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seems to be the most important factor, coupled with the age of the patient (most are under 5 years old) It has been speculated that radiation breaks down the blood-brain barrier, allowing methotrexate to injure myelin Lack of circulation in the necrotic zones prevents the usual liquefaction and eventual cavitation In this respect it resembles radiation necrosis Involvement of the Nervous System in Systemic Lymphoma Extradural compression of the spinal cord or cauda equina is the most common neurologic complication of all types of lymphoma, the result of extension from vertebrae or paravertebral lymph nodes Treatment is radiation or, if a tissue diagnosis is lacking, surgical decompression Systemic lymphoma rarely metastasizes to the brain In a review of more than 100 autopsies at the Mallory Institute of Pathology; our colleague R D Adams observed only a half-dozen instances where patients with lymphomas had deposits of tumor cells in the brain, and in none of these cases were they from multiple myeloma or plasmacytoma (Sparling et al) In the series of Levitt et al, comprising 592 patients with non-Hodgkin lymphoma, there were only 8 with intracerebral metastases Much more common is meningeal dissemination of non-Hodgkin lymphoma, the clinical and CSF pictures being similar to those of meningeal leukemia and carcinomatosis described above In the rare cases of meningeal involvement with Hodgkin lymphoma, there may be an eosinophilic pleocytosis Leptomeningeal dissemination occurs almost exclusively in small-cell, high-grade lymphomas with diffuse (rather than nodular) changes in the lymph nodes Cranial nerve palsies are common, with a predilection for the eighth nerve; the cauda equina is involved eventually in most cases The optimal treatment has not yet been ascertained Radiotherapy and systemic and intraventricular chemotherapy have all met with some degree of success Intravascular Lymphoma (Malignant Angioendotheliomatosis, Angiotropic or Angioblastic Lymphoma, and Lymphomatoid Granulomatosis) These related conditions are presented here with other forms of lymphoma, although their clinical behavior is more in keeping with a vasculitic process and the diagnosis is dif cult Although considered rare, we encounter a new case yearly on our services The nomenclature is confusing and the original term, lymphomatoid granulomatosis, is not universally accepted as equivalent to the more recently elucidated process of intravascular lymphoma; it is more accurate to consider it a prelymphomatous process As originally described by Liebow and colleagues, lymphomatoid granulomatosis is a systemic disease with prominent pulmonary, dermal, and lymph node changes and, in approximately 30 percent of cases, with involvement of the CNS In a small proportion of cases, the changes are con ned to the nervous system According to Katzenstein and associates, a systemic malignant lymphoma develops in about 12 percent of such patients, but others have noted this transformation in a considerably higher number The angioblastic or intravascular lymphoma, on the other hand, is regarded as a multifocal neoplasm of large anaplastic lymphocytes that in ltrate the walls of blood vessels and surrounding areas (Sheibani et al) or grow intravascularly and cause occlusion of small and moderate-sized vessels; hence the several alternative designations for the same pathologic process The disease can be distinguished from brain lymphoma, which is typically angiocentric, meaning centered around vessels, but brain lymphoma does not selectively invade and occlude vascular structures In the brain and spinal cord there are lesions of various sizes that represent the.

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fluctuation or currency fluctuation for exported material or any of the other multiple scenarios involving currency exchange rates, this will help you display the results as you need to in the appropriate currencies In terms of the other options available in this context menu, we will review the basics here and then go into more detail in a subsequent chapter The following illustration shows the options found using the context menu from the executed query