Central nervous system lymphoma is a rare non-Hodgkin lymphoma in which malignant (cancer) cells from lymph tissue form in the brain and/or spinal cord (primary CNS) or spread from other parts of the body to the brain and/or spinal cord (secondary CNS). Because the eye is so close to the brain, primary CNS lymphoma can also start in the eye (called ocular lymphoma). The cancer can also involve the spinal fluid that bathes the spinal cord and brain. This is called leptomeningeal lymphoma.

Both primary and secondary CNS lymphomas are rare diseases. The cancer is a form of extranodal, high-grade non-Hodgkin B-cell lymphoma. Most forms of CNS lymphoma (about 90 percent) are diffuse large B-cell lymphomas; the remaining ten percent are poorly characterized low-grade lymphomas, Burkitt lymphomas and T-cell lymphomas.

Central nervous system lymphoma is more common in men than women. The median age of diagnosis is 55; the median age of AIDS-infected patients with primary CNS lymphoma is 35.

Causes and Risk Factors

Although the exact causes of CNS lymphoma are not known, there are several factors that may increase a person’s risk for developing the disease, such as having a compromised immune system due to acquired immunodeficiency syndrome (AIDS), other disorders of the immune system, or chronic immunosuppression (a reduced function of the immune system) as a result of organ transplantation.

Symptoms

The symptoms of CNS lymphoma depend on the location of the tumor. Patients may experience nausea and vomiting, leg and arm weakness, seizures, headaches, changes in mental alertness or confusion, facial weakness, double vision and hearing loss and/or swallowing difficulties. Patients with ocular lymphoma may notice blurry vision and patients with lymphoma involving their spinal cord or spinal fluid may experience back pain, leg weakness or incontinence.

Diagnosis

Tests that examine the eyes, brain and spinal cord are used to find and diagnose CNS lymphoma. These tests may include

• Physical exam and history
• Neurological exam to check mental status, coordination, ability to walk normally and how well the muscles, senses and reflexes work
• Slit-lamp eye exam – This test uses a special microscope with a bright, narrow slit of light to check the outside and inside of the eye.
• Vitrectomy – A surgical procedure in which some of the vitreous humor (the gel-like fluid inside the eyeball) is removed and examined under a microscope to check for cancer cells.
• Chest x-ray and CT scans of the chest and abdomen
• MRI scans of the brain and spinal cord
• Blood and urine tests
• Lumbar puncture (or spinal tap)
• Stereotactic biopsy, in which a computer and a three-dimensional scanning device are used to find a tumor and guide the removal of tissue for examination under a microscope to look for cancer cells.

Staging

After CNS lymphoma is diagnosed, a series of tests may be done to determine whether the cancer has spread. The information is then used to stage the disease and plan treatment. At this time, patients may also want to schedule a consultation with an ophthalmologist (eye doctor).

Some tests used to stage CNS lymphoma include:

• CT scan
• PET scan
• Bone marrow aspiration and biopsy

• Slit-lamp eye exam
• Vitrectomy
• Testicular examination in men

Prognostic Factors

There are certain factors that affect prognosis (the chance of recovery) and treatment options for CNS lymphoma. These include

• The patient’s age and overall health
• Performance status
• Lactate dehydrogenase level
• Unusually higher or lower level of certain substances in the blood and cerebrospinal fluid
• Location of the tumor in the central nervous system
• Whether the patient has AIDS

Treatment

There is no standard treatment for CNS lymphoma. Your doctor will discuss the best treatment option for you. As CNS lymphoma only affects a small number of people, it is important to be treated by a hematologist/oncologist who is knowledgeable about non-Hodgkin lymphoma. It is important to consider getting a second opinion with a NHL expert to make sure you are aware of all treatment options.

Possible treatment options are listed below. Methotrexate-based combinations have been the most successful for CNS lymphoma patients. These are usually given at high doses and require that the patient be hospitalized while giving the chemotherapy. For patients over age 60 years, radiation treatment can be extremely neurotoxic and it is important to speak to your doctor before receiving this treatment. Patients who have relapsed or refractory CNS lymphoma, cytarabine and topotecan may also be an option. Talk to your doctor about the best care for you.

