Primary CNS lymphoma

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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 associated conditions

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[2]
    • Solitary lesions are often large (>4cm)[3]
  • 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

Disposition

See Also

External Links

References

  1. Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.
  2. Forsyth PA. Biology and management of AIDS-associated primary CNS lymphomas. Hematol Oncol Clin North Am. 1996;10(5):1125-34.
  3. Thurnher MM. CNS involvement in AIDS: spectrum of CT and MR findings. Eur Radiol. 1997;7(7):1091-7.