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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 3  |  Page : 315-317

Mantle cell lymphoma presented with unilateral palsy: A case report and review of literature


Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, China

Date of Submission10-Apr-2014
Date of Decision27-Apr-2014
Date of Acceptance29-May-2014
Date of Web Publication18-Jul-2014

Correspondence Address:
Jing Huang
Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai
China
Xue-Yuan Liu
Department of Neurology, Shanghai Tenth People's Hospital of Tongji University, Shanghai
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.137002

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How to cite this article:
Wu RH, Chen YJ, Huang J, Liu XY. Mantle cell lymphoma presented with unilateral palsy: A case report and review of literature. Neurol India 2014;62:315-7

How to cite this URL:
Wu RH, Chen YJ, Huang J, Liu XY. Mantle cell lymphoma presented with unilateral palsy: A case report and review of literature. Neurol India [serial online] 2014 [cited 2021 Jan 24];62:315-7. Available from: https://www.neurologyindia.com/text.asp?2014/62/3/315/137002


Sir,

Mantle cell lymphoma (MCL) is a rare subtype of lymphoma-one of the most aggressive B-cell lymphomas-and accounts for 5-7% of non-Hodgkin lymphomas in adults. [1] We report a case of MCL presented with unilateral palsy.

A 56-year-old male presented with acute onset weakness in the left limbs and numbness in the left palm and sole. He also reported voiding difficulty and zonesthesia in the abdominal area. Magnetic resonance imaging (MRI) of the spine revealed multiple lesions in cervical and thoracic spinal cord [Figure 1]. Diagnosis of MCL was supported by flow cytometric analysis of cerebrospinal fluid, bone marrow test, and fluorescent in situ hybridization (FISH) of peripheral blood [Figure 2]. Treatment protocol was R-CHOP-VM-26. Clinical recovery was assessed by symptoms, signs, and reviewing MRI results [Figure 3].
Figure 1: MRI images of cervical and thoracic spines before treatment (a) T1WI of the cervical spine. (b) T2WI of the cervical spine. (c) Contrastenhanced MRI of cervical spine. (d) T1WI of the thoracic spine. (e) T2WI of the thoracic spine. (f) Contrast-enhanced MRI of the thoracic spine. Lesions were indicated by the arrows

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Figure 2: FISH test of the peripheral blood Abnormal signal patterns of t (11;14) with the co-localization of green and orange signals (one red signal for CCND1 probe, one green signal for IGH probe, and two yellow fusion signals for IGH/CCND1 fusion gene were shown at a magnifi cation of ×630, which was indicated by the arrow

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Figure 3: MRI images of cervical and thoracic spine after treatment (a) T1WI of the cervical spine. (b) T2WI of the cervical spine. (c) Contrast-enhanced MRI of cervical spine. (d) T1WI of the thoracic spine. (e) T2WI of the thoracic spine. (f) Contrast-enhanced MRI of the thoracic spine. Lesions were indicated by the arrows

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Contrast-enhanced MRI is the preferred diagnostic modality to detect central nervous system (CNS) lymphoma. On non-contrast MRI, the lesions are homogeneously iso-intense or hypo-intense on T1WI and hyper-intense on T2WI. These lesions may be either circumscribed or exhibit irregular borders and show various extents of surrounding edema in 90% of the lesions. [2] However, in this patient, MRI of the spinal cord did not show any of these features. Because of the diagnostic possibility of CNS, lymphoma had not been considered at the first instance until the follow-up test results confirmed this possibility. FISH is a more feasible and repeatable technique with reliable sensitivity and specificity, which is widely used in the diagnosis leukemia and lymphomas. FISH testing of peripheral blood revealed IGH/CCND fusion gene formed by t (11:14) translocation [Figure 2], suggesting the diagnosis MCL. The positive predictive value of FISH probe to determine CCND1/IGH has been 96%, and the false positive rate has been <1%. [3] The clinical course and outcome in this patient also support the diagnosis of MCL. The most frequent clinical manifestations of CNS are related to elevated intracranial pressure or meningeal infiltration and include mental status changes, headache, and cranial nerve palsies. [4] However, the presenting features in this patient were more suggestive of spinal cord. We recommend that CNS assessment should be part of the initial routine examination of patients with MCL. This patient also suggests the spectrum of clinical manifestations for MCL.

 
  References Top

1.Schmidt C, Dreyling M. Therapy of mantle cell lymphoma: Current standards and future strategies. Hematol Oncol Clin North Am 2008;22:953-63.  Back to cited text no. 1
    
2.Baraniskin A, Deckert M, Schulte-Altedorneburg G, Schlegel U, Schroers R. Current strategies in the diagnosis of diffuse large B-cell lymphoma of the central nervous system. Br J Haematol 2012;156:421-32.  Back to cited text no. 2
    
3.Caraway NP, Gu J, Lin P, Romaguera JE, Glassman A, Katz R. The utility of interphase fluorescence in situ hybridization for the detection of the translocation t (11;14) (q13;q32) in the diagnosis of mantle cell lymphoma on fine-needle aspiration specimens. Cancer 2005;105:110-8.  Back to cited text no. 3
    
4.Gill S, Herbert KE, Prince HM, Wolf MM, Wirth A, Ryan G, et al. Mantle cell lymphoma with central nervous system involvement: Frequency and clinical features. Br J Haematol 2009;147:83-8.  Back to cited text no. 4
    


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