Treatment options for CNS lymphoma not related to AIDS include:

• Chemotherapy
• Chemotherapy followed by radiation therapy
• Steroid therapy
• Whole brain radiation therapy
• A clinical trial of high-dose chemotherapy with stem cell transplant

Treatment options for AIDs-related CNS lymphoma include:

• Steroids with or without radiation
• Radiation
• Chemotherapy followed by radiation therapy

Treatment for recurrent (the cancer comes back) CNS lymphoma includes:

• Chemotherapy or radiation (if not received as first-line treatment)
• Chemotherapy and radiation
• A clinical trial

For some patients, taking part in a clinical trial may be the best treatment choice. There are also several clinical trials available nationally that are examining the role of radiation and the role of bone marrow transplantation for the treatment of primary CNS lymphoma. Your doctor can discuss if these clinical trials are appropriate or available for you. For information about clinical trials for CNS lymphoma, please call our Information Specialists or click here for an online clinical-trial search service supported by LLS that offers patients and caregivers immediate access to listings of blood cancer clinical trials.

Treatment Outcomes

Treatment of CNS lymphoma is most effective when the tumor has not spread outside the cerebrum (the largest part of the brain) and the patient is under age 60, able to maintain daily functions and does not have AIDS or other diseases that weaken the immune system.

As you get older, you may begin to notice rough, scaly spots appearing on your hands, arms, or face. These spots are called actinic keratoses, but they’re commonly known as sunspots or age spots.

What Causes Bow Legged?

Melanoma is the most serious type of skin cancer.  Allowed to grow, melanoma can spread quickly to other parts of the body. This can be deadly.

There is good news. When found early, melanoma is highly treatable. You can find melanoma early by following this 3-step process. Melanoma, the deadliest skin cancer, can show up on your body in different ways. You may see a:

• Change to an existing mole
• New spot or patch on your skin
• A spot that looks like a changing freckle or age spot
• Dark streak under a fingernail or toenail
• Band of darker skin around a fingernail or toenail
• Slowly growing patch of thick skin that looks like a scar

Warning signs to look for

Dermatologists encourage people of all skin colors to perform skin self-exams. Checking your skin can help you find melanoma early when it’s highly treatable. When examining your skin for melanoma, you want to look for the warning signs, which are called the ABCDEs of melanoma :

Your risk of getting melanoma increases if you:Seek the sun, tanning beds, or sunlamps: The sun, tanning beds, and sunlamps emit ultraviolet light (UV). Scientists have proven that UV light can cause skin cancer in people. Their research also shows you increase your risk of getting melanoma if you:

• Use tanning beds. Using indoor tanning beds before age 35 can increase your risk of melanoma by 59%, and the risk increases with each use.
• Had 5 or more blistering sunburns between ages 15 and 20. Research shows this increases one’s risk of getting melanoma by 80%.
• Live close to the equator. Sunlight is more intense there.
• Live in a sunny area of the United States like Florida or Arizona.
• Failed to protect your skin from the sun. People older than 65 may experience melanoma more frequently because of UV exposure they’ve received over the course of their lives. Men older than 50 also have a higher risk of developing melanoma.

While exposure to UV light greatly increases your risk of developing melanoma, your other characteristics also play a role. These include:

Having light-colored skin, hair, or eyes or certain moles: The risk of getting melanoma increases if you have one or more of the following:

• Fair skin
• Red or blond hair
• Blue or green eyes
• Sun-sensitive skin
• Skin that rarely tans or burns easily
• 50 or more moles
• Large moles
• An atypical mole (mole that looks like melanoma)

Taking certain medications or having some medical conditions: Your risk of getting melanoma increases if you have:

• Had melanoma or another type of skin cancer
• Had another type of cancer, such as breast or thyroid cancer
• A disease that weakens your immune system, such as acquired immunodeficiency syndrome (AIDS)
• To take medicine to quiet your immune system, such as taking life-saving medicines to prevent organ rejection after transplant surgery

Have a history of melanoma in your family: If a close blood relative has or had melanoma, you have a higher risk of getting melanoma. Organ transplant recipients have an increased risk of getting melanoma.

What causes melanoma?

Ultraviolet (UV) light causes melanoma. We get UV light from the sun and tanning beds. Scientists have shown that UV light from the sun and tanning beds can do two things:

1. Cause melanoma on normal skin.
2. Increase the risk of a mole on your skin turning into a melanoma

How do dermatologists treat melanoma?

The type of treatment a patient receives depends on the following:

• How deeply the melanoma has grown into the skin.
• Whether the melanoma has spread to other parts of the body.
• The patient’s health.

The following describes treatment used for melanoma.

Surgery: When treating melanoma, doctors want to remove all of the cancer. When the cancer has not spread, it is often possible for a dermatologist to remove the melanoma during an office visit. The patient often remains awake during the surgical procedures described below.

