case_images: PMC10668066_01
case_images: Three clinical cases. The first patient received 4 mg Dexamethasone 3 times a day for 7 days after the first MRI (A). The second MRI (B) was performed shortly before the planned biopsy 7 days after the first MRI. Corticosteroid treatment was still ongoing. The second patient received 4 mg Dexamethasone 3 times a day for 10 days between the two MRIs (C, D). Despite the corticosteroid therapy there was no regression on the follow-up MRI and surgery was scheduled for the following day. The third patient received 8 mg Dexamethasone 2 times a day for 7 days after the first MRI scan (E). The second MRI showed distinct regression (F). Corticosteroid treatment still was not tapered. Participating clinics were asked how each case would be treated at their institution.
case_images: gr1.jpg
case_images: PMC10668066_01_gr1.jpg
case_images: fig1
case_images: The first case (Fig. 1 A and B) of a PCNSL described a rather small target for biopsy which also showed distinct regression after CST. The lesion in the second case (Fig. 1 C and D) showed no response to CST. The third case (Fig. 1 E and F) showed a patient who still had a promising target for biopsy despite significant regression of a large frontal lesion after CST.
case_images: General approach on how to treat a patient with suspected PCNSL after preoperative CST for low-, intermediate- and high-volume centers in Europe. High-volume centers generally tended to pause CST more often than low-/intermediate-volume centers (A). There was significant discrepancy between low-, intermediate- and high-volume centers in the management of the exemplary cases and therefore no consensus either in or between the groups (B).
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case_images: PMC10668066_01_gr2.jpg
case_images: fig2
case_images: Fig. 2, B shows the different answers for low-, intermediate- and high-volume centers.
case_images: General treatment strategy and management of the clinical cases from Fig. 1. There was significant discrepancy between general approach and the treatment choices in the exemplary cases.
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case_images: PMC10668066_01_gr3.jpg
case_images: fig3