. |
| Date |
2021-04 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6228rcw |
| Setname |
ehsl_novel_lee |
| ID |
1680619 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6228rcw |