• Excision: To perform this, the dermatologist numbs the skin. Then, the dermatologist surgically cuts out the melanoma and some of the normal-looking skin around the melanoma. This normal-looking skin is called a margin. There are different types of excision. Most of the time, this can be performed in a dermatologist’s office.
• Mohs surgery: A dermatologist who has completed additional medical training in Mohs surgery performs this procedure. Once a dermatologist completes this training, the dermatologist is called a Mohs surgeon.Mohs surgery begins with the Mohs surgeon removing the visible part of the melanoma. Next, the surgeon begins removing the cancer cells. Cancer cells are not visible to the naked eye, so the surgeon removes skin that may contain cancer cells one layer at a time. After removing a layer, it is prepped so that the surgeon can examine it under a microscope and look for cancer cells. This layer-by-layer approach continues until the surgeon no longer finds cancer cells. In most cases, Mohs surgery can be completed within a day or less. Mohs has a high cure rate.

When caught early, removing the melanoma by excision or Mohs may be all the treatment a patient needs. In its earliest stage, melanoma grows in the epidermis (outer layer of skin). Your dermatologist may refer to this as melanoma in situ or stage 0. In this stage, the cure rate with surgical removal is nearly 100%.

When melanoma grows deeper into the skin or spreads, treatment becomes more complex. It may begin with one of the surgeries described above. A patient may need more treatment. Other treatments for melanoma include:

• Lymphadenectomy: Surgery to remove lymph nodes.

• Immunotherapy: Treatment that helps the patient’s immune system fight the cancer.
• Targeted therapy: Drugs that can temporarily shrink the cancer; however, some patients appear to be fully cured.

• Chemotherapy: Medicine that kills the cancer cells (and some normal cells).

• Radiation therapy: X-rays that kill the cancer cells (and some normal cells).

Squamous cell Carcinoma is the second most common form of skin cancer. It’s usually found on areas of the body damaged by UV rays from the sun or tanning beds. Sun-exposed skin includes the head, neck, ears, lips, arms, legs, and hands.

SCC is a fairly slow-growing skin cancer. Unlike other types of skin cancer, it can spread to the tissues, bones, and nearby lymph nodes, where it may become hard to treat. When caught early, it’s easy to treat.

Certain things make you more likely to develop SCC:

• Older age
• Male
• Fair-skinned
• Blue, green, or gray eyes
• Blonde or red hair
• Spend time outside; exposed to the sun’s UV Rays
• Tanning beds and bulbs
• Long-term exposure to chemicals such as arsenic in the water
• Bowen’s disease, HPV, HIV, or AIDS
• Exposed to radiation
• Inherited DNA condition

SCC usually begins as a dome-shaped bump or a red, scaly patch of skin. It’s usually rough and crusty, and can bleed easily when scraped. Large growths may itch or hurt. It may also pop through scars or chronic skin sores, so check for any changes and report them to your doctor.

Your doctor may refer you to a dermatologist who specializes in skin conditions. He will ask about your medical history, your history of severe sunburns or indoor tanning, any pain or symptoms you’re having, and when the spot first appeared.

You’ll have a physical exam to check the size, shape, color, and texture of the spot. The dermatologist will also look for other spots on your body and feel your lymph nodes to make sure they aren’t bigger or harder than normal. If your doctor thinks a bump looks questionable, he’ll remove a sample of the spot (a skin biopsy) to send to a lab for testing.

Squamous cell carcinoma can usually be treated with minor surgery that can be done in a doctor’s office or hospital clinic. Depending on the size and location of the SCC, your doctor may choose to use any of the following techniques to remove it:

• Excision: cutting out the cancer spot and some healthy skin around it
• Surgery using a small hand tool and an electronic needle to kill cancer cells
• Mohs surgery: excision and then inspecting the excised skin using a microscope
• Lymph node surgery: remove a piece of the lymph node; uses general anesthesia
• Dermabrasion: “sanding” your affected area of skin with a tool to make way for a new layer
• Cryosurgery: freezing of the spot using liquid nitrogen
• Topical chemotherapy: a gel or cream applied to the skin
• Targeted drug treatment

• Avoid the sun during peak hours.
• Use sunscreen daily.
• Wear clothing to cover exposed areas.
• Avoid tanning beds.

Fibromas are overgrowths of soft tissue. They appear as raised, relatively small areas. They commonly occur on the lips, inside the cheeks and on the tongue. Fibromas are usually pink. They also can be whitish or light-colored. If injured, fibromas may be reddish or bluish. Fibromas may develop because of constant irritation of the lips, the inside of the cheeks, or the tongue.

Symptoms

You may see or feel the fibroma. There are usually no symptoms. Fibromas may get bigger over time.

