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HIV-1 Associated Opportunistic Neoplasms - CNS Lymphoma: Differential Diagnoses & Workup
Updated: May 8, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Other Problems to Be Considered
CNS toxoplasmosis is the most important differential. A solitary mass is usually primary CNS lymphoma.
Brainstem syndromes
Myelopathy
Workup
Laboratory Studies
- Serology - CD4+ cell count (usually <100)
- CSF - Pleocytosis, elevated protein, and cytologic results positive for monoclonal malignant-appearing lymphocytes
- PCR amplification of EBV DNA in CSF corroborates the diagnosis of primary CNS lymphoma.
Imaging Studies
- CT scan of the brain
- A hypodense or hyperdense lesion that enhances in a nodular, homogeneous, or ringlike pattern may be observed.
- Significant edema and mass effect may be present.
- Multiple lesions can occur, although less frequently than with toxoplasmosis.
- MRI may reveal additional lesions.
- Thallium 201 single photon emission computed tomography (201Tl SPECT)
- Increased 201Tl uptake co-localizing with the lesion on MRI is highly specific for primary CNS lymphoma.
- Tumor size of at least 2 cm increases the diagnostic yield.
- Positive results need to be confirmed by biopsy of the identified lesion.
- 18-fluorodeoxyglucose positron emission tomography (18FDG-PET) has a predictive value similar to that of SPECT.
- Chest radiography and an abdominal ultrasonography may be indicated to rule out systemic lymphoma as the underlying cause.
Procedures
- Definitive diagnosis requires stereotactic brain biopsy, usually after a therapeutic trial for cerebral toxoplasmosis.
Histologic Findings
Histologic findings vary and comprise a small, noncleaved type and a large, immunoblastic type.
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Differential Diagnoses & Workup: HIV-1 Associated Opportunistic Neoplasms - CNS Lymphoma |
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References
Wolf T, Brodt HR, Fichtlscherer S. Changing incidence and prognostic factors of survival in AIDS-related non-Hodgkin's lymphoma in the era of highly active antiretroviral therapy (HAART). Leuk Lymphoma. Feb 2005;46(2):207-15. [Medline].
Biggar RJ, Engels EA, Ly S. Survival after cancer diagnosis in persons with AIDS. J Acquir Immune Defic Syndr. Jul 1 2005;39(3):293-9. [Medline].
Skiest DJ, Crosby C. Survival is prolonged by highly active antiretroviral therapy in AIDS patients with primary central nervous system lymphoma. AIDS. Aug 15 2003;17(12):1787-93. [Medline].
Bossolasco S, Falk KI, Ponzoni M. Ganciclovir is associated with low or undetectable Epstein-Barr virus DNA load in cerebrospinal fluid of patients with HIV-related primary central nervous system lymphoma. Clin Infect Dis. Feb 15 2006;42(4):e21-5. [Medline].
Aboulafia DM, Ratner L, Miles SA. Antiviral and immunomodulatory treatment for AIDS-related primary central nervous system lymphoma: AIDS Malignancies Consortium pilot study 019. Clin Lymphoma Myeloma. Mar 2006;6(5):399-402. [Medline].
AAN Quality Standards Subcommittee. Evaluation and management of intracranial mass lesions in AIDS. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. Jan 1998;50(1):21-6. [Medline].
de Gans J, Portegies P. Neurological complications of infection with human immunodeficiency virus type 1. A review of literature and 241 cases. Clin Neurol Neurosurg. 1989;91(3):199-219. [Medline].
Forsyth PA, DeAngelis LM. Biology and management of AIDS-associated primary CNS lymphomas. Hematol Oncol Clin North Am. Oct 1996;10(5):1125-34. [Medline].
Gendelman HE, Lipton SA, Epstein L. The Neurology of AIDS. New York: Chapman & Hall; 1998.
Hoffman C. Primary CNS lymphoma. In: HIV Medicine. 2005.
Noy A. Update in HIV lymphoma. Curr Opin Oncol. Sep 2006;18(5):449-55. [Medline].
Offiah CE, Turnbull IW. The imaging appearances of intracranial CNS infections in adult HIV and AIDS patients. Clin Radiol. May 2006;61(5):393-401. [Medline].
Said G, Saimont AG, Lacroix C. Neurological Complications of HIV and AIDS. Philadelphia: WB Saunders; 1998.
Singh A, Strobos RJ, Singh BM, et al. Steroid-induced remissions in CNS lymphoma. Neurology. Nov 1982;32(11):1267-71. [Medline].
Further Reading
Keywords
Acquired immunodeficiency syndrome, AIDS, HIV-associated CNS lymphoma, Epstein-Barr virus, EBV, EVB infection, toxoplasmosis, large-cell non-Hodgkin lymphoma, large-cell non-Hodgkin's lymphoma, non-Hodgkin's lymphoma, non-Hodgkin lymphoma, late complication of HIV infection, HIV infection
Differential Diagnoses & Workup: HIV-1 Associated Opportunistic Neoplasms - CNS Lymphoma