Primary CNS lymphoma: Difference between revisions
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==Background== | ==Background== | ||
*AIDS defining malignancy that is strongly related to Epstein-Barr virus (EBV) infection | *AIDS defining malignancy that is strongly related to [[Epstein-Barr virus]] (EBV) infection | ||
*Occurs with profound immunosuppression (CD4 counts <50cells/uL) | *Occurs with profound immunosuppression (CD4 counts <50cells/uL) | ||
* Accounts for approximately 20 to 30% of CNS lesions in patients with AIDs | * Accounts for approximately 20 to 30% of CNS lesions in patients with AIDs | ||
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*CT scan: well-defined focal lesion, isodense or hyperdense to the gray matter | *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 | *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 | **Lesions that involve the corpus callosum, periventricular, or periependymal areas are more likely to be due to a lymphoma<ref>Forsyth PA. Biology and management of AIDS-associated primary CNS lymphomas. Hematol Oncol Clin North Am. 1996;10(5):1125-34.</ref> | ||
**Solitary lesions are often large (>4cm)<ref>Thurnher MM. CNS involvement in AIDS: spectrum of CT and MR findings. Eur Radiol. 1997;7(7):1091-7.</ref> | |||
*Lumbar puncture: | *Lumbar puncture: | ||
**CSF cytology | **CSF cytology | ||
**CSF EBV PCR | **CSF EBV PCR | ||
**Should also obtain toxoplasma serologies, most are treated empirically for toxoplasma while serology is pending | **Should also obtain [[toxoplasma]] serologies, most are treated empirically for toxoplasma while serology is pending | ||
*Stereotactic brain biopsy if necessary | *Stereotactic brain biopsy if necessary | ||
Revision as of 05:52, 5 May 2017
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
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
- 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