Diagnosis

Your dentist will examine your mouth and ask you a few questions. Usually that will be enough for the dentist to diagnose a fibroma and determine a cause. A fibroma can be removed to confirm the diagnosis. In this case it should be examined in a lab to make sure it is not cancerous.

Prevention

To avoid fibromas, avoid habits such as biting your lips or the inside of your cheeks. If you grind your teeth, ask your dentist to fit you with a night guard.

 Treatments

A fibroma will grow if the area continues to be injured. Fibromas that are large or interfere with speech should be removed.

When fibromas are removed, the tissue is sent to a laboratory for a biopsy. If you drink or smoke, your dentist is likely to order a biopsy to rule out oral cancer. Another reason to do a biopsy is if the fibroma has an unusual color. Fibromas are not known to become cancerous over time.

The leg length discrepancy means there is inequality of the length of the lower limbs. It is also called as limb length inequality. The problem is extremely common with 23% of the general population having a discrepancy of 1 cm or more

Leg length discrepancy causes compensatory gait abnormalities, degenerative arthritis of the lower extremity and lumbar spine. In addition to the length inequality, these patients may also have angular and torsional deformities that may influence their functional leg lengths. For example, flexion contractures around the knee and hip can cause apparent shortening of the leg.

Hip abduction contracture and ankle equinus causes functional lengthening.

Small leg length discrepancy is well compensated by body and hardly requires any treatment. Bigger differences need to be equalized to prevent osteoarthritis , scoliosis and backache in later life.

Causes of Leg Length Discrepancy

The causes can generally be divided into two broad categories: congenital and acquired.

Congenital limb length inequality

• Longitudinal deficiency of the fibula
• Hemihypertrophy syndromes
• Klippel-Trénaunay-Weber syndrome
• Skeletal dysplasias.
• Proximal femoral focal deficiency
• Developmental dysplalsia of hip
• Unilateral clubfoot
• Vascular malformation
• Congenital pseudarthrosis of the tibia
• Ollier’s disease

Paralytic disorders

• Spasticity (cerebral palsy)
• Poliomyelitis
• Spina bifida
• Spinal dysraphism

Acquired

• Physis disruption
  • infection
  • trauma
  • tumor
  • Malunion of fracture

Functional Effects of Limb Length Discrepancy

• Back pain
  • increased prevalence of back pain
• Osteoarthritis
  • decreased coverage of femoral head on long leg side leads to osteoarthritis
• Structural scoliosis
  • Limb length discrepancy increases the incidence of structural scoliosis
• Inefficient gait

Classification of Limb Length Discrepancy:

• Static
  • malunion of femur or tibia
• Progressive
  • Physeal growth arrest
  • Congenital
    • Absolute discrepancy increases
    • Proportion stands the same

Treatment of Leg Length Discrepancy

Goals of treatment are

• Leg length equality within 1 cm
• Level pelvis
• Functional improvement

In certain cases small leg length inequality may be beneficial to the patient especially in neuromuscular disorders to aid in clearance in the swing phase of gait.

Depending on the severity of the difference, different treatments can be used for correction of the inequality.

Treatment of leg length inequality involves many different approaches. Non operative treatment involves use of shoe raises or orthotics.

Surgical approach deals with the problem by

• Correction of deformity if present
• Shortening of the normal leg
• Lengthening of affected leg
• Combination of shortening and lengthening.

Non-operative Treatment

An inequality < 2cm projected at maturity is generally without any functional problems. Often, surfices. Up to 1 cm can be inserted in the shoe. For larger leg length inequalities, the shoe must be built up.

Leg length inequalities beyond 5 cm are difficult to treat with a shoe lift.

A foot-in-foot prosthesis can be used for larger leg length inequalities but is often not tolerated well. It is often used as temporary measure.

Surgical Treatment

Shortening of long side

Epiphysiodesis of femur, tibia, or both

Epiphysiodesis inhibits the growth of the limb and can be used to correct 2-5 cm of projected limb length discrepancy.

It can be performed only in skeletally immature patients where growthpotential is still present.

Because the procedure effectively shortens the longer leg and is usually done on the uninvolved side, it may be unappealing to the patient and family.

It can be used alone or with limb lengthening of short limb.

Shortening of Mature Limb

This involves ostectomy and removal of bone segment followed by fixation of remaining fragments with desirable fixation device.

Limb lengthening of short side

It is contemplated in cases > 5 cm projected discrepancy. It can be  combined with a shortening procedure (epiphysiodesis, ostectomy) on long side when the discrepancy is large [>8 cmm]

Lengthening is usually done by corticotomy and gradual distraction

The limits of lengthening depend on patient tolerance, bony consolidation, maintenance of range of motion, and stability of the joints above and below the lengthened limb.

