Primary CNS lymphoma

Background

• AIDS defining malignancy that is strongly related to Epstein-Barr virus (EBV) infection
• Occurs with profound immunosuppression (CD4 counts <50cells/uL)
• Accounts for approximately 20 to 30% of CNS lesions in patients with AIDs

Clinical Features

• Can present with a variety of focal or nonfocal signs and symptoms
• Confusion, lethargy, memory loss, hemiparesis, aphasia, mental status changes, seizures
• Constitutional symptoms (systemic B symptoms)

Differential Diagnosis

• HIV neurologic complications

Evaluation

• CT scan: well-defined focal lesion, isodense or hyperdense to the gray matter
• MRI scan (higher diagnostic yield): variable, isointense or hypointense lesions on T1-weighted images
  • Lesions that involve the corpus callosum, periventricular, or periependymal areas are more likely to be due to a lymphoma
  • Solitary lesions are often large (>4cm)
• Lumbar puncture:
  • CSF cytology
  • CSF EBV PCR
  • Should also obtain toxoplasma serologies, most are treated empirically for toxoplasma while serology is pending
• Stereotactic brain biopsy if necessary

Management

• High-dose methotrexate therapy (3 g/m² for four to eight cycles)
• Steroids
• Potent antiretroviral therapy
• Radiation therapy

See Also

HIV - AIDS (main)