ASH 2022 | Insights into the diagnosis of primary CNS lymphoma and challenges in this space

Primary central nervous system lymphoma is a rare and aggressive form of non-Hodgkin lymphoma, exclusively affecting the central nervous system that is the brain, meninges, spinal cord, and cerebral spinal fluid. The reason it’s a tricky disease is because often the diagnosis can be difficult to make. It can present in a range of ways, often with patients quite debilitated by the anatomical problems from their CNS lymphoma because of where it is in causing physical problems such as weakness and other issues. In order to diagnose central nervous system lymphoma, it is quite an undertaking. It requires a biopsy to show aggressive B-cell lymphoma within the CNS, and then patients also need to undergo full staging to make sure that it is truly a primary central nervous system lymphoma and there’s no evidence of disease elsewhere.

So, it means undertaking the full staging, including a PET scan, often a bone marrow biopsy, in some instances also, ultrasound of the testes to ensure there’s no other disease present. Even once the sample is taken to show the large B-cells by histology, it still is quite a difficult diagnosis to make because there are other lesions that can look similar on an MRI scan, such as glioblastoma and other non-lymphoma CNS diseases.