Numerous fixation devices are available, such as the ring fixator with fine wires, monolateral fixator with half pins, or a hybrid frame.

There are multiple signs and symptoms for leg length discrepancy (LLD). Some are obvious and some are subtle. There are differences between individuals on the extent and causes of leg length discrepancy (LLD). The difference in length between the two legs may vary from 3 and a half to 4 percent. These differences often determine the impact that may be experienced by different individuals. Signs and symptoms usually experienced in the patients with leg length discrepancy (LLD) include:

• If the difference in leg length discrepancy (LLD) is 3 cms and higher, difference will be easily noticed as the person walks.
• The person affected with leg length discrepancy (LLD) will need to exert more energy to walk.
• Some people may experience some pain in the lower back, ankle, or hip as they walk. Some studies have collaborated this, while other have refuted this.
• The person’s posture will be highly affected, causing him/ her to hold the longer leg on the knee for support.
• The person’s gait will be adversely affected, which will be obviously noticed.

The risk factors for leg length discrepancy (LLD) include:

Patients might have serious dissimilarities in the length of the legs as an effect brought by Leg Length Discrepancy (LLD) due to:

• Infection.
• Birth defects.
• Injuries.
• Accidents and other causes.

Leg length discrepancy (LLD) with very high difference can become complicated and lead to severe orthopaedic conditions like lower back pain, scoliosis, or arthritis, if left untreated.

• The patient may experience complications due to contractures of the muscles while having to constantly stand on their toes of the shorter leg for support.
• Another complication is that the shorter side of their body is often lowered down and suddenly lifted by the longer side, causing them to have abnormal gait that goes up and down.
• The abnormal gait can cause the child to be highly disturbed psychologically.
• The patient is often ridiculed and teased by other children, hindering the child’s social life.
• Most patients with leg length discrepancy (LLD) have to constantly support the shorter leg on the knee while standing, causing them to bend often or they may have to stand on their toes.

When a person has scoliosis, their backbone curves to the side.

The angle of the curve may be small, large or somewhere in between. But anything that measures more than 10 degrees is considered scoliosis. Doctors may use the letters “C” and “S” to describe the curve of the backbone.

You probably don’t look directly at too many spines, but what you might notice about someone with scoliosis is the way they stand. They may lean a little or have shoulders or hips that look uneven.

In as many as 80% of cases, doctors don’t find the exact reason for a curved spine. Scoliosis without a known cause is what doctors call “idiopathic.”

Some kinds of scoliosis do have clear causes. Doctors divide those curves into two types — structural and nonstructural.

In nonstructural scoliosis, the spine works normally, but looks curved. Why does this happen? There are a number of reasons, such as one leg’s being longer than the other, muscle spasms, and inflammations like appendicitis. When these problems are treated, this type of scoliosis often goes away.

In structural scoliosis, the curve of the spine is rigid and can’t be reversed.

Causes include:

• Cerebral palsy
• Muscular dystrophy
• Birth defects
• Infections
• Tumors
• Genetic conditions like Marfan syndrome and Down syndrome

Congenital scoliosis begins as a baby’s back develops before birth. Problems with the tiny bones in the back, called vertebrae, can cause the spine to curve. The vertebrae may be incomplete or fail to divide properly. Doctors may detect this condition when the child is born. Or, they may not find it until the teen years.

Family history and genetics can also be risk factors for idiopathic scoliosis. If you or one of your children has this condition, make sure your other kids are screened regularly.

Scoliosis shows up most often during growth spurts, usually when kids are between 10 and 15 years old. About the same number of boys and girls are diagnosed with minor idiopathic scoliosis. But curves in girls are 10 times more likely to get worse and may need to be treated.

Scoliosis diagnosed during the teen years can continue into adulthood. The greater the angle of the spine curve, the more likely it is to increase over time. If you had scoliosis in the past, have your doctor check your back regularly.

Degenerative scoliosis affects adults. It usually develops in the lower back as the disks and joints of the spine begin to wear out as you age.

Treatments:

The main type of surgery for scoliosis involves attaching rods to the spine and doing a spinal fusion. Spinal fusion is used to stabilize and reduce the size of the curve and stop the curve from getting worse by permanently joining the vertebrae into a solid mass of bone.

Other techniques are sometimes used, including instrumentation without fusion, which attaches devices such as metal rods to the spine to stabilize a spinal curve without fusing the spine together. This is only done in very young children when a fusion, which stops the growth of the fused part of the spine, is not desirable. The child usually has to wear a brace full-time after having this surgery.