BING-NEEL SYNDROME: ILLUSTRATIVE CASES AND COMPREHENSIVE REVIEW OF THE LITERATURE

Marzia Varettoni, Irene Defrancesco, Luca Diamanti, Enrico Marchioni, Lisa Maria Farina, Anna Pichiecchio
  • Marzia Varettoni
    Department of Hematology Oncology Fondazione IRCCS Policlinico San Matteo Pavia (Italy), Italy | m.varettoni@smatteo.pv.it
  • Irene Defrancesco
    Department of Molecular Medicine University of Pavia Pavia (Italy), Italy
  • Luca Diamanti
    Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Pavia, Italy, Italy
  • Enrico Marchioni
    Neuroscience Consortium, University of Pavia, Monza Policlinico and Pavia Mondino, Pavia, Italy, Italy
  • Lisa Maria Farina
    IRCCS, 'C. Mondino' National Neurological Institute, Pavia, Italy, Italy
  • Anna Pichiecchio
    IRCCS, 'C. Mondino' National Neurological Institute, Pavia, Italy, Italy

Abstract

The Bing-Neel syndrome is a rare neurological complication of Waldenström’s Macroglobulinemia which results from a direct involvement of central nervous system by malignant lymphoplasmacytic cells. The clinical suspicion of Bing-Neel syndrome may be difficult because neurologic symptoms are heterogeneous, non specific and sometimes underhand. A definitive diagnosis of Bing-Neel syndrome can be confidently made using brain and spinal cord magnetic resonance imaging as well as histopathology and/or cerebrospinal fluid analysis to confirm the neoplastic infiltration of central nervous system. The detection in the cerebrospinal fluid of patients with Bing-Neel syndrome of the MYD88 (L265P) somatic mutation, which is highly recurrent in Waldenström’s Macroglobulinemia, revealed useful for the diagnosis and monitoring of central nervous system involvement. Despite recommendations recently published, there is still no clear consensus on treatment of Bing-Neel syndrome, which includes systemic immunochemotherapy, intrathecal chemotherapy and brain irradiation as possible options. Ibrutinib, a Bruton kinase inhibitor highly active in patients with Waldenström’s Macroglobulinemia, has been recently added to the therapeutic armamentarium of Bing-Neel syndrome due to its ability to pass the blood-brain barrier. However, prospective clinical trials are eagerly awaited with the aim to define the optimal treatment strategy. 

Here we describe four illustrative cases of Bing-Neel syndrome diagnosed and treated at our Institution and review the literature on this topic. 

 

Keywords

Bing-Neel Syndrome; Waldenström’s Macroglobulinemia; Central Nervous System

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Submitted: 2017-07-19 22:27:17
Published: 2017-10-18 00:00:00
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