Primary central nervous system lymphoma and tumefactive demyelinating lesions in multiple sclerosis: a retrospective observational cohort study

Background: Differentiating primary central nervous system lymphoma (PCNSL) from tumefactive demyelinating lesions (TDLs) remains a major diagnostic challenge. Objective: Our study aimed to compare the differences in clinical observations, neuroimaging data, and pathological features between the PCNSL and TDLs, as well as their potential biomarkers. Method: This was a retrospective observational cohort study of 183 patients (97 PCNSL and 86 TDLs). Baseline clinical data were collected. Neuroimaging features were determined by MRI. Pathological characteristics were evaluated by using hematoxylin-eosin (HE) staining, and immunochemical staining of CD3 and CD20. Cerebrospinal fluid (CSF) and serum biomarkers were detected by using the commercial protein assay kit and the enzyme-linked immunosorbent assay. Results: Patients with PCNSL had an older onset age, with the mean age being 59 ± 10 years in the PCNSL group and 36 ± 8 years in the TDL group (p < 0.001). Upon MRI scans, brain lesions in PCNSL showed U-shaped hyperintense, while lesions in TDLs showed slightly diffuse hyperintense on diffusion-weighted imaging (DWI) sequence. PCNSL lesions showed obvious hyperintense and perifocal edema, while TDL lesions showed isointense with partial perifocal edema on fluid attenuated inversion recovery (FLAIR) sequences. CD20 was strongly positive, while CD3 was negative in PCNSL tissues, which was different from a lower CD20 and stronger CD3 levels in TDLs. IL-6 and IL-10 levels was higher in the CSF of PCNSL than TDLs. Conclusion: Careful and comprehensive evaluation of clinical, neuroimaging, and pathological features, and CSF IL-6 and IL-10 levels facilitates the differential diagnosis betweenPCNSL and TDLs.