AIDS-Related Lymphomas Workup

Updated: Sep 09, 2020
  • Author: Christina Poh, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Workup

Approach Considerations

The workup of AIDS-related lymphoma includes laboratory studies, imaging studies, and biopsies. Specific choices in the workup should be guided by the patient's signs and symptoms (see Presentation/History and Physical). In addition, opportunistic infections should be evaluated.

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Laboratory Studies

Laboratory studies should include the following:

  • Complete blood count (CBC) with differential
  • Complete metabolic panel (CMP)
  • Lactate dehydrogenase (LDH)
  • Tumor lysis assays (potassium, phosphorus, calcium, uric acid)
  • CD4 count
  • HIV viral load
  • Hepatitis B and C screening
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Imaging Studies and Procedures

Position emission tomography (PET) and/or computed tomography (CT) are generally used for staging purposes. [28]  Bone marrow biopsy is recommended for unexplained cytopenias. [29]  In addition, endoscopy or bronchoscopy may be considered if gastrointestinal (GI) tract or pulmonary involvement is suspected. [30, 31]

If central nervous system (CNS) involvement is suspected, neuroimaging with contrast-enhanced MRI or CT and lumbar puncture is recommended. [32]  All patients with HIV-related Burkitt lymphoma and selected patients with diffuse large B-cell lymphoma (DLBCL) who are at high risk for CNS involvement should undergo CNS evaluation. [33]

Cerebrospinal fluid (CSF) analysis should include the following studies:

  • Cell count
  • Protein and glucose level
  • Cytology
  • Flow cytometry
  • Immunoglobulin heavy-chain (IgH) rearrangement studies
  • Polymerase chain reaction (PCR) for Epstein-Barr virus and JC virus
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Tissue Evaluation

Histological confirmation is usually obtained with biopsy of involved tissue. Excisional biopsy or multiple core biopsies are preferred, while fine needle aspirations (FNA) are suboptimal.

In primary CNS lymphoma, diagnosis can also be obtained by cerebrospinal fluid evaluation (see Imaging Studies and Procedures). In primary effusion lymphoma, diagnosis can also be obtained from malignant cells with human herpesvirus 8 (HHV-8) in effusion or ascites samples.

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