Diferencia entre revisiones de «Primary CNS lymphoma»
(Created page with "==Background== *Caused by Epstein-Barr virus (EBV) *Occurs with profound immunosuppression (CD4 counts <50cells/uL) * Accounts for approximately 20 to 30% of CNS lesions in...") |
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==Background== | ==Background== | ||
* | *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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*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 | ||
*Lumbar puncture: CSF cytology | *Lumbar puncture: | ||
**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 | *Stereotactic brain biopsy if necessary | ||
==Management== | ==Management== | ||
*High-dose methotrexate therapy (3 g/m<sup>2</sup> for four to eight cycles) | *High-dose methotrexate therapy (3 g/m<sup>2</sup> for four to eight cycles) | ||
*Steroids | |||
*Potent antiretroviral therapy | |||
*Radiation therapy | |||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
[[HIV - AIDS (main)]] | |||
==External Links== | ==External Links== | ||
Revisión del 05:41 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
- Lesions that involve the corpus callosum, periventricular, or periependymal areas are more likely to be due to a lymphoma
- 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