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EHA 2026 | Diagnosing PCNSL: key considerations and assessing for vitreoretinal involvement
Maurilio Ponzoni, MD, Vita Salute University San Raffaele, Milan, Italy, discusses key diagnostic considerations in primary central nervous system lymphoma (PCNSL), emphasizing prompt stereotactic biopsy before corticosteroid use. Prof. Ponzoni also highlights the importance of the slit lamp examination in assessing for vitreoretinal involvement and obtaining brain MRI in patients diagnosed with primary vitreoretinal lymphoma to assess for concurrent CNS disease. This interview took place at the 31st Congress of the European Hematology Association (EHA) in Stockholm, Sweden.
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Transcript
The diagnosis of PCNS cell is an urgent matter. Therefore, clinicians should expedite as much as they can to obtain a biopsy without using corticosteroids before taking a biopsy. Otherwise, we risk seeing necrotic tissue and it’s not informative. This is the only way in which they can speed up the diagnostic approach. Of course, this is an anatomical site which is problematic because you cannot remove an entire lesion...
The diagnosis of PCNS cell is an urgent matter. Therefore, clinicians should expedite as much as they can to obtain a biopsy without using corticosteroids before taking a biopsy. Otherwise, we risk seeing necrotic tissue and it’s not informative. This is the only way in which they can speed up the diagnostic approach. Of course, this is an anatomical site which is problematic because you cannot remove an entire lesion. Therefore, the gold standard approach right now is to perform a stereotactic biopsy. The vitreoretinal involvement is more than an expected common occurrence in patients with primary CNS lymphomas. The problem is that whenever you are diagnosed with a PCNSL, you should perform, as a staging purpose, any of the known staging procedures, but you have to add the slit lamp examination. And sometimes the patient presents with visual impairment. Therefore, the diagnosis is taken primarily on the vitreoretinal fluid. On that ground, when you diagnose a primary vitreoretinal lymphoma, you have to do the opposite. So you have to take an MRI of the brain, because very often the brain involvement is already present.
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