Non-Hodgkin's lymphoma involving the brain. Diagnostic usefulness of stereotactic needle biopsy in combination with paraffin-section immunohistochemistry.

A stereotactic needle biopsy was examined for applicability in diagnosing brain non-Hodgkin's lymphoma (NHL), because the procedure is far less aggressive than biopsy by open surgery. Formalin-fixed materials including four stereotactic specimens were available from nine patients with brain NHL. In addition to routine histopathology and histochemistry, paraffin-section immunohistochemistry was performed using a panel of monoclonal antibodies suited to such sections. Although several histopathological features characteristic of brain NHL could not be evaluated in three of the four stereotactic specimens owing to the small size of the specimens and partial invasion by lymphoma cells, the lesions in all cases could be characterised by immunohistochemistry. Examination for cytoplasmic immunoglobulin (cIg) was also performed, but specific identification of cIg was difficult in five cases because of diffuse background staining and passive diffusion of plasma protein into the cells during tissue processing. A review of the literature indicates the technical difficulty in cIg staining, since the incidence of cIg-positive cases in an individual study varied considerably, and lymphoma cells in 15 of 128 cIg-positive brain NHL cases have been reported to possess both light chains. From these findings, together with the relative difficulty in obtaining fresh tissues for study, it is concluded that, when the specimens are to be examined by paraffin-section immunohistochemistry using the above monoclonal antibodies, stereotactic needle biopsy is a useful, less aggressive method for diagnosing brain NHL.