Clinicopathological features of neuropathy associated with lymphoma.
Minoru Tomita,Haruki Koike,Yuichi Kawagashira,Masahiro Iijima,Hiroaki Adachi,Jun Taguchi,Takenori Abe,Kazuya Sako,Yukiko Tsuji,Masanori Nakagawa,Fumio Kanda,Fusako Takeda,Masashiro Sugawara,Itaru Toyoshima,Naoko Asano,Gen Sobue +15 more
Reads0
Chats0
TLDR
The clinical, electrophysiological and histopathological features of 32 patients with neuropathy associated with non-Hodgkin's lymphoma that were unrelated to complications resulting from treatment for lymphoma are characterized.Abstract:
Lymphoma causes various neurological manifestations that might affect any part of the nervous system and occur at any stage of the disease. The peripheral nervous system is one of the major constituents of the neurological involvement of lymphoma. In this study we characterized the clinical, electrophysiological and histopathological features of 32 patients with neuropathy associated with non-Hodgkin’s lymphoma that were unrelated to complications resulting from treatment for lymphoma. Nine patients had pathologically-proven neurolymphomatosis with direct invasion of lymphoma cells into the peripheral nervous system. These patients showed lymphomatous cell invasion that was more prominent in the proximal portions of the nerve trunk and that induced demyelination without macrophage invasion and subsequent axonal degeneration in the portion distal from the demyelination site. Six other patients were also considered to have neurolymphomatosis because these patients showed positive signals along the peripheral nerve on fluorodeoxyglucose positron emission tomography imaging. Spontaneous pain can significantly disrupt daily activities, as frequently reported in patients diagnosed with neurolymphomatosis. In contrast, five patients were considered to have paraneoplastic neuropathy because primary peripheral nerve lesions were observed without the invasion of lymphomatous cells, with three patients showing features compatible with chronic inflammatory demyelinating polyneuropathy, one patient showing sensory ganglionopathy, and one patient showing vasculitic neuropathy. Of the other 12 patients, 10 presented with multiple mononeuropathies. These patients showed clinical and electrophysiological features similar to those of neurolymphomatosis rather than paraneoplastic neuropathy. Electrophysiological findings suggestive of demyelination were frequently observed, even in patients with neurolymphomatosis. Eleven of the 32 patients, including five patients with neurolymphomatosis, fulfilled the European Federation of Neurological Societies/Peripheral Nerve Society electrodiagnostic criteria of definite chronic inflammatory demyelinating polyneuropathy. Some of these patients, even those with neurolymphomatosis, responded initially to immunomodulatory treatments, including the administration of intravenous immunoglobulin and steroids. Patients with lymphoma exhibit various neuropathic patterns, but neurolymphomatosis is the major cause of neuropathy. Misdiagnoses of neurolymphomatosis as chronic inflammatory demyelinating polyneuropathy are frequent due to a presence of a demyelinating pattern and the initial response to immunomodulatory treatments. The possibility of the concomitance of lymphoma should be considered in various types of neuropathy, even if the diagnostic criteria of chronic inflammatory demyelinating polyneuropathy are met, particularly in patients complaining of pain.
* Abbreviations
: CIDP
: chronic inflammatory demyelinating polyneuropathy
EFNS/PNS
: European Federation of Neurological Societies/Peripheral Nerve Society
FDG
: fluorodeoxyglucose
IVIg
: intravenous immunoglobulinread more
Citations
More filters
Journal ArticleDOI
Chemotherapy-induced peripheral neuropathy: A current review
TL;DR: The approach to peripheral neuropathy in patients with cancer is discussed and the clinical phenotypes and pathomechanisms of specific neurotoxic chemotherapeutic agents are addressed.
Journal ArticleDOI
The diagnostic challenge of small fibre neuropathy: clinical presentations, evaluations, and causes
Astrid Juhl Terkelsen,Astrid Juhl Terkelsen,Páll Karlsson,Páll Karlsson,Giuseppe Lauria,Giuseppe Lauria,Roy Freeman,Nanna B. Finnerup,Nanna B. Finnerup,Troels S. Jensen,Troels S. Jensen +10 more
TL;DR: The diagnostic tests to identify small fibre neuropathy include skin biopsy, quantitative sensory, and autonomic testing, and additional tests, such as those measuring small fibre-related evoked potentials and corneal confocal microscopy, might contribute to a better understanding of these neuropathies.
Journal ArticleDOI
Paraneoplastic neurological syndromes in Hodgkin and non-Hodgkin lymphomas
TL;DR: The type and frequency of PNSs are different between HL and NHL; whereas LE and PCD occur almost exclusively in patients with HL, sensorimotor neuropathies and dermatomyositis are more frequent in NHL.
Journal ArticleDOI
Transthyretin amyloid polyneuropathies mimicking a demyelinating polyneuropathy
Pierre Lozeron,Louise-Laure Mariani,Pauline Dodet,Guillemette Beaudonnet,Marie Théaudin,Clovis Adam,Bertrand Arnulf,David Adams +7 more
TL;DR: Pain, dysautonomia, small fiber sensory loss above the wrists, upper limb weakness, and absence of ataxia were predictors of demyelinating TTR-FAP and marked electrophysiologic axonal loss are red flag symptoms that should alert to this diagnosis and prompt TTR gene sequencing.
Neuropathy associated with lymphoma.
TL;DR: In this paper, the authors performed histological and electron microscopic studies on sural nerve biopsy material from five subjects, and the pathological abnormalities of the myelinated fibres were those of axonal degeneration and segmental demyelination.
References
More filters
Journal ArticleDOI
A revised European-American classification of lymphoid neoplasms : a proposal from the international lymphoma study group
Nancy L. Harris,Elaine S. Jaffe,Harald Stein,Peter M. Banks,John K.C. Chan,Michael L. Cleary,Georges Delsol,C. De Wolf Peeters,Brunangelo Falini,K C Gatter +9 more
Journal ArticleDOI
Interobserver agreement for the assessment of handicap in stroke patients.
TL;DR: The results confirm the value of the modified Rankin scale in the assessment of handicap in stroke patients; nevertheless, further improvements are possible.
Journal ArticleDOI
A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma study group
TL;DR: An international review of lymphomas found that each of us had independently evolved ways of viewing these diseases that were essentially identical, and there was little divergence between European and US participants.
Journal ArticleDOI
A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin's lymphoma
Journal ArticleDOI
Assessment of current diagnostic criteria for guillain-barre syndrome
TL;DR: Criteria for the diagnosis of Guillain‐Barré syndrome are reaffirmed and Electrodiagnostic criteria are expanded and specific detail added.