Mycosis fungoides metastasizing to the brain parenchyma: Case report

Martin Zonenshayn, Suash Sharma, Kenneth Hymes, Edmond A. Knopp, John G. Golfinos, David Zagzag

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

OBJECTIVE AND IMPORTANCE: Mycosis fungoides is a rare T-cell lymphoma of the skin that can, in one-half to three-quarters of patients suffering from this disease, involve the viscera in late stages of the disease. Although autopsy series performed more than 2 decades ago showed that the incidence of metastatic mycosis fungoides to the central nervous system is approximately one of seven, a total of only several dozen cases have been reported to date. As compared to meningeal involvement, intraparenchymal metastases are even rarer. We describe a biopsy-proven case of intraparenchymal central nervous system mycosis fungoides in a patient with nonprogressive skin involvement and no detectable visceral involvement, and we present a review of the relevant literature. CLINICAL PRESENTATION: A 68-year-old man, 3 years after the diagnosis of his skin disease, developed fatigue, confusion, and frontal lobe signs without the presence of cerebriform cells in the peripheral blood or any other clinical evidence of visceral involvement. Magnetic resonance imaging revealed a diffuse area of increased T2-weighted signal involving the white matter of both cerebral hemispheres as well as a focal area of T2 abnormality along the body of the corpus callosum. The radiological differential diagnosis was either leukodystrophy caused by chemotherapy, progressive multifocal leukoencephalopathy, or glioma with associated white matter changes. INTERVENTION: A stereotactic serial brain biopsy revealed diffuse perivascular infiltrates of atypical lymphocytes, as well as several large cells with cerebriform nuclei consistent with mycosis fungoides. The cells were immunoreactive for LCA, MT1, UCHL1, and CD3. CONCLUSION: We stress the importance of including mycosis fungoides as part of the differential diagnosis for a brain lesion in patients with cutaneous T-cell lymphoma, because treatments do exist, and we conclude that a serial stereotactic biopsy may be necessary to provide a definitive diagnosis.

Original languageEnglish (US)
Pages (from-to)933-937
Number of pages5
JournalNeurosurgery
Volume42
Issue number4
DOIs
StatePublished - Apr 1 1998

Fingerprint

Mycosis Fungoides
Brain
Biopsy
Central Nervous System Fungal Infections
Differential Diagnosis
Progressive Multifocal Leukoencephalopathy
Cutaneous T-Cell Lymphoma
Skin
Viscera
T-Cell Lymphoma
Corpus Callosum
Cerebrum
Frontal Lobe
Skin Diseases
Glioma
Fatigue
Autopsy
Central Nervous System
Magnetic Resonance Imaging
Lymphocytes

Keywords

  • Brain neoplasm
  • Cutaneous T-cell lymphoma
  • Mycosis fungoides

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Zonenshayn, M., Sharma, S., Hymes, K., Knopp, E. A., Golfinos, J. G., & Zagzag, D. (1998). Mycosis fungoides metastasizing to the brain parenchyma: Case report. Neurosurgery, 42(4), 933-937. https://doi.org/10.1097/00006123-199804000-00144

Mycosis fungoides metastasizing to the brain parenchyma : Case report. / Zonenshayn, Martin; Sharma, Suash; Hymes, Kenneth; Knopp, Edmond A.; Golfinos, John G.; Zagzag, David.

In: Neurosurgery, Vol. 42, No. 4, 01.04.1998, p. 933-937.

Research output: Contribution to journalArticle

Zonenshayn, M, Sharma, S, Hymes, K, Knopp, EA, Golfinos, JG & Zagzag, D 1998, 'Mycosis fungoides metastasizing to the brain parenchyma: Case report', Neurosurgery, vol. 42, no. 4, pp. 933-937. https://doi.org/10.1097/00006123-199804000-00144
Zonenshayn, Martin ; Sharma, Suash ; Hymes, Kenneth ; Knopp, Edmond A. ; Golfinos, John G. ; Zagzag, David. / Mycosis fungoides metastasizing to the brain parenchyma : Case report. In: Neurosurgery. 1998 ; Vol. 42, No. 4. pp. 933-937.
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